2838 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI- POINT PEN ONLY
PERMIT NUMBER
BU I LDING PROJECT I DENTIFICATI ON APPLICATION & PERMIT ZQ3Q
',Low-' yva acro io ogyLao1111 X11111
AooREss
20400 Mariana Ave. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
0NER'S PLAN CHECK VALIDATION
NAMe OTY. ELECTRIC PERMIT FEE
PHONE
Syva 446-9966
croRs
NAME UTLETS-SWITCHES-RECEP 5.00/1.00
NAME
rvin EngineeringUni.NO. 150751 LIGHTING FIXTURES 5.00/1,00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
A DGREss p /�
3271 Kifer, S.C• PRONE 732-2192-PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGN$ 13.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS ///
SERVICE CHANGE 10.00
w a o LICENSED CONTRACTORS DECLARATION
Q U u l hereby affirm that 1 am licensed under provisions OI Chapter 9 ISSUANCE DATE
.y a w (commencing with Section 7000)of Division 3 of the Business and B ELECT. PLG. MECH.
H H i Professions Code,and}/{{II h�Fg ppse is in full ford
0. - Licens,�-�I 1.-10Lic.Number J. su �1 L- ❑ ❑
Z
z r Dme�/ "� Contractor lJrvrn FC.
a YB VIE-
-DING PERMIT
O
WNER-BUILDER DECLARATION ...:;INFORMATION
o a O MISC.- REFER TO 0RD
w3 a y I hereby affirm that 1 am exempt from the Canuactor's License (I�N $/FT.
Fu0 < Law for the following reason.(Sec 7031.5.Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which requires a permit to construct,alter, @Q A
er ¢ < 2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. y 4,5 4 0.00
O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO Q r
o w m he is licensed pursuant to the provisions of the Contractor's License /u /
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE r
K H p the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR. I
a All_ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) q.00
final more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 sO.FT.FLOOR AREA TOTAL ACREAGE
himself or through hie awn employees.provided that such improve-
ments are not intended or offered for sale If.however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
move for Purpose of sole.). INDUSTRIAL WASTE INTER. 20.00 El ❑ ❑ ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code.'I'lie Contractor's License Law dues not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractods)licensed Pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
Ct tum exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4.00 ACC.DnTE ACC.FILE NO.
WORK E RS'COMPI:NSAT ION DECLARATION WATER TREATING EQUIP, 4,00
I hereby affirm that I have a certificate Of consent to self-imure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance:ora Certified
copy there, hq 0.
Policy No. �`I IMIV65Ar onaut
Q ❑ CrEnifie yishere trashed. FIRESPRINK ENERGY T-Y4
Z Z C e c 0 the city in Cc ' Ilion. MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
I" A of -
c T RTI FICA'1'F.OI'EXEMPTION FROAI WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU > COhIPF.NSATION INSURANCE PLC.CONTR. LIC.NO. PLG. Y❑ N❑ Y❑ N❑
R O t'fhis section need not be completed if the peon it is for w TOTAL
Z hundred dollars(S 100)or less.l.
U O I certify that in the performance of the work for which this Per- DTY. MECHANICAL PERMIT FEE FEE SUMMARY
out is issued, I shall not employ any person in any manner so as to
Ow become subject m the Workers'Compensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 4.00 32.83
>- 'W NOTICE. '10 APPLICANT: If,after making this Certificate o1 Vs-
FZ caption,you should hecomc subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK 50.50
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this perm f shall be deemed revoked. AIR HANDLING UNIT(TO 10)0000.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10SWC.F.M.) 5.00 SEISMIC FEE •50
I hereby affirm that there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cis C.1. HEATING UNIT(TO 100,000 B.T.U.) 4.00 None
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
1 certlfy that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
inrmal..... n correct. 1 agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
fo
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) afire• save, mdenmify and keep Immiless the City of MISC.- REFER TO ORD.
Caper' east I' I les,judgments, cyyto d expenses which PERMIT ISSUANCE 3.00 CONST.TAX
I uy way uc ugnlnst said Ry in onseq uence of the
pm
ng
Ol'this pcnniL MECH.CONT, LIC.NO. MECH.
ay /83 'GTA` TOTAL
Sigh lure al Applie:uit/Cnntraclor Date ��-. . 83.83
OFFICE COPY