3188 ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONL
BU I LDING PROJECT I DENTIF I N ER MBER
BUILDING APPLICATION & PIT 318 8
aDDR ESS
2O� MAftaV6Ul qv� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
.
5-1VA co. PRONE /4416-99
croRs
NAIVE UTLETS-SWITCHES-RECEP 5.00/1.00'
NOME
LIC.No, LIGHTING FIXTURES 5.00/1.00
CONTRACTORS
ADDRESSPPLIANCES-RESIDENTIAL 4.00
CONRAC
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS g.QQ PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARC'I.OR ENG. SPECIAL CIRCUIT $,QD PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00 /1
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
0 0 o LIC17NSED CONTRACTORS DECLARATION
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a"' (commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT] PLG. MECH.
r o i Professions Code.and my license is in full force and effect F-�F ❑ ❑ ❑
z 0 - License Class Lic.Num he,-
2
er 0 F Date Contractor
¢ Y J
Ic ¢ w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
o a " MISC.- REFER TO ORD INFORMATION
w u-y I hereby ul'Dnn that I mn exempt from the Convector's License VALUATION $/FT.
ca LLOj Law for the following reason (Sec.703 1.5,Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which requiresa permit to constn ct,alter.
2Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. �21
- 0 2 squires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w . he is licensed pursuant to the provisions of the Contractor's License /
Fzi