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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
- BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
7045 -
BUILDING
ADDRESS
.20 r -A_Iel 0
OWNERS
"AME '
DTV. ELECTRIC PERMIT FEE..,
PLAN CHECK VALIDATION
I. 1�
.�„pl s
City of Cup QCf111U
GDrvTRAcroRs
NAME
LIC. NO. If
UTLETS- SWITCHES-RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
roN RACT R's
ADOREss
PPLIANCES- RESIDENTIAL 4.00
PANELS 5.00
U/pwrw
DATE OF APPLICATION
OORRCNrtEei _
NGINEER
LEG. No.
SIGNS 5 DO
PLAN CHECK FEE i P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.
ADDRESS
ZIP
SPECIAL CIRCUIT 5.00PERMIT
VALIDATION
TEMP. METER OR POLE INS. 15.00
APPLICANT'S
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
I ,/
LICENSED CON"FRACFORS DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
Commencing with Section ]000) of Division 3 of the Dusincss' J
gyw}1i,ta/SIe
BL
ELECT.
PLG. MECH.
nfcssiona rytioynJ1 p7 sepn �E�y fume c .
Liccnu Clavi:(-ai_�"L Ic�NdfnRcr
Ilalc-� �••-�q�.@E�l:ontrucmr �.�
V ( O
❑
❑ ❑
BUILDING PERMIT''
OWNER -BUILDER DECLARATION
I herebyaffirm that I am exempt from lite Contractor License
p
Code:Law Any city Ecaon.(Scc.]03LS,ermbusiness t F.c.and l'rofesai0m
Cod¢ A, d city or Hol my which structure permittoconstructalter,
impmvq demolish, or repair any structure, prior to its issuance, also
"-�' INF,ORMATI1Q
'"
MISC. - REFER TO ORD
^VALUATION $/FT.
(/v�/ '
PERMIT ISSUANCE
ELEC. GONTfl. LIC. NO.
ELEC. .
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
TOTAL
YERMI TO
CITY. PLUMBING PERMIT FEE
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Dusincss and Professions Code) or (hat he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
I ATORIES T E ONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 4.00
by any applicant forapermit subjects the applicant toa civil penalty
of not more than five hundred dollars (5500).):
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
❑ 1, as owner of the property, or my employees with wages as
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, AREA, COND. 4.00
Code: The Contractor's License Law docs not apply to an owner of
property who builds or inlprove.s thereon, and who docs Such work
F IXTUR ES - PER TRAP 4.00
s0. FT. FLOOR AREA
TOTAL ACREAGE
IIIDISCH or through bis own employees, provided that such improve-
mems are not intended or offered for sale. If, however, the building
GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year.of completion, (he owner.
builder will have the burden of proving that h icee did not build or -
prove for purpose of cele).
CII, as owner of the properly, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
. ..
GAS - EASYSTEM -OVER 4 (EA) 100
BUILOI C. USE
RES IND N PR Omer
❑
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00
ASSESSo PA CEL NO.
and Professions Code: T'he C'ontractor's License Law does no( apply
to an owner of property who builds or improves thereon. and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
Contracts for such projects will, a contractods) licensed pursuant to
time C'ontractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/8.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 4.00
❑ I am exempt under Sec. .B.&P.C. for 01is
.a, HI
Owncr [)ate'
WATER SYSTEM 4.00
ACD. DATE
ACC. FILE NO.
WORKERS'COMPENSA'I ION DECLARATION
WATER TREATING EQUIP. 4.00
1 herehy elfin that I have a certilic to of consent to sell-i-occe.
or a certificate of Workers' Compensation Insurance, or a certified
TOLD NG
ENG. SITE NO.
copy thereof(Sce. 3800, Lrb.C.).
rolicvCNRifica lllnanr
F. copy Bled with t1 , diNision.
❑ reified cop�`I herehy fwilisheJ.f,/�
A ❑ Zti
-
FIRE SPPINK
Y N
❑
ENERGY T.24
Y N
❑
MISC. - REFER TO ORD.
PERMIT ISSUANCE 6.00
FLOOD ZONE
A.L.U.C.
,. "OF IiX1iMl'l'ION FROM WORKIiRS,
PLG.CONTR. LIC. NO.
PLG.
1.TOTAL
ITNSATION INSURANCE
1'fins sectio need not be completed if the permit is In, one
hundred dollars(5100) or les.)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ troy person in any manner or as NI
V� N�
V� N❑
CITY. MECHANICAL PERMIT FEE
'�
, F,EEiSUMMARY,ns,y, .
.
beconm subject to the Workers' Coiopensalion Laws of California.
Dave Applicant
BUILDING
ALTER OR ADD TO MECH. 4.00
NLf ICE ro APPLICANT: IL after making this Certificate of Ex-
emption, you dmuld become subject to the Workers' CUmpensa(ion
provisions of the Labor Code• you must forthwith comply with
such provisions or this permit shall be deemed revoked.
APPLIANCE 4.00
PLAN CHECK
FEE
AIR HANDLING UNIT (TO 10 C.F.M.) 3.00
.�
AIR HANDLING UNIT (OVER 10ACCRIM 5.00
SEISMIC FEE
CONSTRUCT ION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
I hereby affirm that there is a construction lending agency for
the performance of the work for which this Permit is issued (Sec.
3097. C,zC).
HEATING UNIT (TO 100,OWB.T.U.) 4.00
HEATING UNIT (OVER 100,000 B.T.U.P.50
ELECTRIC
Lender's Name
Lender's Address
VENTILATION FAN (SINGLE) 3.00
PLUMBING
I certify that 1 have read (his application and state (hat the alcove
inftrnmtion is correct. I agree to comply with all city and county
ordinances and state laws relating to building Construction, and
BOILER- COMP(31-I.P.o-100,000B.T.U.) 4.00
BOILER -COMP (Ow/ 100,000 BTUI SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter upon (lie
al,ove-mentioned property for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
(We) agree to save. indemnify and keep harmless the City of
Eno against liabilities, judgments, costs and expenses which
may i ny way accrie against City in consequence of the
PERMIT ISSUANCE 3.00
ECH. CONT. LIC. NO.
MECH.TOTA
TOTAL -V'..
n^
,/f//
Iq fir'
grantingo this permit
plican /Contract r Dater
OFFICE COPY