3607 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT NTI FICATION
gppL
BUIICATION & PERMIT 3607
LDI G PERMIT NUMBER
I
AD O �/
TNG-ELECTRICAL-PLUMBING-MECHANICAL
Ow R'S - PLAN CHECK VALIDATION
" QTY. ELECTRIC PERMIT FEE
reaUW
CONT TOR'S
�� � OUTLETS-SWITCHES-RECEP 5.00/1.00
C.NO LIGHTING FIXTURES 5.00/1.00
AA,DDN STons - PPLIANCES-RESIDENTIAL 4.00
PHO N PANELS 5.00 DATE OF APPLICATION
tRCHITECT PLAN CHECK FEE P.C.NO.
oR - SIGNS 6.00
ENGINEER
uC.No. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
AOGRESS • SPECIAL CIRCUIT 5.00
. ZIP TEMP.-METER OR POLE INS. 15.00
O
a u ANTS - - MOTORS SEE FEE SCH. J
l
SERVICE CHANGE 10.00 /
w o o LICENSED CONTRACTO .DECLARATION f
< i w 1 hereby affirm that 1 am licensed under provisions of Chap r 9 ISSUANCE DATE
<e (commencing with Section 7000)of Division 3 of the Busine and BLDG. ELECT. PLG. MECH.
r H z Professions Code 'cense is in full fore
o i� o License lass Lic.Number ❑ ❑
J Date Contractor
a x m BUILDING PERMIT
¢ 0 a D OWNIiR BUILOIiR DfiCLA A N INFORMATION
F.
; LL r 1 hereby affirm that I ani exempt froin the Contractor's License MISC.- REFER TO ORD
w VALUATION $/FT.
_0 Law for the following reason.(Sec,7031.5,Businessund Professions PERMIT ISSUANCE 6.00
Code:Any city or county which requiresit permit to construct,alter,
w Q f improve.demolish,or repair a0 structure,prior to its issuance,also ELEC.CONTR. LIC.NO.
¢ 6O P P Y ELEC.
0, requires the applicant for such permit to file a signed statement Ihm TOTAL PERMIT T
$ he is licensed pursuant to the previsions of the Contractor's License
to H 0 Law(Chapter 9(commencing with Section 7000)ol-Division 3 of the M(_S
< Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 -
of not more than five hundred dollars($500).): -
❑ I,as owner of the property,or my employees with wages asggCK 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 sole(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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
-,o himself or through his ownemployees,provided that such improve-
trellis are not intended oroffered for Sale.If,however,the building GAS-EA.SVSTEM-1 INC.40UTLETS 4.00
or improvement is sold within one,year of completion,the owne
builder will have the burden of proving that he did not build Or imr GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BULLRING USE
-
prove for purpose ofsale.). INDUSTRIAL WASTE INTERRES IND CON PB Other
❑ 1,as owner of the property,ren exclusively contracting w . 20.00 ith ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 - ASSESSORS PAR ELNO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property,who builds or improves thereon,anti who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
contracts for such projects with a contractor(s)licensed Pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractors License Law.'
❑' I am exempt under Sec.-,B,&P,C.for tills WATER HEATER W/VENT 4,00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACO.FILE NO.
WORK ERS'COMPENSATION DEC RATION WATER TREATING EQUIP. 4.00
I hereby affirm thatJ have a certificate of c nsent to self-ma,
or a certiflxale f Workers'Compensation Ins ancr�or ru •d ZONING ENG.SITE NO.
copy there 0,Lab.C.). N
Policy N ompany.
O ❑ Cl ftedcop is he by fur d. FIRE SPRINK ENERGY T 24
Z Z ertificd cop fed
I the It in ection division.as, MISC.- REFER TO OR D.
O ApPI 'ant Y ❑ N❑ V ❑ N❑
~ m PERMIT ISSUANCE 6.00
LU CERTIF E F IFROM WOWORKERS' FLOOD ZONE A.L.0 c.
W � COMPENSATION
ONN INSURANCE, PLc.CONTR. LIC.NO. PLG,
CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
M Z hundred dollars IS 100)or less,)
U O I certify that in the performance of the work for which This per QTY. MECHANICAL PERMIT FEEFEE SUMMARY
LL - mit is issued.I shall not employ any person in any trainer so as to
O W become subject to the Workers'Compensation Laws of California.
Date A licant BUILDING
a PP ALTER OR ADD TO MECH. 4.00
} N NOTICE TO APPLICANT: If,after making this Certificate sa ion
F'Z em vision you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions io the Labor Code, you mus[ forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 3.00
CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER I0)000C.F.M.) 5.00 -SEISMIC FEE
ae
1 hereby affirm that there is a constructiontending agency lin EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. ICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)7.50
Lender's Address ' ELECTRIC
I cerlify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct.I agree to comply with all city and count BOILER-CONIP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, an
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP lover 100,000 BTU)SEE FEE$CH. MECHANICAL
(We) agree to saylill, inti m y and keep harmless the City of MISC.- REFER TO ORD.
are
agains la liti ,jus menti, costs and expenses which CONST.TAX
y w cru ugui t said City in consequence of the PERMIT ISSU NCE 3.00
th unit' .CONT. LIC.NO. MECH.
-5;5TOTA TOTAL
ppliea /Contracto Date
FFICE COPY