8318 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 8 318
ADORE �
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER' PLAN CHECK VALIDATION
NAME TV. ELECTRIC PERMIT FEE
• PHO
°AIEA,cyT1 IOC -' UTLETS-SWITCHES-RECEP 10.00/1.00
��/ uc.N LIGHTING FIXTURES 10.00/1.00
CONTRACDRESSTORS PPLIANCES-RESIDENTIAL 4.00
�- PANELS 10,00 DATE OF APPLICATION
RHCHITET PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO,
D
ENGINEER
Llc.r+o. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
21P ITEMP.METER OR POLE INS. 20.00
ANT'B - I�
ADDRESS MOTORS SEE FEE SCH. J
SERVICE CHANGE 20.00
D 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a (commencing with Section 7000)of Division 3 of the Business and
r o i Poo essim"Cod➢sot y cense Is in full fo c BLDG. ELECT. PLG. MECH.
0 vg License Ciaz Lie..Numb
p D
Date_J �intruclor
Q y 2 J
2 REFER TO ORD w ¢ OWNIi R-BUILDER DIiCLA RATION BUILDING PERMIT
w °a U - INFORMATION
; I- I hereby affirm that I am exempt from the Contractor's License MISC. VALUATION S/FT.
LL o Law for the following reason.(Sec.7031.5,Businessand Professions
PERMIT ISSUANCE 10.00
r -
Code:Any city or county which requires a permit to construct,alter,
CC 4 FD improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit ID file a Signed statement that TOTAL
' Wog he is licensed pursuant to the provisions of the Contractor'sPERMIT TO
Contractor's License �L p
at z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ,J
4 c Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
Ce I-$ the basis for[lie alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
5_; any applicant for a permit subjects the applicant tea civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(85001.1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 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,AREA,COND. 5.00
Code:The Contractor's License Law does tint apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S0,FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
merits are not intended or offered for sale.ll',however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder .will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the properly,am exclusively contracting with1:1 ED El
licensed contractors to construct The project(Sec.7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 600 pSSESSORSPARC1 NO.
and Professions Code:The Contractor's License Law does not apply .
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with u contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,R&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
PCC.DATE ACC.FILE NO.
WORK F:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-inNsr4.
or a certificate of Workers'CompensaY n saoce,or�fied ZONING ENG.SITE NO.
LOP I
Po
Q ertitiedwp Is Eby f_ml Icr. FIRE SPRINK ENERGY T-24
F OZ etlified coP s fi tl ti inspection division. MISC.- REFER TO ORD. Y N Y N
A and ❑ ❑ ❑
O+ PERMIT ISSUANCE 38;80
� - CFRTIFICATIi OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PLG,
CL Z (This section need not be completed if The permit is for one TOTAL Y❑ IN C] Y No
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner, a, to
0U become subject to the Workers'Cc in pensat ion Laws of California.
y Date ApplicantBUILDING
>_ t0 NOTICE TO APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00
I. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO IODWC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.@M.) 6.00 SEISMIC FEE
I hereby affinu that there is a construction lending agency For EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM I
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ^ -
• information is correct. I agree to comply with all city and county - PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representativesofthis city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
property forinsp of (E i purposes.
(We) agree to save, indemnify and keel, harmless the City of MISC.- REFER TO ORD.
lin
gainst liabilities,judgments, costs Co. expenses which PERMIT ISSUANCE 10.00 CONST.TAX
w, accrue against said City in consequence of the
his L MECH.CONT. LIC.NO. MECH.
TOTALTOTALApplican Contractor ale
.OFFICE COPY