16258 (3) APF .ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
l ..
,.CJI LOING PROJECT I DENTI FICATI ON -PERMIT NUMBER
APPLICATION & PERMIT
a0o Ess 1 I('��
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 16258
OWNER'S
NAME PLAN CHECK VALIDATION
l/jr
^C /� CITY. ELECTRIC PERMIT FEE
1 mirl5OfC� PRONE
HA
CONTfl ACTORY
CU ( y OUTLETS-SWITCHES-RECEP 10.00!1.00
�%.t)U ' -Lcno. 7J L.'f LIGHTING FIXTURES 10.00/1.00
ADDRESS Tons PPLIANCES-RESIDENTIAL 4.00
/ Y 9� - CrL/fL j� PRONE PANELS 10.00 '
DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20,00
ENGINEER
LIC,NO, SIGNS TRANS.
aooREss SPECIAL CIRCUIT 5.00 3.00
ARCH OR E.G. PERMIT VALIDATION
ZIP tTEMP.METER OR POLE INS. 20.00
APPucANT s - V
ADDRESS MOTORS SEE FE
SERVICE CHANGE 0
z .00
o¢
FOO LICENSED CON'I'ItACTOItS DECLARATION
a i w I hereby affirm that I am licensed under provi,iuns of Chapter 9 ISSUANCE GATE -
G¢ a (commencing with Section 7000)of Division 3 ul the Business and /l p
rDi Professions Code 'Ind nay l im:ucisin full fore•' J Ilan._ ✓/(,1 Jr,/��IJL+J u� L�`;�- J BLDG. ELECT. PLG. MECH.
z0 0=o License• sx 3 y J
[.it Number-L`( ❑ ❑ ❑
F W�_j Date-dl-J-t4j CX Contractor L'i.1(�('- _'.+
BUILDING PERMIT
w u
OWNER-BUILDER UILUEk UBCLA IiA'I'ION INFORMATION
w;LL y I hereby altirm Ihm I am uxcmpt film, the Com rmlar'a Llcuns, IPERMIIT
REFER TO ORD
.. o J Law for the following reason,(Sec.7031.5,Businessandlittlessiaab ISSUANCE VALUATION S/FT.
Ey> Code:Any city or county which reyuiresa permit w construct, 11.Ld IA:DO� ,Z
RS ¢0 improve,Jentuli,h,or repair any,Vu,tun•,prior to it,issuance,u60 LIC.NO. ELEC. CO u ¢quinas the appicunl forsuch Pttnpit lu iJc a si&sed atalqu,ul that ( ♦ TOTAL/ / U PERMITTO
awm he is licensed pursuant la life Pos,,kionxof Ibe Contractor,Licenw> Law(ChaPtrrY(cunmtencingwilhSection70001o1Division3ol lirecBusiness unJ Proi,s,iuns C'odrl or Out he is exempt tealmm and PLUMBING PERMITaro the basis far the alleged exemption.Any vmlation ofSection70315 DRIES TYPE CONSTR.
a 3 by ony pole Ilia fuel peone subjecs the tau civil Penallyf not more than five bundled Jullvrs(DS001.): DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner ulthe pruporty,or my vmployecswith wages asLOW PROTECT. DEVICE 4.00
their sole compensation,will Jo lite work,and the st ruclure Is not OCC.GROUP RES.UNITS
Intended or uttered for sale ISec. 7044, liminess and PrO6•s,lun, DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Cont radar's License Law Jucs not apply to an owner of
prop,rywhobuild,of. improves th,rcum,and who Joe,loch work FIXTURES-PER TRAP 5.00
himself or through own wn employee',,provided flat such improve-
SO.FT.FLOOR AREA TOTAL ACREAGE
of nts are.1.1 intended or offered for sate.It,IIuwever,IIIc building GAS-EA.SYSTEM-1 1PIC.4 OUTLETS 6.00
or impRAlpicul is,alit """'I one Y,ar or compl,lion, III'uwner-
builder will have the burden of provlog that he JIJ not build or fir- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpux•of skj, INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am excllui,cly contracting with
El El Q El 0
and Professions
onions Crr, toie Contractor's
pmjem LS 7094,111ippl, LAWN SPR IN KLERS-1INC5V.B. 6,00 ASSESSORS PARCEL NO.
linesedouca Co, to
occ Ctruct ar's Liccns(Lew 7045cutapply
(u an owner of properly who builds or imprmo thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a nmtraclorlal licensed Pursuant m
III,Conlructor',Liccnm Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
reason❑ lam exongn under Scc. ,B.AI'.C.tilr lhi' WATER HEATER W/VENT 6.00
Owner
sunDate WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK I:Bs'conu'E:Nsn'IION Dec'LneA'[ION WATER TREATING EQUIP. 5.00
1 hereby infirm that 1 have'a certitirateofuaue nl t0,III'In,ora',
ur a certih,me or Worker;Cmnpcnsmion In>umnec,ur a ecrlil ted ZONING ENG,SITE NO.
copy thereof(See 3800,Lab C)
Policy No.c x.1,�;;L-omP:In>'.�G ul j:-i.!' i.0 n
0 ❑ Q•Itillcdcupy'iah,orf, urnwilif FIRE BPRINK ENERGYTY<
Z 2 ii Ccrli(IeJ gpy i> IiIcJ 'i CI lire oily in,paliont division.
O AlSphcant-(_It_'.i,.i',-r>_,e �C' --gG/tC' MISC.- REFER TO ORD. Y 0 N� Y [_ N[D
jr N CFRI'IIICAI'I OF Ii.CI NIP"I'ION FROM WOk KEIt S' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
W COAII11.1 be PI ON HJSUId NCI: PLG.CONTR. L:C,NO PLG
Z CL 0 (This section need nn1 La cump,IcJ it the Permit is lin onr TOTAL Yo NE] Y EJ N[D
U O hundred dollars IS 1001 of lea.I
I certify IIIuI m Ili, pol omuann•ul the work It,,which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any Person in any manner was to
Q U hecome Mub)ect m The N'nrkurs'('ompen,atiun Law,of CAR...If,,
C. Nate Applicant g,p0 BUILDING
W [)air
} Ii 'IU ,\I'I'I-16\8'' Il.:door nnlltiug This Cc, ul ia-
ALTER OR ADD TO MECH.
)- ? e...Plan.You should becoom subtler to the Worker,'ContpcmaHou APPLIANCE
U tlunlill o 1y stiff 5.00 PLAN CHECK
Much or thispcnit 1;ode Wl be doneJ resulted.
AIR HANDLING UNIT(TO 10 FEE
,000 C.F.M.) 4.00
CONST RUCI ION LP:NDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby aOirnl that Onrc la a camstrucliml Icodio,,ip,T,, for EXHAUST HOOD (WITH DUCT) 5.00
lin periannuncc al IIIc wad far wIfi,b This permit is aau'd ISce. MICROFILM
3097,Ci, ,I,, HEATING UNIT(TO 100,000 B.T.U.) 8.00
'1 Lcnderi Nemo HEATI NG UN IT(OVER 100,000 B.T,U.)9.50 ELECTRIC f .�
Lender.AJJrcs.
I certify thrift I has,recut thi"Pplicwiun and sale rill lbc::hove VENTILATION FAN (SINGLE) 400
mmco
foraliun is ned. I agree .
Io comply' with all airy and cuunly
1 oldumuces and Mau` laws relating o budding e.0 MrU, jou, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
/ hereby autborie, reprrtsen lative> of Ibis rill to enl.•r upon Ibe BOILER-COMP (Over 100,000 BTUI SEE FEE$GH.
abuvrmemimoJ pVj%,RY lin inspection purposes. MECHANICAL
(We) agree m sura. indenmify' wit l.Ccp hannl'ss the ('it, ul MISC.- REFER TO ORD.
odic( against liabilities,Iudunwnl,. o Ii and „Pa•o,r,which C CONST.TAX
may in aC"w1 cry way' accrue against aid o sti, ice of Iia• PERMIT ISSUANCE 10.00 nm g//I!iris prnniL/- /� / / MECH.CONT C NO MECH.
to, " p TOTAL TOTAL
. x`�um ul APPlicantlConlmnor /�-prate-Jl
OFFICE COPY