6379 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
lif BUI LDING PROJECT I DENTI FICATION -
PERMIT NUMBER
O
aGroJINGNfAPPLICATION & PERM IT 3•7
1� AoeREaa e 1�E A
GUPP 9-FINO1 CALIF, qGn BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S �.. '-- _
NAME p1SS• ISCJp DTV. ELECTRIC PERMIT FEE P�•L/ANyCHECK VA{IOATION
HEASUReX. coI?-P,
CONTRACTOR'S • J
NAME UTLETS-SWITCHES-RECEP. 5.00/1.00 � ad
Skye/
LIC.rv0. LIGHTING FIXTURES 5.00/1.00
nooHess TPb 944 IV APPLIANCES` RESIDENTIAL. ' t 4.00 4...
PHONE PANELS - 5.00 DATE OF APPLICATION
ARCHrteCi /
OR �E'T �. ' SIGNS' ' 6.00 PLAN CHECK FEE P.C,NO.
L9 F
ENGINEER n
�-�y� uc.NO. - 1(7 SIGNS TRANS. 3.00
. ARCH GR ENc.S� KAY V-N`? '5 .%' SPECIAL CIRCUIT ''5.00 PERMIT VALIDATION
OURESE
5AN PRI OI C/4 ,,q,4108 TEMP.METER OR POLE INS. 15.00
AADD PPLICANTS's .4 ' MOTORS SEE FEE SCH.
• : " • SERVICE CHANGE 10.00
02i 7 V
r o O LICENSED CONTRACTORS DECLARATION "
I,,
z w 'I hereby affirm that I am licensed under provisions of Chapter i)
(conortiming with Section 7000)of Uivmon 3 of the Business and ISSUANCE DATE
I- y
Polifiesomrs Cod�and Ici rse rs infill fort jftq:� BLDG. ELECT. PLG.' MECH.
o I icer' Clnis: Lrc =CT ❑U'teQ' Conlratlorrc w a :.R-BUILDER DECLARATION
BUILDING PERMIT
" °A " MISC.- - REFER TO ORD INFORMATION
w g LL I hereby affirm that I am exempt from the Contmcmr's License
u O j Low for the following reason.(Sec.7031.5,Husiness and Professioms - - VALUATION S/FT. -
• - PERMIT ISSUANCE 6:00
Code:Any.cilyorcounty whichrequiresapermit to construct,alter, ELEC.
P'> improveELEC.CONTR LIC.NO.
R.R. ¢ ¢O ,demolish,or repair any stn¢mre,prior to its issuance,also
iL m-a inquires the applicant fooSuch permit to file a signed statement that ` NOTAL
6 W he is licensed pursuant to the provisions of the Contractors License PERMIT TO CdAg7
Fza �
Law(Chapter 9(commencing with Section 7000)of Division 3olthe Le&VT�
�.E O Business and Professions Code)or that he is exempt the®fronr and DTV. PLUMBING PERMIT FE '
lk
se r he basis for life alleged exemption.Any violation of Section 7031.5 _ STORIES ppTVPgGONTR,
of by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.14.00 yoffiUpQrfIR u�1 - ��
- of nor more than five hundred dollars(5500).): -
❑ I,as owner of the proPCRY,or my employees with wages as BACK FLOW PROTECT.DEVICE their sale compensation,will do the work,and the structure is not 200 CC.GROUP RES.UNITS, .
mended or ontract for sale(Sec, 7044, Business oto In owner
of DRAINS-FLOOR,ROOF,AREA,COND. 4.00 . 15- 2-
property
2 -
Code:'the who
builds or
License th does not apply to an owner of '
property who builds Or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 50.A FLOOR AREA TOTAL ACREAGE
himself re of rote his own offered
employees,provided that such impmve-
memsarenotintendcdoroffcreJforsale.If,however.the building GAS-EA.SYSTEM-11NC:4-OUTLETS 4.00 /• t4
or improvement is sold within one year of completion,Ore owner- �V/ /
huddler willt"se.the burden of rovin Orin he did not build or im- GAS-EA.'SVSTEM-OVER 4 (EA.) '1,00
P g BUILDING USE
prove for purpose'of sale.). INDUSTRIAL WASTE INTER. REs. oao. CON" PB orae.
❑ L as owner of Ihe'prstomt,he exclusively. 7044,Bu with 20,00 ❑ ❑• ❑ ❑
licensed contractors m wnstruct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B, 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 ��
contracts for such projects with u contractor(')licensed pursuant to - _
Ore Conlractor's License Law. - SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under Ser..,B,&BC.for this WATER HEATER W/VENT
masmr4.00
r Owner Uute - WATER SYSTEM. 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPE°NSATION DECLARATION WATER TREATING EQUIP, 4.00 - I
I hereby affirm tool I have a certificate ofconsent to sal Pinsure.
x r a certificate of Workers' remotion Insurance,/Or a certifre ZONING ENG.SITE NO.
copy t hereot(Sec.3900, CIA A,
Policy No. _ r Y Q.
O* ❑ Certified is nnished
.z'Z ❑ Certifim opy w �Iy ins ec ion ivi'inIF FIRE SPRINK. ENERGY T-74
F Applicant _ _ MISC.- REFER TO,ORD. v Ibr NE Y Q NE]
LU CH I'll§CA'I'Ii OlzFXI;MI'1'IONIzROMWORKl:RS' PERMIT ISSUANCE 6.00 FLOOD zoNE 'A.L.u.c.
W �_ COMPENSATION INSURAN : - PLG.CONTR. LIC.NO. PLG. '
D (This section rent not hu wrap Bled if perntil is for one 'TOTAL Y❑ N� Y 0 N�
Z '. hundred dollarv(S 100)or less.) - - -
U O 1 certify that in the performan', Ih or which this far- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
(L k- Init is isOboul"'111cila,voine
. at empla per any a as to
U hcvunrc 'Worker r rpe n .a crow. =
n Uate- elican - - BUILDINGtoPANT: f,' to in this erti icatc nl Ex- ALTER OR ADD TO MECH. 4.00z ran tionsubject to the Workers'Conr ensarionp. . 1' p APPLIANCE 4.00 PLAN CHECK
prvisionsof Ilia Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO_1Op00C.F.M.) 3.00
CONSMUM ION LENDING AGSNCY AIR HANDLING UNIT(OVER 10MO C.F.M.) 5.00 SEISMIC FEE �S
_ I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) - 4,00
Lender's Name -
Lender''AJJR%s HEATI NG UNIT(OV ER 100,000 B.T.U.)7.50
ELECTRIC -
I,certity thin I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information iscorrect. I agree to comply with all city and county BOILER-COMP(3 H.P.of 100,0008.T.U.) 4.00 PLUMBING "
ordinances and stare laws relating to building construction, and
hereby authorize p re 'rtey motifor inspection purposes.ve, of this city to enter upon the
'love-mentioned . BOILER•COMP (OVBr 100,000•BTUI SEE FEE SCR. MECHANICAL
We afire h - I comity and keep harmless the City of MISC. REFER TO ORD. '
Caper'no ai i' es,judgments, costs and expenses which CONST:TAX
nmy I ny ue against said City in corse Rene of the ' PERMIT.ISSUANCE- 3.00
Ta of iL 1 MECH.CONT. LIC.NO, MECH, _
TOTAL TOTAL S ck
Si Store fit plicani/Contractor Da
t) OFFICE COPY .