18291 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY \
BU LD1 NG PROJECT I DENTI FICATI ON - PERMIT NUMBER
BUILDING APPLICATION & PERMIT ��(�J�
ADDRESS D BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
DW NER'$ 15�0PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE (� r--� 9
- PHONE - I �II� 7r
CONT ACT s UTLETS-SWITCHES-RECEP 10.00/1.00
NAME /
G LIC.No. LIGHTING FIXTURES 10.00/1.00 1 / Z��.
COry RACTORS APPLIANCES-RESIDENTIAL 4.00 1 1
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATIO N .
ARCHITECT T u PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR +
ENGINEER
nLIC.No. SIGNS TRANS. 3.00
ARC
R ENC.
ADDfLLWt8J*% SPECIAL CIRCUIT 5.00 (30E�
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
Layl SERVICE CHANGE 20.00
O¢ i
FOO
LICENSED CON1'RACIORS DfiCLARATION
¢v 1 hereby affirm that I am licensed under p...skimrs of Chapter`) tL7 IS�IIAFIf •B"'
n a n (co mnteneing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F O z Professions Code,and my license is in full force and effect ❑ ❑
Z, License Class Lie.Number
9 seO se r ct
O Dam Contraor
Qy i J
¢ ¢w a OWNER-BUILDER DECLARATION BUI DING PERMIT
w 3 n m 1 hereby affirm that 1 am exempt Isom the Contractor's License
MISC.- REFER TO ORD INFORMATION
uoa Law for the following reason.(See.7031.5,Bainessand Professions pERM1T ISSUANCE 10.00 j2, VALUATION OS/FT.
� - Code:Any city or county which requires a permit to construct,alter,
M ¢ <O improve,denwlish,or repair any vfracture,prior 10 its issuance,also ELEC.CONTR. LIC.N0. ELEC.
ar
D ¢ requires the applicant for such permit to file a signed statement that TOTAIL PERMIT„TO
o. w m¢ he is licensed pursuant to the provisions of the Contractor's License I13 �-,IV rYsT
FZi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or(lilt be ie usrmpl theruflnm and QTY. PLUMBING PERMIT FEE
f I D
¢F o the basis for the alleged exemption.Any violation o(Section]031.$ STORIE TYPE CONSTR.
by any pplicantr..a permit sobjeas(he:mplicunl to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500)J:
❑ I,as owner of life property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:1'he Contractor's License Law does not apply to cot owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 -SO FT-FLOOR AREA TOTAL ACREAGE
himscllor(hm ugh his own employees, ovided thin such improve
musts are nm intended or offered for sale.If.however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one your of completion.the owner GAS-EA.SV STEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or in,- RES IND CON PB Omer
-h prove for purpose of sale.). m INDUSTRIALWASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the property,aexclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
10 an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant In
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tail exempt under Sec. .li.&P.C.liter Ibis WATER HEATER W/VENT 6.00
awn
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO.
WORKERS'COM 11I7NSA9'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate offunsenl W set Gionre. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or it certified
copy thercof(See.3800.Lab.CJ.
Policy N..-Cor....any
O ❑ Cerlilred copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z2 ❑ Cenil'ic 'opY , ti d with lh ciy ' :memos 'iI MISC.- REFER TO ORD. v N v N
O Applicant- - - - ❑ ❑ ❑ ❑
F- y PERMIT ISSUANCE 10.00 FLOOOZONE A.L.0 C.
Cr CIi R'fIl%C I'I:OF EXITMI'1'ION PROM WORK S'
LLI COMPFNSATION INSURANCE It1h,
PLG.CONTR. LIC.NO. TPLGOTAL. YE] N❑ Y❑ N❑
CIL O (This section need not be completed if the Permit is fL
or
Z hundred dollars 18100)or less.)
U O 1 certify that in the performance of the work for which Ibis per- OTY, MECHANICAL PERMIT FEE FEE SUMMARY
F mi( is issued,I shall not employ any person in any mannerso as to
O become subject to the Workeri Compensation laws of California. BUILDING Id-76
7/
�-�
U w Date Applicant ALTER OR ADD TO MECH. 5.00
} Do N'OT'ICE 'I'O APPLICANT: IL after making this Cr,rdicale nl 1!x-
? emption,you should become subject to the Workers'Compensatimh APPLIANCE 5.00 PLAN CHECK
provision, of life Labor Code, you must lbrthwi(h comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10AOOCF.M.) 4.00
CONSTRUCnON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �J43D
1 hereby al'lirm that them 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
3097.Cis C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 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 countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.Ror100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
abovc-mentioned property for inspection purposes.
(We) agree 10 Save, indmnn)fy and keep harmless the City of MISC.- REFER TO ORD.
.per tirm against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in -onsequcncc o the PERMIT ISSUANCE 10.00
run li of this pe mil. MECH.CONT. LIC.NO. MECH. Gq�
TOTAL TOTAL / IJ
Signatu 'Applicant Contractor Dxtc
OFFICE COPY