4994 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
BUILDING PROJECT I DENT(FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT SS 4994
ADDRE10600 Ridgeview Court
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S //�y PLAN CHECK VALIDATION
/
NAME v�g V .VOgQ QTY. ELECTRIC PERMIT FEE
unavail le PHONE
ArvrRAcrons
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
N
)L
Viking Fire Protectianol87293 C-16 LIGHTING FIXTURES 5.00/1.00
CONFEss TORS 969 Industrial Road, Ste. APPLIANCES-RESIDENTIAL 4.00
San Carlos CA.940701.0sE (415)592- 670 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 600 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
Lie.rvo. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP TEMP. METER OR POLE INS. 15.00
APPLICANT. MOTORS . SEE FEE SCH.
ADOREss
SERVICE CHANGE 10.00 6/u
0 0 o LICENSED CONTRACTORS DECLARATION '
¢ I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H < H (commencing with Section 7000)of Division 3 of the 1lminess and BL ELECT, I PLG. MECH.
F w z
L'riocel'enssseiu�njsasCsode,ad mlicemx nis. in full fore`y
cff
y r aqy(r�a
El0 Date Contract.,_ BUILDING ❑
PERMIT
¢ ¢ w a OWNER-BUILDER UECLn RATION INFORMATION
REFER TO ORD
w 3 LL y I for the
affirm that 1 am exempt front Ihu metra Contractor's o License MISC.- VALUATION $/FT.
u O a Law for the following rcasoa(Sec.70J L5,Business and Professions PERMIT ISSUANCE 6.00
HN ,I Code:Anycity ureounly which requiresapermit to CDllatrtlt,alter,
ce K¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC NO. ELEC. $67,873.0
O
0 ¢ requires the applicant for such permit to file a signed statement that TOTAL y�[{r,1q TO
a w m he is licensed pursesul to the provisions of the Contractor's License IRS Ldll
rzi Law(Chapter9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE FIT
¢ r D the basis for the alleged exemplion,Any violation of Section 7031.5 STORIE TYPE CONSTR.
d 5_; by any applicant fora permit subjects the applicant R ivil penalty ALTER-DRAIN -WATER (EA.) 4.00
of nut more than five hundred doll...($500).):
❑ ].as owner of the property,or my employees with wages as BACK 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 sale (Sac. 7044 Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply 10 an owner-I'
property who builds Or intmoves thereon,and who dUfs such work FIXTURES-PER TRAP 4.00 SQ FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such ingvove-
-enare oat intended or offered for sale.If,however.the building GAS-EA.SVSTEM-11NC.40UTLETS 4.00
rts improvemmtt is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
' builder will have the burden of proving Iltat he did not build or im-
ProveforpurPoscofs:dc.). INDUSTRIAL WASTE INTER. 20.00
er REs IND c PB onto.
❑ I,as ownof Ilse property,am exclusively contracting with ❑ ❑� ❑ ❑
licensed contractors 10 ron,tuml the project(Sec.7044,Business I LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 A55E550R RCEL NO.
and Professions Code: the Contractor's License Law does not apply
to an owner of property who builds or improves themon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
Contracts for such Projects with'a conlractonO licensed pu¢u.nt to
the Contractor's license Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL NO.
❑ (ant exempt under Sec .B.&P.C.Ibr Ibis WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSMION DECLARA"LION WATER TREATING EQUIP. 4.00
^ I hereby affirm that I base a certificate W consent to sel Giitsurc. ZONING
I\!(' or a certificate of s WorkerCompensation Insurance,or.Certified ENG.SITE NO.
copy thereof(Sec,3800,1ab.CA
Pohcy No. Conmany
O Certified copy is hereby furnished. - FIRE SPRINK ENERGY T44
Z Z ❑ Certified copy is Iiled with the city inspection division. MISC.- REFER TO ORD. v ❑ N❑ v ❑ No
H � Applicant
PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
CCCIIkT'IP ICA'I'Ii OF li%IiMI"1'IUN PROM WORKERS'
LU > COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 O (This section need not be Completed i1' the permit is for one TOTAL v❑ N C] Y C] N❑
::) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
!] w bccontcnlbjcct to the Warkcrs'Cmnpcnsulion Laws of Culilornia. BUILDING
Date Applicant ALTER OR ADD TO MECH. 4.00
} N NOTICE TO APPLICANT': IL after making this Certificate of Ex-
r2 emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
prvisions oI' the Labor Code, you must forthwith comply with FEE $219.05
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.1 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 5.00 SEISMIC FEE $ 4.76
1 hereby alfinn that there is o construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,C'iv.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that I have read this application and suite that the ahoy.. VENTILATION FAN (SINGLE) 3.00
afonDalion is correct. I agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
diumees and state lows relating to building construction, and
reby au(horire representatives of this city in enter upon the BOILER-COMP (Over 100,000STU)SEE FEESCH. MECHANICAL
bove-mentioned property for inspection purposes.
(We) agree to save, i emit and keep bunnies, the City of MISC.- REFER TO ORD.
Caperti agaiD.O limbi' e.,judgmm�ls, Costs and expenses which CONST.TAX
may ' any way ere 1st s:'d City in consequence of the PERMIT ISSUANCE 3.00
gran "1 14,11 MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
alum of ApD
pliclnjContr.ctor ate $560.81
OFFICE COPY