14551 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-BUI LID I NG PROJECT I DENTI FICATI ON PERMIT NUMBER
XAOORENG APPLICATION & PERMIT 14551 A ���
ADDRESS I L�
�,(*� �/ BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
Si 1.17 i L14
"x rvNw ERSEL PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
I' SOv� 41f it ONE
NTRACTOHS
�( J(.c •L I „ jE 4 / UTLETS-SWITCHES-RECEP 10.00/1.00
fam�Oka 17' I.Ic.NO.-5 /' LIGHTING FIXTURES 10.00/1.00
f.ONTRACI OIi'S
AOGREss 54ir,J41 STj Ly APPLIANCES-RESIDENTIAL 4.00
72-1�( h& I Sft
AflCH1iFCT NIO" b( -S2,75 PANELS 10.00
DATE OF APPLICATION
OR PANELS (OVER 200 AMPI 20.00 !'LAN CHECK FEE P.C.NO.
ENGINEER
sec.No. SIGNS TRANS. 3.00
ARCH.OR ENG.
ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METEROAPOLE INS. 20.00
ANT'S
ADDRESS MOTORS SEE FEE SCH.
i
SERVICE CHANGE 20.00
o a
FOO LICENSED CON Tk ACTORS DECLARATION
a v 2 1 hereby efllrm that I am hcenacd under Provisions of Chapl4r 9
h Q h Icumnu'ncing with Section 70001 UI Uiviniuu l of the Ihrsinrm alw ISSUANCE DATE
H H a Prali'ssiolte Cod al d my lieeu.+c'u in lull lure•a11 ,l I.� SLOG. ELECT. PLG. MECH.
2 O w License C aS G Lic.Number- 7 ❑ ❑
Y�Contracwr_J /
a p w tai ON%Ni:R-RUILI)1iR DECLARATION BUILDING PERMIT
E
. 3: A, I hrn•by ailirm that I am rs4ngn Iron the Contra:mr'>Li;cnae MISD.- REFER TO OR INFORMATION
�+ O< Law,for the follc inN reason.(Sec.7071.5,BlninnsanJ Professions VALUATION $/FT.
Ew�E Code:Any city or county which rcquireaa Permit t04un.Uumuln,r, PERMIT ISSUANCE 10.00
a a ¢O unprove.JClou iah,or rt•,,airony structure,prior to its issuancq;dsu ELEC.CONTR. LIC.NO. ELEC.
I a O u requires 16e aPpliewu for such Penni!w iilc a sdoled statrinenl thin TOTAL
w m he is licensed pursuant w The Provisions of rhe Contractors Licrnae PERMIT TO
riQLaw(Chapter9(commencing with section 7000) fDivision 3 of the
Business and Profession.Code)or that he is a,cn,pt tlb,m onl and Y. PLUMBING PERMIT FEE
¢ _ $ the basisfor0lnallegedvaemptiun.Any'Uhhon afScclion 7071.5
s3 by any appliram lixuPcrmil subjects the a I,lwunt waciSTORIES TYPE CONSTR.il Penalty ALTER-DRAIN ofnotnre
tothnnlh'ehundreddullan(S500),I: (EA.) 5.00
❑ I,as owner Of the progeny,or m
their sole'Gin, )'4mplcly" with wages us BACKFLOW PROTECT.peliI.R.1,will do Ihr work,and the,(maul,ie noDEVICE
t 4.00 OCC.GROUP RES.UNITS
intended or uttered fur sale IScc. 7044, RO'h eas and ProlcseiO1s DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Code:III,Cub0allors License Law Law dues nal apply Ise an owner of
Property who builds or improves thereon,and who does urh work FIXTURES-PER TRAP 5.00 _
hjntit•If or thRough Ilia own e111ployees,provided Ihat suell in1pruva'- SO.FT.FLOOR AREA TOTAL ACREAGE
s menti are not intended or dI r,J lar sale.11,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
�„�• or intpru.enlent is ,,It wiurr one Year ul''.."('lion, Ibe owner
builder will huvr the burden 01 Proving thus hu did 1101 huild Or Iln. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
Prose for purNeosa of wlc.L INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB OVw
❑ L' ter of the.r,Rucy,am rselmi rely contracting xilli ❑ ❑ ❑ ❑ ❑
licensed contractors to carotnml the pinjcLt(Sec. 7044,Bo...I... LAWN SPRINKLERS- 1 IN 6,
anb d PTo1LSslmCode:'Fit,Ccrlm cw!>License I.aw duce nal'apply ASSESSORS PARCEL NO.
t0 sn owner of property who bllllde or unpruvus Ih.lran,and who LAWN SPRINKLERS-OVER 5(E
contracts lin rich pmieets will:I cunlra.wrhl licensed Pu,,uwu w
the Contrctcr's License Lew, SEWER-SANITARY-STO 01/10
❑ .00 TRACT NO. PARCEL NO.
reason
andeumPl under Sec. ,B.81tC.lin this Wq TERHEAT ERW/VEN
Owner Uwe WATER SYSTEM 5.00
that ACC.DATE ACC.FILE NO.
I hereby a
WORK CRS'Chate,ccniATION UECLA RATION WATER TREATING EQUIP, 5.00
t hienthatI Ilavr a linlc ul ttnucm h+sell-mauc,
` or a certilio:Je set Workeri Ccnlpen+aliun Luurnnce,or a cLmlicd ZONING ENG.SITE NO.
copy therew(Seo.3800,Lob.C.),
Policy No__Canlpany
0 ❑ Crrtilied copy is hereby lumiahed.
Z Z ❑ Cerlilicd cop)' is tiled with the c,IY' ilupeclion division. FIRE SPRINK ENERGY T-24
IOx APPncant MISC.- REFER TO ORD, v ❑ N❑ Y N❑
y CERTIFIC'AI 1i OP EXE,MPI'ION FROM WOkK1:RS' PERMIT ISSUANCE 10.D. U
W > CO.11PI,NSA 1'ION INSURANCE PLG.CONTH. FLOOD ZONE A.L.U.C.
d 0 LIC.NO. PLG. �)
IThjs arpun need not he coudd,i,d n it, pencil i+ lar on, TOTAL �V '� Y❑ N❑ Y ❑ N❑
L) Z hundred dull,,,1$100)or Ina)
U_ O I be
01x1 in the perfon11ance of thv work Inr which thin Per FEE SUMMARY
LL U mit is issued,I shall not employ un� non in an QTY• MECHANICAL PERMIT
1 pc ymm�ncr.0a+w FEE
O w bccom• It to lire Workc,2C 1lif1re, q,eggs nnineifornie.
a Dwr_t 9(y_�]_A nhPucarlt_�I//}}// �y}'�"f'n ALTER OR ADD TO MECH. BUILDING
} to NOTICE'10 AI'PLIG\N'C II, Ile,making Ibis CeR il'ieale ul li s 5.00
F- Z' wnpt10n,You should hemnle suhjcct to Ore Workers'Co rp,b,wiun APPLIANCE 5.00 PLAN CHECK
U wphlp.ls on.+11or ti is penuu siwli I a d.cst m.•J n.1vukrJ ith e.t111ply will) AIR HANDLING UNIT(TO 10 FEE
,000QF.M.) 4,00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency lar EXHAUST HOOD (WITH DUCT) 5.00
the Pednnnanae Or the work nor which this permit is issued(Sao. MICROFILM
7097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,0008.T.U.)9.50 ELECTRIC
I certify tial I have read this application and state that the ubovr VENTILATION FAN (SINGLE) 4.00
inlOnbwion is comet.I agree to cunlply with all City and county PLUMBING
0rdibunees and stay lows relating to building const uclion, and BOILER-Q7 MP(3H.P.or100,000B.T.U.) 6.00 �-
i hereby auth.rize representatives of this Lily to enter upon the
ahuve.memiuned Pr.AH,,to,inspection pulp..... BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep hunnle, the City nt MISC.- REFER TO ORD.
uPenino against bl bdrb"'ludgmenu, coats and Lgssbses which
may i any w4,, accrue agail W CIIY in consequence 01'the PERMIT ISSUANCE 10.00 CONST.TAX
.anti UI thprpyil. L MECH.CONT. LIC.N0. L
j / MECH.
X TorATOTAL
Sig arc ol'Applicans/Cumnclor Uah•
OFFICE COPY