No preview available
9432 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESSezig L N Alts BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 9432 OWNER'S PLAN CHECK VALIDATION NAME CITY, ELECTRIC PERMIT FEE 1644 Z!/: r,,ter pp 5PHONO �) CONTRACTOR' /"�/Yrs Na E //���/� OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S �+.dr APPLIANCES-RESIDENTIAL '4.00 ADDRESS /]� }T� /J/j �1(,` O/ L/4�IlJy'- PHONED 55 PANELS 10.00 DATE OF APPLICATION ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER i LIC.No. ISIGNS TRANS. 3.00 ARCH.OR ENG. , PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 411 at5/oLl Sr. GAM{ /P EMP.METER OR POLE INS. 20.00 n avvucANrs /2 C/r/ MOTORS SEE FEE SCH. l//A'"''•�"r---_J ADDRESS O/(� ©/i/i✓jJ SERVICE CHANGE 20.00 /ds,� IS o LICENSED CONTRACTORS DIE ATION TEMP.POLE 30.00 F0 w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r w z Professions Cod �d�y I ae is in full fur c Zip ; License ass Lic.Number Date 'Contractor a sc s A�/JlNO BUILDING PERMIT d ¢o o U OWNER-BUILDER DECL IO INFORMATION . 3 u H 1 hereby affirm that I ant exempt from the Contr actor's License MISC.- REFER TO ORD H u 0 ve Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. ,a0J Code:Any city orcounty which requires a permit to construct,alter, pa, Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ¢ requires the applicant for such permit t0 file A signed statement(]lot TOTAL JJ P. m m w he is licensed pursuant to the provisions of the )ofDivision License PERMIT TO ^ �i et Law(Chapterand Professions Codeng )with Section is exempt Division and U a Business and Professions Code)or that he is exempt therefrom and the OTY. PLUMBING PERMIT FEE ¢ _ $ the basis for the alleged exemption.Any violation or Section 7031.5 STORIES TYPE CONSTR. i3 by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ 1,as owner of the 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:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- ments are not intended or offered for sale.ll',however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200 builder will have the burden or proving that h - . - . . e did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business' LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 11 El and Professions Code:The Contractor's License Law does not apply to An owner or property who builds or improves thereon,and who LAWN SPR INKLER$-OVER 5 (EA.) 1.00 contracts for such projects with a contractor(,)licensed pursuant 10 SEWER-SANITARY-STORM EA.200th/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec,-,B&P.C.for this reason WATER HEATER WIVENT 6.00 Owner Duce WATER SYSTEM 5.00 ACC.GATE ACC.FILE N0. WORKERS) P SA yp�_ LAR 'PI WATER TREATING EQUIP. 5.00 I hereby m e!I hov u ctTficate of con l6 Self-insure, or a certify le of Workers'Compensation Insurance,or a cettilied ZONING ENG.SITE NO. copy thereo Sec.3800,Lab.C.)�j Policy No. Company f yp` 44dAGXLB O ❑ Certified copy is hereby furnished. 24 Z Z �ertified copy is f d�RL the hip• it tl vi i0 FIRE SPRINK ENERGY T-N F O a brant', L'l�1//�C!-X MISC.- REFER TO ORD. Y N v ❑ N� CC y CI: TIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU C041:NSATION INSURANCE PLG.CONTR. LIC.NO, PLG. 0' O (This section need not be completed if the permit is for one TOTAL Y NY [] N� 7) Z hundred dollars IS 100)or less.) ��-'""""''''````�����'''' U O I certify that h the performance of the work for which this per- OTY MECHANIE IIT FEE FEE.SUMMARY LL H mit is issued,I ,ball not employ any person in any iof CAI wl as to cr �• __ O W become subject t0 the Wlicant Compensation Laws of California. a Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,art,,making this Certificate of Ex- F.. ? emption,you should become subject to the Workers'Compensation APPLIANCE5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Comply with FEE C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10 4.00 CONSTRUCTION LENDING AGENCY y AIR HANDLING UNIT I p00C.EM.) 6.00 '1 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued ISec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 , Lender's Name Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50j`�Aj ELECTRIC I certify Rant I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and 1301LER-COMP(3H.P.or100,000B.T.U.) 6.00 „� i hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEX E fl/�/ MECHANICAL above-mentioned property for inspection purpous. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. CA perfino a ainst iia 'lilies,judgments, costs and expenses which PERMIT ISSUANCE 0.00 /' CONST.TAX may i a wa true against said City in consequence of the gmn ' g this it ALY�I MFr H.(0�NLIC.NO. Kill A ' �o - Z rTIJJ` 1 Z�382�f �/�� TOTAL tgnature rApplic t/Contrac or Date (,� • - OFFICE COPY /