18902 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUI
ADDRESS APPLICATION & PERMIT 18902
aOTEss
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATIBNJ
OWNER'S
WE OTY. ELECTRIC PERMIT FEE //VV//��////
'4AI Ey Ck4U1ZCH 1HONE41
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
CI4 LIC.NO. LIGHTING FIXTURES 10.00/1.00 -T
CrORs
ADDRESS - APPLIANCES-RESIDENTIAL 4.00
CONTRA
PHONE PANELS 10.00 DATEOF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 `
ENGINEER
LIC.NO. - SIGNS TRANS. 3.00
ADDRESS ENG. _ SPECIAL CIRCUIT 55,00 PERMIT VALIDATION
'zIP EMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE'SCH.
AOORRAs
SERVICE CHANGE 20.00
woo LICENSED CON'T'RACTORS DECLARATION '
T v w 1 hereby affirm that I nm IicenseA under provisions of Chapter 9 ISSUANCE DATE -
z (commencing with Section 7000)of Divisloo 3 of the Business and
ti ¢ c BLDG. ELECT. PLG. MECH.
r H i Professions Code,and my license is in full farce and effect. u �.�(
a,Z a License Class • Co Number LCI Dq,
m r w Date Contractor [ � 1I-y I"-"
rc w ¢
OWNER-BUILDER DECLARATION V BUILDING PERMIT
°a O MISC.- E ORD INFORMATION
X g w - 1 hereby affirm that I am exempt from the Contractor's License
LL 0 ¢ Law for the following reason.(Sec.7031 5,Business mal Professions PERMIT ISSUANCE .00 VALUATION $/FT.
Code:Any city or county which requiresa permit to contract alter, '1D Q
¢ Q 0 improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NQ ELEC. eL D O ��
w O ¢ requires the applicant for such permit to file a signed statement that - TOTAL
n m ac he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F z >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 D Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
MJ_ the basis for lire alleged exemption.Any violation fSccticF 7031.5 STORIES TYPE CONSTR.
by any Marcha fore permit Subjects $500o.applicant toucivil penalty ALTER-DRAIN Of net arc than five hundredProperty,
dollar,(my employees
'
❑ Las owner at the properly,or ork,an the
with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP ES.UNITS
their sole compensation,will do the work,and the structure is not
tended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00Vr
Code:The Contractor's License Law does not apply to an owner of
property who builds m Improves thereon,and who does Such work FIXTURES-PER TRAP 5.0U SG.FT.FLOOR AREA TOTAL ACREAGE
himself or Got hrough
ownemployees,for sale.
If,howevered that ,
the
ibuildig GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 -7 Iq
r mems are not intended or of for sale.Ic h plevre the building
.0 or improvement is sold within one year of completion,the owner. -
`C� builder will have the burden of proving that he did not build or inn. GAS-EA.SYSTEM-OVER 4(EA.) 2,00 BUILDING USE
RES IND CON PB Other
rev ors owner of the J' INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
I,as owner of the property,nm exclusively contracting with -
censed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
In an owner of property who builds or ramoves Person,and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00
contracts for such projects with.a contrachims)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
Elie Contractor's License Law. TRACT NO. PARCEL NO.
❑ lumexemptunder Sea - ,B.AP.c.tie this . WATER HEATER W/VENT 6.00 s
reason
Owne - Date _ ' " WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS AfITINSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certtpcate nl consent to self insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sne.38009 Lah.C.). ,
Policy No. Com Puny
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with city inspection cinspection division.
FO Applicant MISC- REFER TO ORD. v ❑ N❑ V ❑ N[3t2 CERT IFICAI'Ii OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU D COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLD. f� -yic�
0- 0This section need not be completed if the permit is for one TOTAL e[�lam(/ y❑ N❑ v❑ N❑
hundred dollars($100)or Icss.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws ol'California.
n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /.0 63,L
} W NOTICE TO APPLICANT:dL after,making this Certificate of Ex-
H.. Z emplion,you should become subject to the Workers'Compensation APPLIANCE5.00 N CHECK
provisions of the Labor Code, you must forthwith comply with �
f,) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 :
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00SEI(SMICJF EE 33
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 6.00 'I 1'a
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.l. .. HEATING UNIT TO 100,000 B.I.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC 40EL'tO
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct I ague tog to b with all city and countyti PLUMBING c ,ems
information
and state laws relating to building construction, and BOILER-CUMP(3 H.P.Or 100,000 B.T.U.) 6.00 2SEm
hereby authorize representatives of this city to enter upon the BOILER-COMP (Ovar 100.000 BTU)BEE FEE SCH. MECHANICAL
above-mentioned property far inspection purposes. `
(We) agree to save, indemnify and keep ICrinics, the City of MISC.- REFER TO ORD. Ar
upertino against liabilities,judginents,costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX W
may in any wayraccrue against said City in consequence of the
ant f this peon it. TOT"`MECH.CONT. LIC.NO. MEH.C
4-3-90 TOTAL
ttuddur,of App[' nt/Con racer Date
OFFICE COPY