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� � BUILOI NO PROJECT IDENTI FICATI
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APPLICATION & PER
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BUILDING ELECTRICAL PLUMBING MECHANICAL
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PLAN CHECK VALIDATION
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FA(Z\^I!f�Z
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SNITCHES RECEP 600/1.00
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3:ts2[•H� Llc. xa
RES. 5.00 /1.
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DooniT,rona _
PpLIANCES!RESIDENTIAL .4.00
-
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�g- i:y'�•�[Z1�j�AV�iwon[ �`i1�1
PANELS' 6.00
onLryrr[LT'
on -
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SIGNS ' 6.00
_
CATE OF APPLICATION
PLANCHECKFEEr - ,.C:NO.'.
FxcmEER
SIGNS TRANS. 3.Of(
ee
...R .. Exp.
Aoon[Ea
SPECIAL CIRCUIT `6.00
PENM T VALIDATION
: as "
EMP. METERiOR POLE INS:' 15.00
MOTORS S. F CH.
/" OP7'
APPLILAHT'6
Aoonau _
SERVICE CHANGE - .00
1. ICENSVDCONTRACIORS ,DCCLARA'TIDN'.
l
nCy�,ij
90
.0
hereby rffmt Dml tan licenad and r onsmnwf Chapter 9
- '° U I ❑O
o IT
Immor ncl l with Sect, 1000) of Division 3 041oe Bminess tim1
IL6SJ UFg4N E6OAVT6
DATE
S aez
Ptofu ch Cn4cJ d my Irc Is in full fy 1, rl t
r Li Numprr
f
BLOO. E t. MECN..
f 0 a
4 -
Dian.
Dme
LJ L_J'
W S
OSMERBUILDF.R DECLARATION
NM'
.F,( <IA
u i A r
I h eby nfn,m final 1 a xtmpl from the Convector's L na
'-
misc.- - RE¢EA TO ORO
-
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a`9L'
-¢¢ <�
tow for tl e following rt om (S't, 703 1.5, Dinceuund Prof esb
Code Ayc0y0 rndnty wh hn9uireu Mrmntocomwet Jln,
Improve d.molbh, or rcp lr ny Wcmre; to lu iquance, odd
PERM. IT- ISSUANCE 0.00
ELEC.eon)n. LIC. NO.
_
VALUgnON
are.
O--tO,T
/FT.
S ° w
prior
O'9o1rc1 the applicant CI such p r it to File.. enld slotemeN IIUI
qq/
TOTAL 1a
p1✓.'?
m $
h,4.1.1
If,... d Pun i t t the c ovinoin f the Cold fa t Limn
-
B.
PERK T TO
Lzi
a z e
Law (Chapter 9feci imen.in, Rich Section 7ODi Dilhimi 3aflbe
Buonet, end P of u ons Code) or that he itaxoni lh rarrom and
�' �'
(j�BINOtpk'RMIT e'Z i to a
V
!FEE'
¢�B
i
thee,- rl a Ileled < p A Y -Iro' fSe Lion ]0115
bp
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'�Pii'' 2D iw,e .. t. •t .I dd y f,. + 7.y
Ae ML
''a ^I
4 n %4
STOflIE6r
t ECONST11
3..
eny, mAl inl for rP r 11 ubjeets the nppll Ilpu cNECAn Ily
of not more dum CO. lmodred t llar. fSSOOI,:
O I The or
IiA R- DRAIN& VENT -WATER (EA.) 4.00
~4
e di r of pmpcny, mplpy n th wgcs s
will
ompered nd
BACK FLOW PROTECT. DEVICE 2.00
n
CIhtlrsole or
ISelhework' nJON
ITT Prolcisn1
od,, TI c offered mr Oak IS el, do,, v l and . ciao 1,
or Code The Ca
LltttnJ Lew Joes of Pyly torn ow
-
DRAINS- FLOOR, ROOF; AREA,OOPID. 4.00
O°OnOUp
nEfi uw lS'
b.11d, or
work opnty arlo bulWr or imp e[Omton and ho Joes [u.h work
Plmulf ar thrau6h hb own employees, prowled that such improrr
mend ere not lmcnded ur nrtamd fonrle lr howovcr, the baiNMg
'
FIXTU RE_
S +PER TRAP" ':. q,pp
OAS- EA:SVSTEM -,i IN C.4,pUTLETS,q,Op
WFT. ILOOP AIRA
.
'TOTAL.CRFAOE;
or Imymament I[ cold within one Year of complat rr 3be owner -
bullJn will have flic burden of proving math did I build o Im-
GAS • EAr SYSTEM • OVER 4 IEA) - 1.00:
poor. for porno. or talvl.
U 1. at owner of the proprrty am ercl' ively contracting III
IlnnaJ
INDUSTRIAL WASTE INTER.. PD.DD
BOIL In0 USE
flia' INod ]NO USES Om'
O. O O O
mntndprs to cnn+fnNf the Prmeal lSe.. ]CN. Business
ell Proreselom CnJe rla fmnroeois Lirrnu Law JInc apply.
LAWN SPRINKLERS- S INC 5 V. B.. .'' 5.00
ID
A EsOg6PgPCELxO.
lO an owner of propeny "In NdWs or improves thereon and wlm'
contract, rut such old, a cnnoammin b[[nad
LAWN SPRINKLERS -,OVER 5 RA.1. 1.00
/fy�•. ��p� +/
/f7 �pL, -
Omit", It rsvu I to
the Conlrorfors Liaen+o Law.
❑ lam exempt nndcr Sec._ fonhis
SEWER- SANITARY - STORM. EA. POOR /5.00
vC%' F�
,TflACT NO.
P;,flcfum:.'
,N.gP.C:
"Coon
WATER HEATER W /VENT ;4,p0'�'��
Duu
Doti,
WATER SYSTEM COD
qeG
WORKERS'COhIPENSATION DECLARATION
WATER TREATING EQUIP. 4.00
.' „1[
�
AcL FILE N°
. I belch, affirm mTI I ham a[minenrt of cone t Ip ulf m+ a
or e certificate .. Worker,' Comprnsagan Im n nrtlgtJ
a
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ENO SITE NO'
op, Ili,, Cas&DO, Lab C'.1-
PohrY No.ClL7 -_IQ' IwnY -
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n4ONINO
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.
Ip CertlflNrepylsheabyfurivided.
$ rs
❑ CerlllOOttQd eopy i�� ea wrlh Ou t 1PPre'rl n Jiitlon
APPligrnS�JL6&•3f luS[_
-MISC
.REFER TO ORD;
FIRE 6Pfl INK
- ENEROVT N
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CERTIFIC'ATROF EXP.kIPTION FROM WORKERS'
PERMIT ISSUANCE B.00
. RIXIO ZONE
COAIPF.NSATION IVSUAANCE
PLC CONTR LIC NO PLO
2
(TNS lion Toed not be completed if the perm 1 Is for o e
TOTAI
r o
�..�....� -
SJ O
f
undri J doll ...IS I00) or Ilia.)
I eerllly 111.1 in the Performnnee of the Rock for wMW tbi +l
ail it Bund. I +brit rim employ
CITY:,
t i - 4 ff
MECHANICAAAA PCNMfT
Ly
0 w
an, CcemT m any inaoorr so 0 1
bhmnc nAJeu mtbr W'o ter,' Campemvwn LtiwwfCnllforn
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Doe - Apnll[am
NOTICE. TO APPLICANT If, after nuking 1011 Certifteatc of I.a.
ALTER OR ADD 70 MECH. 4,00
BUILDING
�--8
F.,?
vmlamn, you mould become subject to the W'orkeri Lmolenmtictl
notAtInc. of the Labor C de, y u mmI farlhwith wish
APPLIANCE q00
4. DO
PLAN CHECK
_
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such Conditioner lbb period dell be deemed revoked.
AIR HANDLING UNIT (TO IO=C.F.Mj 3.00
FEE
CONSTRUC 1C.:ENDIN(;AOI.NCy
AIR HANDLING UNIT IOVEi IDAMCLEM.) 5.00
SEISMIC FEE
I hereby affirm Ibut thew it a constmco.". kndinp u .... y for
EXHAUST HOOD (WITH DUCT) 2.00
Ole pTformanrt a' the work for which Ibis Permit it mom d ISee.
309],aCkC. j. c
HEA71NG'UNIT (TO 100,000 B.T.U.) 4.00
MICROFILM
Lou.. i Name]._Fr�? �o/>\V IIJ •
I.rndc%Add... !T+ �IP�'I�C
-
HEATING UNIT [OVER 100,000B.T.U.17.50
'ELECTRIC
I certify UUl lllave tend lhis.tppllertien id Tam D,ac the ubme
VENTILATION FAN iSINGLEI -3.00
immmnmipn n comet. I agme to comply rI0, oil any till v, ,d
hcrib, mt and halt low abllnp m it i Ry en.,c, o no+ A
L ruby rnlhnriea• O•praenlotives r Hit qty In tinier npml the
BOILER H. P. or 100.000B.T.U.) 4.00
_
PLUMBING
ahmt- nunliuntd P,.,,•r,y hn im,nown p.om.,
DOILERCOMP IO+er +00,000 BTU) SEE FEE 6DH.
MECHANICAL
(We) apr.< to save, indemnify and keep hmndra the city of
MISC. • - REFER TO ORD.
-
IuplIIII
imy
npmnD Iabilitice, jnd,ine , on, and npenas wblcl,
In any "' me tip ml avid City in eohi R ny. of III •
PERMIT ISSUANCE 3,00
CONST. TAX
pOnting
I
Of II& mill. MECH.
C3 . LIC NO.
MECn
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- Slpminrc
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fAPhl e I'll 'm trarlar
�TD�AL
t
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4
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, ,.OFFICE COPY.: