6807 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PE
-OIL 13U I LDING PROJECT I DENTIFICATION -
A N ONLY
APPLICATION & PERMIT PERMIT NUMBER
' NAMERs BUILDINGELECTRICAL—
1 "ANE PLUMBING— ^^O
� - MECHANICAL lhJ l}J(
H
CONTq ACTOgs
NAME QGG PHONE },' I�.,. 1 PLAN CHECK VALIDA8
TION
CONTRA c]ogs� 6� uc.NGQyO /Q SWITCHES-RECEP 6.00/100
ADDRESS LIGHTING FIXTURES
�- PPLIANCES-R 5.00/1.00
OR
ggcRlTecT PRONE yq a o PANELS ESIDENTIAL q�
ENGINEER
SIGNS 5.00
ARCR
OGRESS SIGNS TRANS..DR ENG LIG ND. 6.00 PLAN CHECKFEE
LIGATION
AC.No
APPLICANT'S
SPECIALCIRCUIT 3.00 x
ZIP
°°DgEss EMP,METER OR POLE INS. 5.01) PERMIT VALIDATION
MOTORS 15.00
''I ¢
o SEE FEE SCR. / n
0 LICF-NSED CON SERVICE CHANGE
i w I bomb TRACTORS DECLARATION 10,0 is is
y affirm that 1 am licensed under provisions of Chapter 9 l •/�/IAe/
w Z rommrncm6 wi Rl Section 7ppp)of Division 3 of the Business and
Professions Cods�sa�tl rDY=icrna,is'in
full for a and efr
'^ Lscense Class Q ff
- to Lic.Number 4 s t
v� ontractor ISSUANCE DATE
ic "BLDG. ELECT. PLG.
A OWNER-BUILDF-R DECLARATIONMECH.
1 hereby affirm that I am exam t City f Caper ❑ ❑
Or, Law for the foil IS from the Contnctor's
> Code:An B reason.(Sec.]031.5,Basin License MISC.—
�o improve,�emolish,cor nlY whichrc LYSand Professions REFER TO ORD
pair an 4mresa permit Pat 1,aper, PERMIT ISSUANCE ,
s u rcyuims the applicant for such Y structure,prior to its rssuantt,also ELEC.COhflr
hr is licensed pursuant to the PeRnll m file a signed statement that 6.Op VALUq TION
. > Law IChupter 9(Com ❑roNsions of the Contractor's LIC.NO. S/FT.
- a Business and Pro fessions Cng wlth Section] Littnse ELEC.
- O ode)or that OWIofDivision3ofthe TOigL �
mo the boas for the alleged exemption,Any vto dtion oltSeclion 7 and _
by anydppliCanl fora PRMIi TO
of not mare than five hundretdsdollars the applicant too civil - �" v
O I,as ow (55001.1: Penalty -e s s• . a ,
nee of the property,or my employees with wages as glN
;heir ALTER-pg
wlenompensation will do the work, &VENT-WATER ' s BT RIES
mended r orfered for sale and the structure s not BACK F 4.00 TYPE CONSTq.
Contrails-- (Sec. it Business and Prof LOW PROTECT. DEVICE
arty who builds License Law does not a essr of 2.00
.elf or through or Improves thereon, apply to an owner work
DRAINS-FLOOR R OCC.GROUP
R his own em Io and Who so such work •ARE,q GOND, q,pp RES.UNITS
S are not intended or offered for.1,Provided w.hat such int _ FIXTURES PER TRAP
MITDSmenl is ever, Prove
Sold within one year of completion,tlhebowdin8 GAS-E 4.00
er will have the burden of _ A.SYSTEM-7 IN s0.FT.FLOOR AREA • .
prove for purpose of sale.), proving that he did not huiltl nee C.4 OUTLET$ 4.00 TOTAL ACREAGE
1,as owner of the or int. GAS-EA.SYSTEM-
b"ITSed contractors to pro Petty,am exclusively
OVER q(Eq,)
onsholl the Y contracting with INDUSTRIAL W 1.00
end Professions Cope:The CDntractor'sproiact(Sec 7 ASTE INTER. BUILDING USE
m an owner o!prOpert w Lice oeq•Business 2p-00 RES INO
Y ho builds or "'Y Law does' apply LAWN SPRINKLER ❑ CON PB ornar
contracts for such projects with a contracluN"Oillicensed
n.and who S- 1 INC 5 V.B. ❑ ❑ ❑
Ile Contracmr's Li cense Law. LAWN SPRINKLERS, 5'00
O
,a
exempt under Sec Pursuant to OVER 6(Eq,) gSSESSOq PggCEL NO.
reason SEWER-S NITq 1'�
Owner —,B.&P.C.for this RV-STORM EA.200ft/6.00
WATER HEATER W/VENT TRACT NO.
WORKERS'COMPENSATION DECLARATION 4.00 PARCEL NO,
WATER SYSTEM
I hereby affirm that 1 have a Certificate of consent to sell'- WATERT 4'�
or a certificam Of Wot,I have
REATING EQUIP, ACC.DATE
If Iherepfl C. satin Insurance, Inunre, 4.00
ACC.FILE NO.
Pohcy h'oI�I � Qr a certified
O Ce"RieI"pB"Y s
Corti copyls here
lb r urnisbrd.
ZONING ENG,SITE N0.
pP 'ant -th the Cil
�srauion division.
CERTIFICATE OF GXEMPTI MISC.- FIRE SPRINK
COMPENSATION FROM ORKERS' PERMIT ISSUANCE REFER TO ORD. ENERGY T-24
fl De w I need not be completed INSURANCE
ANCE Y❑ N❑ ❑
huI c,,I dollar(51001 ur less,) PLG.CONTR. 6.00 Y N❑
I i, s m,that in the erlo permit is for one LIC NO FLOODONE
P manse oft work for which this Dper QTY 9 _
ml s issued,I shall not employ any person in an A L u
h cont•subject to Ihr Worker Com Y ma"nor w us to QTY yi's
T PILE.
TAL
Date pensationLawsofCalifornia '� MfiCNA�y1CAL'P RMIT-, H`x ❑
Y❑ N❑ v
NOnce--Anphcam -
N
emphon, TO APPLICANT' If after making this Certificate of Ex- ALTER
you should become subject to Ole W OR ADD I U
Prov tons of Ihr Labor Code, orkers'Compensation MECH.
such provisions or Ibis permit sha
110 be dru 1 forthwith comply with APPLIANCE 4.00 BUILDING
CONSTRUCTION LENDING gcENcv AIR HANDLING UNIT(TO 10 4 PLAN CHECK
1 hereby affirm that there iorms a construction Iendin6 agency fine AIR HANDLING .GOOF M,) 3.00 FEE
tis' peel v.C,), r of the work for which this permit is issued y for
UNIT OVER 10P00QF,M.) 5,00
O9],r'v Na I. EXHAUST HOOD SEISMIC FEE
ender's home (WITH DUCT) 200
end adrcs HEATING UNIT(TO 1000
I 00 B.T.U.) q-pp MICROFILM
lohat I have read This n HEATING UNIT(OVER 100�p
is cuRecL 1 agree to eolm Doo and state Thai the above 00 B.T,U.h,Sp
d° nr state laws relalin wply with all Cit VENTILATION FAN ELECTRIC : A/ o djC
'rs orire x City y and county (SINGLE)
Iles, representatives of This cit g construction the BOILEq-L'pyp 3.00
f Wel agree to property for insMclion purposes.to enter u on 13 H,P,Or 100,
000 B.T.U.) q,pp PLUMBING
save, th,ii,i f BOILER-CO a against liabilities,ludBmrn s keep harmles the City of COMP IOwr t DDD BTU)SEE FEE SCR,
y way a against said C(hosts end expenses which MISC'- MECHANICAL
niillp of this it. y in Conseyurnce of the PER REFER TO ORD.
F� MIT ISSUANCE
_ MECH.CONT. 3.00 CONST.TAX
uture of Pp cant/Co to -- I LIC.NO. MECN,
Date TOTAL