6854 APPLICANT TO,FILL IN.INFORMAT.ION WITHIN RED, LINES - USE BALL POINT'PEN,'ONLY
BUI L'DI NG PROJECT I DENTI FICATION PERMITNUMBER -
nDILDING "- - - • _ .r' .APPLICATION & PERMIT - `%'
ADDRESS ; -.. - ;. •8854G—ELECTRICAL—PLUMBING—MECHANICAL
BUILDIN
OWNER] rr •-4�
NAME ,W•L YYJ'47em OPO .. I 1 OTV. � � PLAN CHECK VALIDATION '
_ l/ ELECTRIC PERMIT • FEE
PHONE C ..' • - -
TRACTOR'S - •�
Na E - UT,LETS-SWITCHES-RECEP 5.00/1.00
uc rvo.r��f,�� LIGHTING FIXTURES . 5:00/1.00 ..
AOoDRESS a APPLIANCES.-RESIDENTIAL 4.00 j - -
:P IPRONE _ S PANELS' - - 5.00 'R"(
aRCHRECT _ DATE OF APPLICATION
At- - ., �On +• G �( SIGNS 600 - PLAN CHECK FEE .PC.NO ,
.. ENGINEER.A 2' •'
- LIC.NO SIGNS TRANS. 3.00
'AKIN OR END I 1$.
-+ ADDRESS • If SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
'ZIP+ EMP.,METER OR POLE INS. 15.00 '
APPLICANT s: SEE FEE SCH r'
ADDRESS n ,�. bt '- '' MOTORS J
oa �O�o I aNm licCnseJ mt
SERVICE CHANGE '
10.00
LICENSED CTNACTORSDICLAAI IfIN
drpro IslsofCt9
-'"
S�/
U.0I heneby-0tont that
la
''ISSUANCE OATS
H a i [ n m Ing w d 5 t j7000)of Drvls on 3 f tire Buamess'and _
r w 2 I t f to s Cosy au ty feensc ism full for CL r - BLDG.- SELECT, PLG. 'MECH.
C
z,n O - I tt (la C. C. Number E O
m H t ITII CDnDuctDr - , ❑ ❑ ❑
¢ ,w ¢ OWNER-BUILDER DECLARATION" BUILDING PERMIT
o ,o•. INFORMATION
E
;u w I henrtby affirm-that l fencxcmpl fronf'tlia Contracmis Liwnsc MISC.— �r REFER TO ORD'
u O j Law for the following reason.(Sec.7031.5,Businessund Professions _ VALUATION $/FT.
Code:Any city or county whichre uiresa PERMIT ISSUANCE
E " i 4 permit to construct,alter, 6.00
R ¢ ¢ O inn prow,de on lislt,or,mpair any strut l u re,prior to its issuance,,-also ELEC.CONTIi..� LIC.ND.- ELEC.'
O 0 requires the applicant fur such permit to rite a signed statement that _ TOTAL
n w m he is licensed pursuam la the provisions of the Contr:¢nor's License • PERMIT TO.
L:w(Ch 1pler9f o ni n nF with Suctmn]000)ol'Division3of the y .. p�� O
Business and Prof sslons Code)or,that he is exempt therefrom and OTV: •. PLUMBING PERMIT FEE f+
.� o the basis far Clic allegid exemption Any violullon of Section 7031.5 -
n3L' ly any appliern, nru.pmmit sublecls the aPP ieaa[Ina civil penally: • STORIES TYPE CONSTR.
ol'not more Chari"five hundred dollars 6500).):- ALTER-DRAIN&VENT-WATER (E.4.I+4,00 ' '
❑ us owner of the property,or my employees with wages m BACK.F,LOW,_PR OTECF DEVICE - - "
1 then sole Com pensotion,will do the work,and the structure is not — 2.DB OCC.GROUP RES.UNITS
'trended r offered fur Tale ISec. 7044, Business:md Professions -'DRAINS-FLOOR'ROOF,ARE COND. 4.00 t
Codr:I'h.Cotnracfor's License Law does ndt apply to an owner of f' - A'
properly who builds or improves[hereon,aid who docs such work FIXTUR �P ER TRAP,. "'-' 4:00 ,� Sp:FT.FLOOR AREA
TOTAL ACREAGE
himself.r Through his own einPloYees.Provided That such improve:
meats are not i....ad dor offered for sale.-I I';however,the building GAS-EA.SYSTEM-I I C.4 0UTLETS'4,00
or'impnrvement'IS sold within one year irf completion, Dm owner- -
builder will hova the buiden of proving Ihut ho did not build or im. GAS-EA.SYSTEM-.OVER 4,(EA.)._ 1,pp - BUILDwGug E'
prove for purpose of sale.):� INDUSTRIAL WAST RES IND CON 'PB Other
❑ 1.d as owner D the property, a exclusively contracting with - 20.00 O ❑ O ❑ ,�Q,
and Pro colons ode: re Contra Tho project La 7044,of apply
LAWN SPRINKLERS'-1-INC 5 V.B. - 5.00
and Professions Code: IT. lml s s License Caw does not apply r ASSESSORS PARCEL NO:-^'
to un owner of property whu builds nr improves thereon,and who LAWN SPRINKL 09ER 1.00 - .•.},
' contracts COT such projects wiW:i contract Or(sl licensed pursuant to
the ContracR>ri License Law. .. "/ : SEWER-SANITA T�O,�.RyM EA.200ft/B.00 �Q TRACT NO. PARCEL NO.
O _lumexenlpttmder Sec: ,B.&P.C.Ior this vl up 4.00
reason " WATER HEATER.
Owner Date WATER SYSTEM• 4.00 -
R
ACC.DATEALC.FILE NO.
WORKERS'COMPENSATION%DECLARA'I'ION. WATER.TR EATING EQUIP, 4.00
X•' I herep;aflinn Thal I have a certificate of consent In self.home
'or it certificate of,Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof lSre,3800;1 IT C.l�pn /r '
O ❑ Certified ropy is hereby furnished. •'
Z z I ❑ Cmtiftvod�opy�I�filed.wall the inspection division. FIRESPRINK ENERGY T-24
O Applicam_t/�. +E/r/lf/'LV� MISC.- - REFER TO ORD. v�. N� ' Y NO
LLICIiRTII'ICATti OFF.�MPTIONIrROMWORKIiRS• -PERMIT ISSUANCE 6.00 4
IL 0 COMPENSATION INSURANCE FLOOD ZONE t7 A.L.u.c. ,
CL 0P CO 'LIC.�Na NO.
p 'PLG.
= z 1'fhis action need no[,be Completed if Ol noir is Ior one 'pqp p TOTAL�fsl•ev Y NOS Y O NC
U O bun re'l Dollars ln10le pinb'ss.)' "
I certify,that in Bte performance n' a work for which this per. QTY MECHANICAL PERMIT FEE SUMMARY
LL 1- mit is issued, 1'shall not employ�Arr person in any manners.as to FEE
O w hocmne suhi,a to the W.rkeD1'Compcos,ion Laws of California.
A. Date APPIiI ot -[ _ - -
} to - NOTICE TO AI'I•LIGAf,11 If,after making this Certificate of Gx- ALTER OR ADD TO MECH. q,0p BUILDING
F z engttion,You sI r t become mbleci to it Worker CompCnsntion APPLIANCE - 4.00 PLAN CHECK
provision of lC labor Codc;you ronalc tnrthwlth =1 ly with
U such Prov ns or this permit shall be deemed revoked - AIR HANDLING UNIT(TO 10A000F.M.) 3.00 v FEE -
CONSTRUCTION LENDING AGENCY,atL AIRHANDLINGUNIT(OVER,t0,000C.EM.) 5.00 SEISMIC•FEE
_
I hereby affirm that there is a construction lendingagency.for ,EXHAUST HOOD(WITH DUCT) 200
the performance of the work far which this permit is issued(Sec. ,, '
'- 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 4.00. MICROFILM;,'
Lender's Name
'
Lender's Address' rHEATING.UNIT(OVER 1000000 B.T.U.P.50 ELECTRIC
• ICrtdy that scorrect read Torece al comply and all cthat the above VENTILATION FAN (SINGLE) 3.00
information is correct
I agree ID comply with all city and county '
ordinances and slate laws relating.tl building consPLUMBINGtruction, and BOILER-COMP(3H.P.or 100,00013.T.U.)•4.00 �Q
hereby authorue representalrves of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP loser 100,000 BTU)SEE FEE SCH, MECHANICAL
(We) agree to Sove, indemnify and'kcep Imrmless the City of MISC.- REFER TO ORD.
Cu PeUTO against liabilities,judgments, costs and expenses which CONST.TAX
may in'any way accrue against mid City in consequence of the PERMIT ISSUANCE 3.00
' 6T:It1 ' gal iS PCTmiL' MECH.CONT. -a- LIC.NO. /�
. 'ei. J TOTAL TOTAL
Signature o(Appli rot/ ontmctor � - -
,) •p OFFICECOPY'