7068 „APPLICANT TO FILL IN INFORMATION WITHIN RED LINESY- USE BALL POINT PEN ONLY' „
PERMIT-NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
6ULLDINc /�
ADUHEss Qa C�J
LDING-ELECTRICAL
-PLUMBING -MECHANICAL • .•t,706,8 '
OWNER'S U: ! V
1J PLAN CHECK VALIDATION'.
rk "-A 1 QTY. ELECTRIC PERMIT -FEE' _
N°AMERacro s UTLETS-SWITCHES-RECEP 5.00/1.00 -
�: LIGHTING FIXTURES.' 5.00/1.00
• •,
CONTRACTORS _
AD R ss 4.00
`(`///fQ�
APPLIANCES RESIDENTIAL
a%Y „PANELS - - 5.00 DATE OF APPLICATION
n C ITECT SIGN$. - 6.00 PLAN CHECK FEE . '� - P.C.NO. ,
OR
ENGINEER -
SIGNS TRANS. - 3.00
48CRESS ENG, SPECIAL CIRCUIT 5,00 PERMIT.VALIDATION
f '
•'r., '
ZIP TEMP.METER OR POLE INS. 15.00
♦ APPLICANT'S
• ADDREss MOTORS SEE FEE SCH.
• SERVICE CHANGE10.00 � .
`o¢i
-,00 LICENSED CON'TRACI'ORS DECLARATION „•,
. ¢u'� I hereb affirm}hal I am bc.i sed u , C 9 -
¢ o y n under if the of Chapter ISSUANCE DATE
w 3 w (commencing with$CtlioD 7000)of Division 3 of the Business and - BLDG. ELECT. -PLG. M
Professions Code, I '�ense Cull fort jjqq��hI�O ❑ ❑ ❑• '
•o Z m W Lae uc Cl las L' NumM1-ryjjLL�
F y F J Ddlc. -f _ C at.clr
¢ x s , !- 'r - BUILDING PERMIT
¢ o a OWNER-BUILDER R DI CI-ARA'110N - INFORMATION ,
- w ; a y I hereby aflinn that I.um exempt frenn the Contractor's License MISC.' REFER TO ORD
VALUATION $/FT.
� u.o ¢ Law for the,following reason.(S 7031:5,Business and Pro fesainns PERMIT'ISSUANCE 6.00
Code:Any Cit%or county which regmres a permit to construct,alter,
a2 a,o"; improve,Jemnlish,or repair any stn¢luru,prior to its issuance,also ELEC.CONTR.: LIC.NO. ELEC.
a, - requires the applicant for such permit to file a signed statement that TOTAL. 'A PERMIT TO'
w se
U. he is licensed pursuant m the provisions of the Contractor's License
z.Q ,
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ D Business and Professions Code)or that he is exempt therefrom and OTY. } PLUMBING PERMIT -FEE
,¢ I- o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
u ; m bypny applicant for.permitsubjects the applicant too civil penally ALTER-DRAIN -WATER (EA.) 4.00
'
of not more than five hundred dollars(5500).): .
17:1 I,as owner of the property,or,my employees with wages as BACK FLOW PROTECT. DEVICE . 2.00 - Occ.GROUP RES.UNITS
Side comnsa
petion,'will do the work,and the structure is not
intended or offered for Sale (Sec. 7044, Business and Professions. DRAINS.FLOOR;ROOF,AR EA,COND. 4.00 .
Code::Elie Contractor's LiceaSe Law docs not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 460 SO.FT.FLOOR AREA - TOTAL ACREAGE'
hln..elf or through his own employees,provided that such Improve-
mems arc not Intended or offered for sale If,Imv"cC the budding GAS-EA.SYSTEM-1.INC.40UTLETS'.,4.00
or mpros anent is sold within one year of completion the owner- GAS EA: ;EM OVER 4 IEA) -
budder will have the'M1n urde of proving that he did riot -ot hold or im- - SVST - . 1.00 BUILDING USE
- ES IND PB Oahe,
for purpose of sale:). I INDUSTRIAL WASTE INTER. '20.00 . ❑ ❑ ❑ El
I,as owner of the property,am exclusively"contracting with
'- licensed ...tractors Io Construct the project(See.-7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 - ASSEss SPARCELNO.
= and Professions Code:The Contractors Liemw Law does not apply '
to an Owner ol'property who builds or improves thereon•and who, . LAWN SPRINKLERS-OVER 5(EA.) 1.00
- contracts for such protects wilh a contnmtorls)liccnwd pursuant to -
meContractor'sLicenseLaw. - SEWER-SANITARY-STORM'EA.200ft/8.00 n TRACT NO, PARCEL NO.
- ❑ 'I;un exempt under tics. - ,B.&P.C.for This WATER HEATER W/VENT -q.Op
reason
Owner Dale WATER SYSTEM - 4.00 ACC.DATE: ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION .< WATER TREATING EQUIP. ' 4.00 -
h r ifi ate 7 th l I have u fl' ion onsu nsut to s cern _
or a carDficale'01 Workers'COmp tmn'I mumnu r r a cerlilh d • ZONING - ' ENG.SITE NO.
'7 'u,,fhLr-o fS B00 Iary .� -
1'cY npony - .,
�,�C Died cop Is Nonyf rishd FIRESPRINK ENERGY T-24
z y�'�C rlificd tpY 's..fled it th• c'Iy,.ina Clion.divison -
O M T1r I MISC.'' - REFER TO ORD. Y ❑ N'❑ YE] N❑
~'va , . PERMIT ISSUANCE 6.00
�.- ^ CIERIriCA11.01 I:XIEMI'71(1N PRO1WORKIERS:, '' .- FLOOD ZONE A.L.u.C.
W-� COMPIINSATION INSURANCEPLO.CONTR.' - LIC.NO. PLG.
si?'E (This section need not�Pv conlplet ed-if•lhe'ye nn fo
it is r one TOTAL ,Y❑ NE] ❑YN❑
'hundred dollars IS 100)or less.) . .
"
0,0 I certify that in the performance of the work for which this per-; T - •. MECHANICAL PERMIT FEE FEE SUMMARY
LL} mil is issued,I shall not employ'any person in any mann or w;rs to
O W hecomesubject to the Workers''Compensation Lawsof California. - BUILDING
a Date Applicant, ALTER OR ADD TO MECH. 4.00
} N N0'1'ICI. '1'0 APPLICANT':'If,after making this Certificateoflis.
h Z_ rempticn,you should becomesubject of the,Workers Compsax,ui.n APPLIANCE - - 4.00 PLAN CHECK
,pr.visions of the Labor Code, you must lorlhwi th comply with --FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.P.M.) '3.00
CONS'fRUCI'ION LENDiNG'AGENCY p�_;'n,':,. AIRHANDLING UNIT(OVER 10,000GEM.) 5.00 .SEISMIC FEE
I hereby affirm (not there,is a conslructiori lending agency for EXHAUST HOOD (WITH DUCT) 2.00
'lire per¢mnmmc of the work for which this porut is issued(Sec. - MICROFILM, '
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address' ' ELECTRIC
I certify:thm l have read this application and state thalfhe above ' VENTILATION FAN (SINGLE) .,. 3.00
*` ordinacesascorrect.1s relticomply with all city ucQcounty d BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ord
inances ncio .is correct.
.I a relating c to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes."
Cu(We) agree to-save, indemnify and keep'harnrless'the City of MISC. REFER TO ORD.
pertino against liabilities,judgments, costs uad expense's which pERM1T'ISSUAN CE 3.00 CONST.TAX .+.
may in a way accrue against said,City in consequence f the '
yr:urtin of Ifi nnit. ECH.CONT. - LIC.NO. MECH.
./ TOTALsi�3.. TOTAL
(( .o r f ele /!]GYM+'✓' N d(�6 �Jr`•�r
_ , • _ • ^ OFFICE COPV .,, .. .