8179 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - L T Yp85�fI /
BUILDING PROJECT IDENTIFICATION PERMITNUMBER
BUILDING APPLICATION & PERMIT
OOREa51
IVUILDING - ELECTRICAL-PLUMBING -MECHANICAL8179
Owry ER's PLAry ECK VALIDATION
CITY ELECTRIC PERMIT i +'e?3, FEB'.w I•�
PHONE
CONTRA ORa AUG z t9�5
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 ( ti
ND. LIGHTING FIXTURES 10.00/1.00
ADORES To s PPLIANCES-RESIDENTIAL 4.00
City of CuDertin0
.ON PANELS IO.00 DATE OF APPLICATION
7C T PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 n��
ENGINEER G
C.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PER MIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
AvvucANrs MOTORS SEE FEE SCH.
AODRE:
SERVICE CHANGE 20.00
Wo LIC EN SED CONTRACTORS DECLARATION' TEMP.POLE 30.00
a v I hereby affirm (hat I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a "' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. UEC
H y z Professions Code, icense is in full force ❑ ❑ ❑
. o m - License las Lic.Number
? m Date Contracto
If¢ w a O NF:R-BUILDER DECLAR TI N y:_yfr;:BUILDINO FERMI
o A U RMATION ry;._ :
k ; I hereby affirm that I am exempt from the Contractor's Lic a MISC.- REFER TO ORD
LLD ¢ Law for the following reason.(Sec.7031.5,Businessand Profe one PERMIT ISSUANCE 10.00 -VawaTION S/FT.
Code:Any city or county which requiresa permit toconstru ,alter,
¢ ¢ FO improve,demolish,or repair any structure,prior to its iss ce,also ELEC.CONTR. LIC.NO. ELEC.
P w m¢ requires the applicant for such permit to file a signed st ment that TOTAL PER T TO
he is licensed pursuant to the provisions of the Contr or's License _
H i
Law(Chapter 9(commencing with Section 7000)of Wision3o the - '-"'• "N"^"'if°v
sic Business and Professions Code)or that he is exe t therefrom and OTV. ' - .PLUMBING PERMIT,k,' "P r"I^ "FEE',s�
the basis for the alleged exemption.Any violat of Section 7031.5 '• '.';',.:' w;',1•`"y+ �'; :�'iti STORIES TYPE CONSTR.
by any applicant for a permit subjects the up cam toa<ivil penalty ALTER-DRAIN&VENT-WATER-IEA.1 5.00
of not more than five hundred dollars 155 .7:
❑ I,as owner of the property,or employees With wages as BACk F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the rk,and the structure is not
intended or offered for sale (Sec. 4, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
'Code:The Contractor's License does not apply to an owner of -
property who builds or improv thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own a loyees,provided that such improve.
mems are not intended or coed for sale.If.however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
or improvement is sold in one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the b den of proving that he did not build or im. BUILDING USE
prove for purpose of e.). RES INO 0 PB Omer
❑ 1,as owner the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
licensed contrac rS to construct the project ISee. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSOR RCELNO.
and Profession ode:The Contractor's License Law does not apply
to an owner f property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts r such projects with a contmctorts)licensed pursuant to
the Con etor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ am exempt ruder Sec. .B.&P.C.In,this WATER HEATER W/VENT 6.00
ea
O er Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG.SITE NO.
ora certificate of Workers'Comp ratio Insurance,or a certified
copy Cher a C.1.
Policy N y
v❑ CIifmd c Is h re y turn hed,
z 2 F•�Certi c0 Is filed wit the CI spetli disi0! FIRE SPRINK ENERGY T.24
O Applicant MISC.- REFER TO ORD, y❑ N❑ Y ❑ N❑
~ w PERMIT ISSUANCE 10.00
CC CER I" I N R MWOft RS' FLOOD ioNE a.L.U.C.
W COMPENSATIONINS UTRAI /whicha
PLG.CONTE. - LIC.NO, PLG.
CL O (This section need not be completed if the pTOTAL Y❑ N❑ y ❑ N❑
Z) 2 hundred dollars IS 100)or less.) -
V O 1 certify that in the performance of the work fo �' -(., a `FEE.BUMMARV -
OTV: `MECHANICAL'PERMIT FEE . - a
LL I- mit is issued,I shall not employ any person in any _ -
OW become subject to the Workeri Compensation Law •- e'
u Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NOTICE TO APPLICANT: If,after making thi ertificate of Ex-
F'- ? emption,you should become subject to the W 'Kers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most rthwith comply with I FEE
U such provisions or this per/rwhich
d revoked. AIR HANDLING UNIT(TO 10,QODGF.M.) 4.00
CONSTRUCAGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE
I hereby affirm that thion lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the ws permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 /
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address -__ ELECTRIC
I certify that 1 h read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is co CL I agree m comply with all city and county BOILER-CONP 13 H.P.Or 100,0000.LU.) 6.00 PLUMBING
(� ordinances an late laws relating to building construction, and
hereby aunt d representatives of This city m enter upon the BOI LER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
above-men ned properly far inspection purposes.
i c) gree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cape o against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
ma m any way accrue a ainst said City in co quence of[he
ndng Of ertn- /� M CH.CONT. LIC.NO. MECH. � ,K }q. -,n•.4+_•' A/)
Y OTAL / _,.'TOTAL_.'TOTAL-..
OW
re of Ap cant on tact ate g,y "
OFFIC OPV