8181 `N" — Wt BALL POINT PEN ONLY
MI LD1 NO PROJECT 1 DENTI FICATION
ADOREADOAPPLICATION & PERMIT PERMIT NUMBER
RE ax
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OWNER'S BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 8181
NAME �".'j- "T. H' n
q-
PLAN CHECK VALIDATION
PH NE
OR
,. ��y v+ } ELfiCTgIC PERMIT
CONTRA
NAME '� `�,. b.tiU�'.E�fG�•.1;"f;m+t;v= ,N � xPBB•.
U I LETS-SWITCHES-RECEP 10.00/1.00
r- N At ORS LIC.
NO' LIGHTING FIXTURES
10.00/1.00
A Rs PPLIANCES-RESIDENTIAL
4.00
wan PANELS
ifl N T CT
OR 10,08
PANELS (OVER 200 AMP) DATE OFAPPLICAt I ON
ARCH.EER 20,00 PLAN CHECK FEE .C.NO.
ADDRESS ENG. NO,
SIGNS TRANS.
ADDRESS 3.00
SPECIAL CIRCUIT 5,00 PERMIT VALI DATION
- PPLICANTS ZIP EMP.METER OR POLE INS. 20.00
4o0R MOTORS , A '
SEE FEE SCH. -/J a'^ —
w ¢ i SERVICE CHANGE 20.00 ✓/K`
F uo o LICENSED CONTRACTORS DECLARATION TEMP.POLE _ // (0 F 6
w I hereby affirm that 1 am licensed under provisions of Chapter 9 30.00 ,�/J J
y (commencing with Section 7000)of Division 3 of the Business and
H N 2 Professions Code Ii cenSe is In full fore ISSUANCE DATE
2 O w - License C ass BLDG. ELECT, PLG. MECH.
o Z h w Dam Lic.Number
H ac Contract ❑ ❑ ❑
¢ y F
LE ¢w< OWNER-BUILDER DELL ATION
non ° v f`
w 3 H I hereby alfirm that 1 am exempt from the Contractor's Licem MISC.— j 4 §UILDING PER IT
H v,y' Law for following reason,(Sec.7031.5,Businns and Profits, REFER TO ORD r:�k. `,INIFORMATIONL ry,
Im> F Cmlovc.ode ymolish county wh ich requiresapermit to construct it's PERMIT ISSUANCE VALUATION
¢ Q a O improve,demolish,or repair any structure,prior to its issue e,also ELEC.LONTq, 10.00 S/FT.
o LL requires the applicant for such Permit to file a signed stat enc that LIC.N0.
n w Be he is licensed Pursuant to the provisions of the Contra is License ELEC.
'H > Law(Cha(Chapter TOTAL
iQ P (commencing with Section 7000)of ision3ofth
or that he i7a 't
_ PERMIT jO
Imp Business and Profession Code) s axe therefrom and QTY;.
Esq the basis for the alleged exemption.Any violati ofSeclion]0315 r `a)rµ � L
¢ UMBINDPERMIT i /-` Q'L_(Ir�
a3 by any applicant for a Permit subjects the cep ant to a civil penalty t -Y,P"sx - X;, y,- ^'2af
-f not marc than five hundred counts,n .): ALI FR-DRAIN VENT-WATER IEA.) 5,00 STORIES TvvE CONSTR.
❑ Las owner of the Property.illdot or m employees with wages as
their sole compensation,will(S the rk,and the structure is not BACK FLOW PROTECT.DEVICE
intended or offered for sacs:feet. 4, Business and Professions 4'00 OCL.GROUP Code:The Contractor's License DRAINS-FLOOfi,ROOF,ARE qEs.unrrs
does nal apply to an owner of A,COND. 5.00
property who builds or improv Ihercon,and who does such work FIXTURES-P
himselforThrough his own t ptoyees,provided that such improve- PER TRAP 5,00
mems arc not intended or fared for sale.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 S6 FT,FLOOR AREA ToraueflEACE
or unprovemenl is sold thin one Year of completion,the owner-
builder will have the rden of proving that he did not build or im. GAS-EA.SYSTEM-
proveforpurposeo le.). OVER 4 (EA.) 2.00
O 1,as owner f the property,am exclusively contracting with INDUSTRIAL WASTE INTER. BUILDING USE
licensed contr ars to construct the project(Sec. 7044,Business 30.00 RES IND CON PS Osher
and Professi Code:The Contractors License law does not apply LAWN SPR INKLERS- I INC V.B. 6.00
10 an ow of property who builds or improves thereon,and who ASSESSORS PARCEL NO,
conmac or such projects with a contractor(,)licensed pursuant to LAWN SPRINKLERS
r so tractor's License Law. SEWER-SANITARV-
I um exempt under Sec. B.&P.C.for This STORM EA.200h/10.00 TRACT NO, PAR CEI NO.
` 9O° � WATER HEATER W/VENT
owner 6,00
Date WATER SYSTEM
WORKERS'COMPENSATION DECLARATION 5'00 ACC.OATE ACC.FILE NO.
I hereby affirm that I have a certificate-!consent m self= WATER TREATING EQUIP, 500
or a certificate of Workers'Comp nation Insurance,or a certified
pC!$Q'}t�y�,.���}y�g�yDM•yR/s1.ab.C.).
COlcy Iy1FiYAIJ any hie ZONING ENG.SITE NO.
O e"I and copy Is hemby fu Ished.
Z Z Certiw'th t c'y ins 'o division.
O App, MISC.- FIRE SPRINK ENERGY T-24
v_a REFER TO ORD.
CERT FICATE OF E%EMPTI N FR M WORKERS' PERMIT ISSUANCE Y N Y ❑ N❑
CLU COMPENSATIONINSURANCE 10.00 FLOOD ZONE A.L.u.C.
4 O (This section need not be completed i(the PLG.tONTR, LIC.NO.
2 Permit r One PLG,
O hundred dollars(E100)or IessJ TOTAL V N y
1 certify [hal in the Perfortnan¢of the w or which this per �� wy'r, Y'3"!I" jy"-f!'tj+ .G�tr• N
'J_ U mit is issued,I shalED
l net=y any many manner so a,to aTr MECNANICA � •
J w become subject to the WC Y •. r L PfiRMITnT "efiHP`r '�.aI �fiUMMARY,+ ,.
Date nvtlon laws of California. x,.+ y,_.x-�'a�• �''h'$4 ,
a Applica
> Z NOTICE TO APPLIC . If,after making this Certificate of Ex- ALTER OR ADD TO MECH. BUILDING
emption,you sh come subject to the Worken'Compensation 5.00
provisions a Labor Code, you mutt forthwith comply with APPLIANCE 5,00 PLAN CHECK
such dons or this permit shall be deemed revoked. rmy-]
AIR HANDLING UNI C.F.PA) 4.00 FEE G>v=
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10
I hereby affirmthat 'here is a construction lending •M) 6.00 SEISMIC FEE
the Performance of the work for which this agent EXHAUST HO T
3097,Civ.C.). Permit is iss Sec. 5.00
Lender's Name HEATING UNIT(TO 100,000 B ,) 8.00 MICROFILM
Lenders Address HEATING UNIT
I certify that I have read this applic n and state that the above 1 •. -T-U.19 Rri ELECTRIC
information is correct. I agree 1 ply with all cit VENTILATION FAN(SINGLE) 4.00
N inances and stale laws Y and ceunly
sn0 t1 building construction, and BOILER•COMP(3H.P.or 100,000B.T.U.) 6.00 PLUMBING
reby authorize rtprc siva of this city to enter upon the
ove-mentioned pr y for inspection purposes. BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. ,�/7
(Wt) agree save, indemnify and keep harmless the City of MISC.-
ay MECHANICAL Ufa
'upertine snst liabilities,judgments, costs and expenses which REFER TO ORD.
in of t �' c'm st said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
I'm
MECH,CONT. CIL.NO. MECH.
Sign o plica ontrD
act
be dD
OFFICE C PV
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