8182 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT)DENTI FICATIC _ PERMIT NUMBER
APPLICATION & PERM. ^
BUILDING L
ADDRESS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S 'af,Tr `TT.Y r� r,L y'AyYr�j I PLAN CHECK VALIDATION
ir.ONTCTOR
PHONE ,; +nfECBCTRIf:RERMIT4 %N I F,
UTLETS-SWITCHES-RECEP 10.00/1,00
LIC ND. LIGHTING FIXTURES .96ADDRSE, , I PPLIANCES-RESIDENTIAL .00
pry PANELS 10.00 DATE OF APPLICATION
` ARCHrtErPAN ELS (OVER 200 AMP) 20,00 PLAN CHECK FEE C.NO.
OR
ENGINEER
Ic.No. SIGNS TRANS. 3.00
ARCH.OR ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE S. 20.00
APPLICANTTs MOTORS SEE FEE SCH.
AVORE ( Ci-L -
SERVICECHANG 20.00 ��I��LLLLL�
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 / ��/�
< u I hereby affirm that I am licensed under provisions of Chapter 9 (SSU CE GATE
Vs< i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. 1 PLG. MECH.
r i Professions Code a license is in full for
. o H License CI ss Lic.Number ❑ ❑ ❑
m[w Date Contract
¢w¢ NER-BUILDER DE AT ON 1EUICDINQIP,BRMIT �u�u
o A " REFER TO ORD W'^=S INFORMATIONzI._>s.:Cr
3 LL y I hereby affirm that I am exempt from the Contrac/, n,
a VALUATION S/FT.
Loa Law for thefollowing reason. 7031.5,Businessans ERMIT ISSUANCE 10.00
� Code:Any city or county which requires a permit to co ,Be¢ improve,demolish,or repair any structure,prior to its o EL .CONTR. LIC.NO. ELEO.D , requires the applicant for such permit to file a signed stt TOTAL PERMIT TOw$ /Cdg
is licensed pursuant to the provisions of the Contr e
H z i Law(Chapter 9(commencing with Section 7000)of vision 3ofth< h s y ate 011
�..a.•, r •.tv' XW
7 ¢ o siness and Professions Code)or that he is axe t therefrom and GTV .sPLUMBINO,PtiERM1T3,Tj w
¢ H p basis for the alleged exemption.Any violati of$action 7031 5 ,.4.c1 Vv' pt_ ? f Y?'1.F:.3<n"P"F';b ".}ar+E+, f „rt- STORIES TYPE CONSTR.
La any applicant for a permit subjects the ap cant to a civil penalty ALTER-DRAIN& VENT-WATER IEA.15.00
not mare than five hundred dollars(S5 .):
I,as owner of the property,or m employees with wages as BACK FLOW PROTECT.DEVICE 4.0 oce.GROUP RES.UNITS
ir sole compensation,will do the w k,and the structure is not
ended or offered for sale (Sec. 7 44, Business and Profession DRAINS-FLOOR,ROOF,AR EA,COND. 0
de:The Contractor's License L does not apply to an owner of
perty who builds or improv hereon,and who does such work FIXTURES-PER TRAP 5.00 SQ.FT,FLOOR AREA TOTAL ACREAGE
self or through his own a oyees,provided that such improve-
nts are not intended or 0 erect for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTL S 6.00
improvement is Sold w' in one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 1 .) 2.00 BUILDING USE
ilder will have the b en of proving that he did not build or im- RES IND CON PB Omar
ve for purpose of e.). INDUSTRIAL WASTE (NTE .00 I,as owner the property,am exclusively contractingwith ❑ ❑ ❑ ❑ ❑nsed contract to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 1 5 V.B. 8.00 AMESSORSPARCE LNO.Profession ode:The Contractor's License Law dou no[apply
an owner property who builds or improves thereon.and who LAWN SPRINKLERS- ER 5(EA.) 1.00
tracts f such projects with a contractorls)licensed pursuant to
Con clot's License Law. SEWERSANITARY ORM EA.200f1/10.00 TRACT NO. PARCEL NO.
❑ m exempt under Sec. ,B.&P.C.for this WATER HEATER /VENT 6.00
ser Date WATER SYST 5.00 ACC.DATE ACC.FILE NO.
WOR KERS'COMPENSATION DECLARATION I WATER TR TING EQUIP. 5.00
I hereby affite of that I have a ca c nCala�nl 0 selCertifed ZONING ENG.SITE NO.
or a certificate of Workers'Com nsar n Insura e,orified
copy the "is
any- sl�l
Policy Niy�L�any f
O � Certl led v Is ereby fur ishe FIRE SPRINK ENERGY T-N
Cerci ' g y s f d ith t cit a lot d'nslan.
ZZO Applicant r k C.- REFER TO ORD. y ❑ N❑ Y N❑
F I-
CC CERT OF EXEMPTI0 FROM WORKERS' ERMIT ISSUANCE 1400 FLOOD ZONE A.L.u.C.
LU �_ COMPENSATION INSURANCE PL .CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for o TOTAL Y❑ N❑ Y ❑ N❑
Z) Z hundred dollars IS 100)of less.) �1+ ^) I(.7lI's' -may.^+y� daa ck Ks`H
V O 1 certif shat in the erformance of.the work for which t ' r t ^ ,�fRBB BIMIIMARV '4•t+'
r P pe Ol'Y NIECNANICAL PERMIT FBI = 41'F."CPf_ _ Z d +�•..
IL F mit is issued,I shall not employ any person in any manna as t0 �t ttmLK?&A i .a2,3 d rw na
U become subject m the Workers Compensation Laws of ifomia.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making thu C Team of Ex.
F" ? emption,you should become subjecl to tha rc 'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must fo with comply with FEE
U such provisions Or this permit shall be deem revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTI/LENDAGENCY AIR HANDLING UNIT(OVER IO .00 SEISMIC FEE
I hereby affirm that theretion lending agency for EXHAUST HOOD(WITH DUCT) .00the performance of the woris permit is issued(Sec. HEATING UNIT(TO 100, T .). .00 MICROFILM
3097,Civ.C.).
Lenders Name HEATING UNIT(OVER 100, .U.1 .50 ELECTRIC
Lender's Address
I certify that I hav ad this application and state that the above VENTILATION FAN (SIN ) 4 0
information is torr . I agree to comply with all city and county PLUMBING
ordinances and to laws relating to building construction, and BOILER-COMP I3 H.P.or 100, OB.T. .
/hh,emb /e`m1.-1-
a representatives of [hu city to enter upon th< BOILER-COMP Over 1W,000 BTU)SEE FEE SCN. MECHANICAL
ed property for inspection purposes.
to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
nst liabilities,judgments, costs and expenses which CONST.TAX
ay accrue against said City in consequence of the PERMIT ISSUANCE10.00 P MECH.CONT. LIC.NO. MECN. P .n
ur� OTAL :
°,TOTAL,,,,;,
Si at scant o acro Date
OFF( ECOPY