09746 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN=ONLY
-BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
HU_OutDRESs APPLICATION & PERMIT
_ DqS � � CC. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
09746
'\ OWNEH'a - _ • PLAN CHECK VALIDATION
X NayyM.yE ` , C�CC6 0Li'. QTY. ,ELECTRIC PERMIT FEE,
RCW� 10ob - 1
NAAMERncroR's OUTLETS-SWITCHES-RECEP' 10.00/1.00
LIC.No. LIGHTING FIXTURES, •10.00/1.00
f TRacroRa
ON - r APPLIANCES-RESIDENTIAL 4.00 '
All DRESS '
PHONE PANELS 10.00 DATE OF APPLICATION
Ogcwracr • PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No.
ENGINEER - v LIC.NO, ISIGNS TRANS. , 3.00
ADDDRESS ervG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 1
ZIrEMP.METER OR POLE,INS..: 20.OG - -
APPur
carvs MOTORS, SEE FEE SCH. /J -
SERVICE CHANGE ` 20.00 GJ
woo - LICENSF:DCONTRACfORS DECLARATION TEMP.POLE 30.00 /✓�'�/��"'
a u'� I hereby affirm that I am licensed under provisionsof Chapter 9' ISSUANCE DATE
(camn.er6ro with Section 7000)of Division 3'of the Business and
g - BLDG. ELECT. PLG. MECH.,
H m i Professions Code,and my license is in full force and effect. 'I
O m - License Class z
Ire Lin.Contract.,
•O z H w Date Contractor
.t: '131985
a u '•' BUILDING PERMIT
OWNIi R-BUI LIJER DECLARATION
wo d u ,thV INFORMATION
; LL N 1 hereby affirm That 1 am exempt from the Contractor's License MISC.- City O OpQI lf1R/-ER TO ORD
uOj Law for file following reason.(Sec.7031.$,Businessand Professions VALUATION $/FT.
r - PERMIT ISSUANCE 10.00
Code:Any city or County which requires a permit to wnstruoq alter,
2 rt ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.,NO. 'ELEC.
¢ ' requires the applicant for such permit to file a signed statement that TOTAL Pte'
n co
w-$ he is Incensed pursuant to the provisions of the Contractor's License' ' PERMIT TO
i'
Law(Chapter 9(commencingwith Section 7000)ofDivision3 ofthe _ �7
io• 'Business and 1'rofessions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE 7� EL�C
X n-$ the basis for the alleged exemption.Any violation of Section 7031.5 ' STORIES TYPE CONSTR.
a3 � by any applicant fora permit subjects applicant loacivil penalty ALTER-DRAIN 5.00 '
of not more than five hundred dollars($5001.$500).1: &VENT- '
- O 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC GROuv RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'file Contractor's License Law does not apply to an owner of
• prOperty Who b"IId,or improve,(hereon,and who docs such Work FIXTUR ES-PER TRAP 5.00 _ 50.FT,FLOOR AREA TOTAL ACREAGE .
himself or through his own employees,provided that such improve-
ments.,a not intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200
builder will have tire - . - . .
'burden of poising that he did not build or BUILDING USE
prove for purpose ofsxle.). - INDUSTRIAL WASTE INTER, 30.00 RES IND CON �Pa Other
❑ of,as owner of file property,am exclusively contracting with ❑ 0 0 O ❑
licensed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:1'he Contractor's License Law docs not apply -
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such
projects with acomractor(s)liccnud pursuant to
theContractorsLivensLaw. SEWER-SANITARY-STORMEA.200ft/10.00
TRACT N0. PARCEL NO.
❑ Iamexem a dfS . ,B.&P. 'forms WATER HEATER W/VENT _ 6.00 `
reason ._( - _ ,
>( Ownor��]���f DI WATER SYSTEM 5.00 ACC.OATE ACC FILENO.
., `RKJRP T' ct.n RAT ION WATER TREATING EQUIP. 5.00
I hereby off rcertificate of consent to self-insure, - ZONING - ENG.SITE N0.
or a certificate Compensation.Insurance,or a certifiedcopy thereof(Seb.C.). '
Policy No. ' Company
.0 ❑ Certified copy is Imrehy,furnished FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fit ed with tire city Inspection division.
O Applicant MISC.-.' REFER TO ORD. Y [:) N� ,v0 N[
PERMIT ISSUANCE 10,00
- CERTIFICATE OF EXEMPTION FROM WORKERS'.. FLOOD'20NE " A.L.U.C.
LL:> COMPENSATION INSURANCE' PLG.CONTR. LIC.NO. PLG.
C' O (This section need not he completed if the permit is for one TOTAL - Y Q NJ Y ❑ , N[3
7) Z hundred dollars IS 100)or less.)
00 1 certify that in the performance of the work foi which this per,
LL,F mit is issued, I shall not employ any person in any thannDTV. MECHANICAL PER er so as to FEE FEE SUMMARY
O become subject to the Workcrs'Compensation Laws of California. -
Go Dat° APPlicam ALTER OR ADD TO MECH. 5.00 BUILDING "
} N NOTICE TO APPLICANT: IL he,making this Certificate OF17.. "
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply,with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00)CF.M.) 4.00
CONSTRUCTION LENDING AGENCY- AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm ther,therer is a construction lending agency for - EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT TO 100,000 B.T.U.), 8.00 .
Name N
Lender's HEATING UNIT(OVER 1
Len00,000 B.T.U.19.50 ELECTRIC �Q N
ders Name s
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 `
.• information is correct. I agree to comply With Tall city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
aboherve- authorize representatives forms c this city to enter upon the BOILER-COMP (Over 100,0000TU)SEE FEESCH: MECHANICAL
above-mentioned property for ins edion purposes. '
+ (We) agree•t0 ave, i ,nil' and keep hurmles file City of MISC.- REFER TO ORD.
C erti agar t o bib hes,ju ments, costs and expenses which CONST.TAX
m i y ccr a a•'' st Said City in-consequence of the 'PERMIT ISSUANCE 10.00
gr fl o This rt IL MECH,CONT, LIC.NO. MECH.
TOTAL TOTAL
Si to uI• pplicr o no, Or `
OFFICE COPY