18290.r, APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIF[CATION
,y,-•,
.. APPLICATION & PERMIT`
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
IllrNUMBER
s' :1! 29�
:�
PALIPPIG
ADDRESS �.o6-
0 IR'6 1
NAME; C4(ffl rtl N.O 1 D lyl,9��•
n
YIA J S PHONE
„`;Y Iy}'.(rl cY {�'�s.' F k•j�e Y� titi',�i1.1
OTY.. �'.-� „t� ELECTRIGPERMITnw i�•.".t}".?.°v f.;IFEEN
' i't - v. (_ .: .. w-a:-fY,et
PLAN CHECK VALIDATION
CON711ACTORS L-10
NAME
OUTLETS:SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
10111 H DQ C. L CTIZ' uc.rvO. -31 D
- 1
•' DATE OF APPLICATION
CONTHACTOR'S
AOO11R,,Ess q 511 Np-nJ B-S.�
VIIC ` 1Ig11' CRflpOIi gRONE 166 OSS
PPLIANCES-RESIDENTIAL - 4.00 ,
PANELS -10.00 _I;
ARCHITECT.
OR , .s
ENGINEER
' lac. NO. �
PANELS (OVER 200 AMP) 20.00
PLAN. CHECK FEE P.0 . N0µ
,
'
SIGNS TRANS. 3.00
ARCH, OR ENG.
ADDRESS
SPECIAL CIRCUIT 5.00 -
PERMIT VALIDATION {,
,.
EMP. METER OR POLE INS. 20.00 -
_
- ZIP
.•_; P�D
,I /�
1 J (�� ' 1986
r,ll
ADDRESS rG C
ADDRESS bllib AiCF 'G 61µN0[ (:i •
4 S I
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSP.D CONI' RACTORS DECLARATION
TEMP. POLE 30.00
�j'
d 1 eby affirm that I am licensed under provisions of Chapter 9
E
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect
License Class Lie. Number'
Dale - Contract.[
. BLDG, L .MEGH.-
- ❑ .❑ ❑
/ f• ♦
r • s . y
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'
DING PERM"
OWNER -BUILDER DECLARATION
-y1�8�UI
RT N F0AMAT10N,,:•+ra.y
ISG.- REFER TO ORD
1 hereby n((irm that I am exempt from the Contractor's License
Law for the following reason, (Sec. 7031.5, Boonessand Professions
Code: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit 10 file a signed statement that
he is licensed pursuant to the provisions ofthe Conlr ctor's License
Law (Chapter 9(commencing with Section 7000) of Division J ofthe
y'!j}lf[
VALUATION
$/FT.
-
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO.
-
.ELEC.
TOTAL 1�
PERMIT TO .
_ y-)
I hi Y Ip''q"'�' t;y{r rT A (a'k1E
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
OTY br4"+�e �,Gq7 PLUMBIN PERMIT y, •, ysFEE
f - '"^ 1
STOF44eS
TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars (55001.):
EA -DRAIN ER (EA.) 5.00
.O I, as owner.( the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW P E&li DE 4,0
OCC. GROUP
RES. UNITS
DRAINS -FL REA, COND. 5.00
intended or offered for sale (Sec. 7044. Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who EL, such work
himself or through his own employees, pfovided Out such improve.
1. mems are not intended or offered for sale. if, however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden Of proving that lie did not build or im-
for purpose of sale.).
13I, as owner of the property, am exclusively contracting with
-
F IXT AP I 111 5.00
AS EM- 1 I O LETS 6.00
SO, FT. FLOOR AREA
TOTAL ACREAGE
$
SYSTEM - O 4 (EA.) 2.00
BUILDING USE
HES IND CON PB OIL...prove
❑ ❑ .❑ ❑
I RIAL E IN R. 30.
licensed contractors to construct the project (Sec. 7044, Ihisinesf
and Professions Codc: The Contractor's License Law does not apply
to an owner ofproperty who builds or improves thereon, and who
N SPRINK - 1 INC 5 V.B. .00
IIAWN I RS - OVER 5 (EA. 1.00
ASSESSORS PARCEL NO.
. . '
contracts for such projects with a contractor(s) licensed pursuant t.
the Contractor's License Law.
SEWER -SA ITARY-STORM EA. Oft/10.00
TRACT NO..
PARCEL NO. ,
❑ lam exempt under Sec. .B.&P.C. for this
WATER HEATER W/VENT 6.00
rens..
Owner Dote
WATER SYSTEM. 5.00
ACC. GATE
ACO. FILE NO.
WORKERS'COMPENSATION DECLARATION
WATER TREATING UIP. 5.00 _
te. of insurance,
I harcby ale of that 1 have a ce Compensationor a certified
co a c hereof to of Workers' Compensation Insurance, or a certified
copy thereof( Sec. "' --
ZONING
��
ENG. SITE N0.
�\
��-
Co pang
Policy No. Company
_
-
FIRE SPR INK
- Y ❑ N❑
ENERGY T-]4-�
Y ❑ No
furnished. ?
❑ Certified copyisI, filed
O Certified copy is fled with the city inspabms division.
Applicant
MISC.- REFER TO ORD.
•
CERTIFICATE OF FXEMPI'ION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.O.
PLG.CONTR. LIC. NO,
PLG.
TOTAL
COMPENSATION INSURANCE -
(This section need not be Completed if the permit is Iia one
Y❑ NEI
Y❑ N❑
:.' hl '11-1,•'•- Wit," !'
OTY � b` MECHANICAL PERMIT /�v 4$2 FEErf'
g, ..,) ,fir xa lr s j' .RtA�
'
*"sk'� ± '.
- : ,' h -FEE SUMMARY s
hundred dollars IS 100) or less)
that in the perfonnanu• of the wm for which this per
1 is issued,
mB is simd, I shall nm employ any person In ly ,manner so as to
been ne ss bl ttgthe Workeri Pe tun s (Coliforms
Datc_1.�.k yap_Apphcem Il\._11
NOTICE IO APPLICANT' If, a0u a H (. r Ica r of Ex -
BUILDING
- ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
'
.notion, you should berome subject to the WmkCrs' ComPensatkm
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall he deemed revoked,
FEE
AIR HANDLING UNIT (TO 10,000C.F.M,1 4.00
AIR HANDLING UNIT (OVER I0=C.F.M.) 6.00
SEISMIC FEE
'
CONSTRUCTION LENDING AGENCY"
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permiLis issued.(Sec.
3097, Cie C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 6.00
HEATI NG UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
Lender's Name
Names
Lender's
• I certify that I have read this application and stale that the above
information is correct. I agree to comply with all city and county
/ndmances and slate laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER- COUP 13 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP [Over 100,000 BTU[ SEE FEE SCH.
MECHANICAL
Uereby auomrize representatives of this city to enter upon the
- above mentioned property for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
:.
(We) agree to s4v indemnify and keep harmless the City of
upe rano o alnsl Ila dies, judgments, costs and expenses which
"I m a y way'at a against said City in const µhence of the
II ingo 1 f n't
1 S_ D
SiR lure .(Applicant/Contractor Date
PERMIT ISSUANCE 10.00
MECH. CONT. LIC. NO,
MECH,
TOTAL
a f .TOTAL"r.`;
INSPECTOR COPY