14375 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• `BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
tan-.1NG S_Z,%U UtSJL1-&z- /lei APPLICATION & PERMIT 14375
ADDRESS ��� s" 0
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S HY PLAN CHECK VALIPATION
"N vIE � `�"""�- r1'�e'C'T. � CITY. ELECTRIC PERMIT FEE 2
G�S� Vu X11_ -2./'Z
CONTnaCTOP 5
rvAM ����r
� `q- V OUTLETS-SWITCHES-RECEP 10.00/1.00
cK�ri Q(, I'�' allo. LIGHTING FIXTURES 10.00/1.00
_.!. ADDRE1S,S1roes 9fiI Lo /S� ( APPLIANCES-RESIDENTIAL 4.00
VD W ekt- ,Q( t QC"\O PHONB_12 74 -I PANELS 10.00 DATE OF APPLICATION
ARCHITECTon PLAN(OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.N0.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT Vqu.DATION
ZIP EMP.METER OR POLE INS. 20.00 in
APPLICANTS MOTORS SEE FEE SCH. FFI 7 '•s' I•�I
ADDRESS
�Illrta�'a
SERVICE CHANGE 20.00.
Oai
Foo LICENSED CONI'RACTORS DECLARATION _ Cllj (]fl'jn0,11no
rt u LI I hereby Alinal that I and Ii ce RN.d under prav'o ions ul Chupler 9 i ISSUANCE DATE
wan (connnneing with Section 7000)0l Dirision 3 of the liusineas and BLDG. ELECT. PLG. MECH.
F w i 1'rolessions Cole,vW my licenseis in full lurc
o iml fll+n. El El El z - License s_ Li..Number !J.!l!
4„ a�l DaeCllncmnrannrN
7.- Ft-t-Sch.�:ti
BUILDING PERMIT
¢ R w ¢
OWNER-BUILDER I1
ER 1iCLARA""PION
D A u INFORMATION
g A.N 1 hereby nflllo that I and exempt Iron the Contractor's License MISC.- REFER TO ORD
a0 ¢ Lew for the foluwinrcown.lSea.70J L5,Bmincssund l'roiaaions VALUATION SIFT.
H _ 1, PERMIT ISSUANCE 10.00
3 � > E Code:A,deouy nr countywhichieh rttpurrsu p an In it,luV ueL nheq r ./T
IL M ¢O improve,tlmnolish,o.repair any slmcturt',prior to IIs iasu'ana•,also ELEC.CONTE. LIC.N0. ELEC. 1 � J
u y Oo w requires the applicant for such permit to lilt a signed slarenllml ilial TOTAL PERMIT TO
w es In he is licenmd pal snout to the pnmuma at the Contractor's License IA/�I_I?_�,
rzQ L..(Chapler 9(eolRmcncingveth Scow,,7000) f DivO,.R 3 of lite _
4 0 Business and Professions Code)or that he is csaupl lheadronl and OTY. PLUMBING PERMIT FEE •��'�, '-
n I- o The basis fur The alloyed exemption.Any ululation at Section 7031.5 STORIES TYPE CONSTR.
u ; m by any appinanl l'ur a permit subjects lheapplivant In a civilpenully ALTER-DRAIN -WATER IEA.) 5,00
DI not entre than lis.hRGd.sd dollen(15001.1:
0 I,a owner ul the muPrt,or RRcnlployvos with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC,GROUP RES.urvITG
their sole colnpen,i lion,will Ju the wolk-mal the Structure knoll
Bended Dr nlfimd for sale (Sec. 70-44, Bosine,, and Pr.e,,mns DRAINS-FLOOR, ROOF,AREA,COND. 5.00
Code:The Contractor's License Law Hues not apply m an ov4ner ui
properly who builds or inpruvcs ticreon,mud who Jou Such work FIXTURES-PER TRAP 5.00 so.ET.FLOOR AREA TOTAL ACREAGE
•
himself or through his own employees,provided Ihm such intpnnc meaRrHenol intended orolleed lorsale.if,however,the buildinh GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvcmenl is sold within ane year of con,letiun, the owner- GAS.EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING LDWG USE
builder will have the burden of pruvng That he did not build ain+ RES IND CON PR Omal
prove for purpox of sal4.l' INDUSTRIAL WASTE INTER. 30.00
U d as nwner of the p.struct he exclusively. 7044,IIU with ❑ ❑ ❑ ❑ ❑
licensed .omnnurs to nn¢Irun the project(See. 7044,If usincss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code: The Contractor's License Low dues mol apply
to an owner of property who builds or Improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts tar such projects with a contrxnor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200h/10.00
The Ccatin,im s License law. TRACT NO. PARCEL N0.
❑ tont exampt under Sec. ,B.&ItC.li+r this WATER HEATER W/VENT 6.00
rcusol
Owner Dae WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W0RKERS'C'OMPI'NSA IIUN ULCLARA'I[ON WATER TREATING EQUIP. 5.00
1 hereby of larn that I have a certificate of consent to xil'-inwrc. ZONING or a certificate of workers'Co iperoutiun Ilnll.unce,or a cerlilied ENG.SITE NO.
cup,thercol(See.3800,Lub.C:.). -
Policy Na.- I any
❑ C J.s ",'I, by lumlal'ud' FIRE SPRINK ENERGY T@4
Z 2 eWC
led wish the city' ilnpc.no" Jiv'niun.
At +0 a MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
~ OfPERMIT ISSUANCE 10.00IiXG, ION IBOAI WORKP:It S' FLOOD ZONE a.L.0 C.
W , ('Phis Section and all( be 1'`ON INSURANCE
lea iR Aif the i'perwil is for one PLG.CONTR. LIC NO. TOTAL Y❑ N❑ Y ❑ N❑
ao
2 handed JU I Wn I S 100)ul less,)
U O 1 ...lily mut in the perfunnnn.c uI the work fur whirl this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ F nit is issued.I shall Put employ any Pcnvw in any'IR:nner SO v m
Ow become subject m the W.4,,,'Compensation Lows al CAduania. n K 1
y Dam Anphcum ALTER OR ADD TO MECH. 5.00 BUILDING I IL Y
} m NOTICE TO AVPLICAN'I': Il,aNcr muting Ibis C,Rifi.me of I.,-
rZ enption,you should hecumc s.Ijen to the Workers'Cwnpensatiun APPLIANCE 5.00 PLAN CHECK
laoUsioro of IIIc Labur Cole, you nand IuIIIIA011 conli ly with FEE
U such provisions or this permit shall be decined revoked. AIR HANDLING UNIT ITO 10=C.F.M.) 4.00
CONSTRuc riON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F,M.) 6.00 SEISMIC FEE S
I hereby affinu ilial there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perlimmnce of the w.,k far which this Penni) is iasucd(Sc,. MICROFILM
3097,Cie.C.), HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Nam, H EATI N G U N I T I O V ER 100,000 B.T.U.)9.50
Lender's ELECTRIC
I cenily that l lime nvd this application a RJ slate that the above VENTILATION FAN (SINGLE) 4.00
�,• advol,al ion is correct. I agree to comply wish all city and county' PLUMBING
ordinances and slate laws relutiny to building construction, and BOILER-COMPI3 H.P.or100,000B.T.U.) 6.00
hereby authorise rcp..senwtives of tltis city ro cn', upon Ibe BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
abovo-n.enlar eJ,.upon,for p,pe,I ion purpox'.
tWel agree la sac., indemnify and koop 1,NUIeu lh. City m MISC.- REFER TO ORD.
'upcnin. ,,,act IloblhllCa,iuJgmauls, ense and cspenacs a'hldl PERMIT ISSUANCE 10.00 CONST.TAX
in any ay :cru, agar ns l"said Cit' in colt-, n" oI the
cunt F TI a pal til. MECH.CON.. LIC.NO. MECrs.
/y�}�� _ coral. TOTAL
�� Ipna re of dpplieanlll n .sant. U:ne 11
OFFICE COPY