14790 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
FCHECK
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
ADDRESS 14790
ADDRESS
/C? .Te G)C'+. 'S G'� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS (1N/"T �2-2U ION
`�. NAME CITY. ELECTRIC PERMIT FEE
w n� PHDNE
ll�r/ CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
e"T-2J 4V� LIC.NO, C- LIGHTING FIXTURES 10.00/1.00
CONTRACTORS JAPPLIANCES-RESIDENTIAL 4.00
AD
%v 2 ,
PHONE cy /)�/ PANELS 10.00 DATE OF APPLICATION
ARCHITECT
PANELS (OVER 200 AMP) 20.00 PLAN CHECK 7 P. .No.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCOCII ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 .D ..
Dai
FDO LICENSELICONTRACTORS DECLARAIVIN
¢ u I hereby of firm that I :un IivenxJ un Jet,...III..m,d Chapin,`I .AA ;' 1'; - ;ISSUANCE DATE
H4 m (vontrnenaing with Section 7000)Of Division 3 of the Business and iTTTrTt•r- BLD ELECT. PLG., MECH.
r w z P ofoniaus Code,and Iny liccn,c is in full tore•and ellecl. 51.1`, m' ..❑
zo - Licnue Chess I.ie.Number 1
o z Dam Cam moot- _
C-3 �' r BUILDING PERMIT
a ¢ w `u OWNER-uU1LDI R DECLARATION INFORMATION
w3 LL F. I hereby al Grin that I am esampl tram the Coal elor's License MISC.- REFER TO ORD yALUATION $/FT.
.. o¢ Lawlor the following reason.(S,,.7031.5,Bu,in...:mJ l'mie,i.ns PERMIT ISSUANCE 10.00
Cale.Any Cily.rc.muy witchrequitesa Perm.Ito amxtRa,Am,
QQ12 improve,dcwoliJt,orrel+iran)',Iruelurv,Ptim LUTIRIaaltCe,al.o ELEC.CONTIi. C.NO. ELEC.
myuins Ilm appllcanl fur.xmh'11111111 to fill a,ignn slatnncnt 1hW TOTAL PERMIT TO
wm he is licensed putumm to the pmvuion,of 1111 Conmm«,'s Llcame
F z i
Law(Chapter`)(,x,nunen,mg with Section 7(100).,Division 3 of the �•_j�-
a PLUMBING PERMIT FEE
Business and I'nn4ssium Code)or that he is.•,nnpl Ih,ro RNn and CITY.
¢ r � the basis for the alleged escntphon.Any vlo ali.n ofSculnn 7031.5 STORIES TYPE CON$TH.
a , by any a,pli,,., let a PCRnit auhicau till appll"llt tua CIN,Paitill ALTER-DRAIN -WATER (EA.) 5.00
of not nwrc Iran]I,,hundred dullan 1S500).):
❑ I,ns oivh,r of the p'.petty,or my 1lnpluy,rs with wage.a. BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sol,compensation,will Its,the work,and the si,n1111te ie not
intended or .,fared for sale IS,1. 7044, Busts.. and Pmtesdmts DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The C.m rams', Lilnue Luw Joe.nut'JPPIY III all°wner ul
property who builds or imp..vn Ihere.n,ant whu Jne..udt work F IXTUR ES-PER TRAP 5.00 sO.P1,FLOOR AtIL. TOTAL ACREAGE
hilt... .r through bis own cmpluyvc.,pruaweJ that such ilnpro,c GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
��• menu are nal inlnnJeJ or uilvrcJ tier sale.II',huwoep the building
or impinvvinent Is.old within one year of eumplelinn, Ilw uwnet- GA$-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
build,,will Leve the burden of Proving Ileal he did net build ur in .t- RES IND CON PS Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER, 30.00 El F-1 El El El
1,as owner of the pR,II1,ly,ant esclu.aivcly conimcn,%wlth
licensed contractors to eunstmol the project ISec. 7044,liuslness LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions C'.d1:"rhe Con Oact.r',Li,en.e Law due,nu l'J pply.
to all own,,of properly who build,or imprnvm tlmrcoll.and whu LAWN SPRINKLERS-OVER 5(EA.) 1.00
contrnru for such projects will a cLRr,a.Ne)licen.u•J purutwu to
SEWER-SANITARY-STORM EA.200,2/10.00 TRACT NO. PARCEL No.
the Contractor's License Law.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner nate WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
x'ORKERS'C'OMPENSATIUN DECLARA I'ION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cerlil'idm.f 1...twul to+ell-inwrl. ZONING ENG.SITE NO.
Cr a Critical,of\Yorkers'Qnn Pcn.w ion Iluurun,e,ur a ecrtil"L
Copy thereof(Sec.3800,Lnb.C.).
Policy'No._ _ComPmp'-
O ❑ C,n:fI,W tt,i,hereby l mJ, FIRE SPRINK ENERGY T-24
z z ❑ Cerci mpy is 1111 the ury inspect ion Jivi,ioa MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
0 APPlicanL t -
♦- rn N PERMIT ISSUANCE 10.00 IC'' ---FLOOD ZONE aL.uses
UI'h:XliAll'rlO ' IWUItKGRS'
LU _ ( MPIiNSA'IIUNI SURANCIi PLG.CONTR. LIC.NO. PLG. A�
CL 0 (This ,,tion need nut be completed if the permit is tie ma TOTAL I.`7 ' Y❑ N❑ Y ❑ N❑
0z hundred dollars l S l OO)of I",J
U O 1 certify that in the perionoatice of the work lot,vhich this Per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued, I.hall ,or employ'any penin in anY mannenn as to
Ow become,ubject to the WOrkvn'Cbmno
pe ,ution Laws f CalllianbL BUILDING
Data Applicant ALTER OR ADD TO MECH. 5.00
6
to
NOTICE 1'0 APPLWAN
)CCO N,eject making this Certificate of E,
2 pyovison,YOU of should halm,subject m the WuthaO'CcomPly:Ilion APPLIANCE 5.00 PLAN CHECK
ptuvis rTs Of the Labor Code, you nmsl furlhwilh comply will FEE
U such pruvisium or tllis'11111111.hull be J.•cmed revoked. AIR HANDLING UNIT(TO 10)000GF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that Iherc is a c.,RtI.1tioh lending agency fur EXHAUST HOOD (WITH DUCT) 5.00
rte pal o,nwne, of thu will,NIP which this Permit is issued(Sc,. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
3097,CRITIC.),
Lender's Name
Lender's Addmss HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read Ihi,application and state That Il,,abov, V ENTI LATION FAN (SINGLE) 4.00
infonnaliuo i, cutrec, to w
I agree coply will,all city and c.mrty PLUMBING ;)
urdodnocs and ]tate laws telaling w building mn,Iruclinn. and BOILER-CUMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby awllnrie, n'Preuo]mivcs of this eiry 1. 1111.1 upon Il,`' BOILER-COMP 10eu,100.000 BTU)SEE FEE SCH. MECHANICAL
ob,ec-nwrawriLt property for inspection Purposes.
ewe grle tOsave m nnlly and keep harnde„ the Citr nI MISC.- REFER TO ORD.
upert t against liabihye IUJgvavh, cont, ant espen.c,which CONST.TAX
ata any W" accr a uneI said City in Cou..y....t" of the PERMIT ISSUANCE 10.00
Ira uftlu,pont a MECH.CONI'. LIC.NO. MECII.TOTAL TOTAL
N 1C/
Stgt mare r ApP In( ells/Gun Ru niyt�- 1/
OFFICE COPY