6200APP4-ICANT.'TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BU I LD ING PROJECT I DENTIFICATI ON
APPLICATION & PERMIT
ELECTRICAL- PLUMBING -MECHANICAL
BUILDING CT.RICAILl
PERMIT NUMBER
6200 -
awn -DING
ADDM ESS
00m
OWNEHS
';-.LE-TLE
j4VA.,�,;";rk4 H,rWv1
iq,
�','�ELECTFI
i-11 ,-r, "
PLAN CHECK VALI CATION
DATE OF APPLICATION
CONTRACTORS
N
&_'C LICA.,
SWITCHES -SWITCHES 5.00/1.00
012UT
LIGHTING
GHTING IXTURES 5.00/1.003c/,2
CONTRACTOR'S
ADOH ss
k104,r- PHONE
APPLIANCES - RESIDENTIAL 4.00
-
PANELS 5.00
io
ARCHITECT
09
, . NGINIEEn LIC. NO.
SIGNS 6.00
- P
PLAN CHE57FEE C. No.
SIGNS TRANS. 3.00
ARCH08 ENO.
ADDRESS
ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
ISSUANCE DATE
TEMP. METER OR POLE INS. 15.00
APPLICANTS S
ADDIZES
44A)
MOTORS SEE FEE SCH.
SERVICE CHANCE
. LICIzNSErkON'I RkTORS I)L61ARATION
I hereby all ... I that I .. licensed Code, provision, or Chapter 9
(,maunncia, will, Section 7000) of Division 3 of tire OrnimV,r, and
A F I
BLDG.
ELECT.
PLG. I MECH.
IT I So
Date I i, Number
�Inlvracunr
OWNER-BUILD1 R DECLAKA I ION
I hereby .flumina I an, exempt Iran the Contractor's License
Law for tire following reason. (See. 703 1.5, Basnessand Professions
City 01 CUPeil_
MISC. - REFER TO ORDVALUATION
e-i`CI�EIIJILOING PERMITN'1"Yx,P.
N
$/FT.
PERMIT ISSUANCE 6.00
Code Any city catamay dcbN,,UrrcSTpermit I.ecmsRucI,UII,,,
improve, dcantlish, Or repair any structure, prior to its issuance, also
requires the apidicn for such permit to III, a signed statement that iu
he is licensed pursuant to the provisions or the Contractor . s License
Law (Chapter 9(cujiinicnciiigwilliSectioit7OOO)ofD,vi,ioii3ot tire
Business and lsrolficsoions Code) or VAR lie is es
the basis for tire alleged exemption. Any violation;;f1ViWP
E EC CONT
jr 'I
PERMIT TO
-7
"` t;
0,t� XFEE,�,
'JIDth,4111
STORIES
TYPE CONSTR.
JALTER-DRAIN & V ENT -WATER (EA.) 4.00
by any applicant for a Permit Subjects the Applicant Ran Civil penalty
of not note than five hundred dollars (5500).):
BACK F LOW PROTECT. DEVICE 2.00
_OCC. GROUP
RES. UNITS
0 1, as owner of the property, or my employees with Wages is
their solecom FUTICITURI, Will do the Work, Unit the structure IS not
intended 0,offered for sale (Sec. 7044, Business and Professions
DRAINS -FLOOR, ROOF, AREA, COND. 4.00
Code: The Contractor's License Law does not apply to an owner of
property who build, or improves thereon, and Who does Such work
himself or IIRuC,Ir his Own employe", provided that such mpoT.-
nuents are [lot intended Or OHCIVd for sale. 11, however, the building
FIXTURES - PER TRAP 4.00
SO. FT. FLOOR AREA
TOTALACREAGE
GAS -EA. SYSTEM - I INC. 4 OUTLETS 4.00
offnapo"Vint,nn is old within .'TV year of Completion the Owner-
eniIde, will have the burden or proving that he did nut build or air-
prove for pull,.. .1 vie.).
[1 1, as come, of the property, am exclusively contracting with
licensed coutnelon, to COusRUCI the project (SVC. 7044, Business
GAS - EA. SYSTEM - OVER 4 (EA.) 1.00
BUILDING USE
RES IND CON PEI Other
El 0 0 El 11
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS- I INC 5 V.B. 5.00
ASSESSORS PARCEL NO.
and Professions CREW: 'Fire Contractor's Liceinse LAW does not apply
to an owner of property who builds or ilnpruves Thereon. and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a contractums) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 20011/8.00
TRACT NO.
PARCEL NO.
WATER HEATER WIVENT 4.00
0
reason
Owner Date
WATER SYSTEM 4.00
ACC.DATE
ACC. FILE NO.
WORKERTCOMPENSAFION DECLARATION
WATER TREATING EQUIP. 4.00
I hereby Alien that I base a eVniticat, III ewnserit 1. sIIINNOOV,
or a certificate of Workers' Conipcloatimi Insurance, or . V,Lifi,d
-
ZONING
ENG. SITE NO.
C .... Y theremi is 38ou I I C - I
II.Ile, No ' ec* ' C.' -a 03lA
I Cell-iredluo, is I�Iqcby ono'hed. '-wo-4
ViCc�fifiSdl copy is/riled with tire city in,peOdmi.n.
CI'R*III:ICArtiod: EXEMPTION 17RONI WORKERS'
6
FIRE SPFRNK
Y [] N[]
ENERGY T-24
Y N[3
REFER TO ORD.
PERMIT ISSUANCE 6.00
FLOOOZONE
A.L.0 C.
PLG. CONIII. LIC. NO.
PLG
TOTAL
COMPENSATION INSURANCE
I This victim, Tried not be Completed it ']TV Permit is I'll ane
Y [:] N 0
Y0 IN El
..14 ,
CITY f[,%t MECHANICAL P toIi��
ERMITf' 1p
"/FEE SUMMARY H
, �,T
hundred dull... IS I OWN, less 1
I Certify that in tire PCrIOrIIlance Of the Work for Ind, this per-
all is Mace, I shall no, Vaud., any pV ... ... in an, numanerso a, 1.
Income Subject I. tire Worker,'CIOnpeasatim) in Of California
DaRV-ApplilanI
BUILDING
ALTER OR ADD TO MECH. 4.00
NOTICE TO APPLICANT: if, After making this Certificate, of E..
cialition, YOU sloold beemin, subject to [tic Worloos'Compensation
po,vtdcans of the Lidbo, Code, you must hurthwith comply will,
such provisions or OR, Permit Shall be deemacdoRi.ked.
-
APPLIANCE 4.00
PLAN CHECK
FEE
-
AIR HANDLING UNIT (TO 10PWC.F.M.) 3.00
AIR HANDLING UNIT(OVER 1000C.F.M.) 5.00
SEISMIC FEE
CONS rRum ION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 2.00
-
MICROFILM
I hereby airno that there is ir V,Rsuii,tau, lending a,cN,y for
[tie performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
Leader's Nater
HEATING UNIT (TO 100,000 B.T.U.) 4.00
HEATING UNIT (OVER 100,000 B.T.U.P.50
ELECTRIC
LV,,dC,*, Address
I Certify that I have read this application and,late That the above
information is Correct. I agree to comply will, all City And countyPLUMBING
ordinancesand stale I..% oddlim, to building ... orceficit a., ..
VENTILATION FAN (SINGLE) 3.00
BOILER -COMP (3 H.P. or 100,000 B.T.U.) 4.00
BOILER -COMP (over 100,000 STUI SEE FEE SCH.
MECHANICAL
1,L,,by authorial represemwives or this City to enter ta,mi'Llue
x1b,av,-nientuniedpropeny In, in,pVctionpruposcs,
(We) agree to Save. indemnify and keep harmless the City of
Cripenin. against liabilities, judgments. mas and expOrCAS Which
may in any way accrue against said City in Consequence of The
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 3.00
MECH CONT. LIC. NO.
MECH.
e""Ato .i�
T!TOTAL'XvFk
t
gm' "C'not.,I
L
Uate
OFFICE COPY