C 6266I T 11i I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION F
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BUILDING APPLICATION & PERMIT
ADDRESS
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OFFICE COPY
BUILDING - ELECTRICAL- PLUMBING - MECHANICA
��UMBER
6266
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... THIS
AME
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QT1 '-ELECTRIC PERMIT. 4 "F&'
'tl
PLAN CHECK VALIDATION
CONTRACTOR S
NAM
LIC. N..
JOUTLETS -SWITCHES - AECEP 5.0011.00
ILIGHTING FIXTURES 5.0011.00
CON TRACTOR S
CON
APPLIANCES - RESIDENTIAL 4.00
5.00
PHONE nn-
DATE OF APPLICAT I ION
OAFICHRTTECT
, NGINEER LIC. .0.
-PANELS
SIGNS 6.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
A.URARCH E.SR OENG.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 15.00
zli,
All
APPLICANT S
ADDRESS
MOTORS SEE FEE SCH.
SERVICECHANGE 10.00
43
LICE,NSED CONTRACTORS DECLARATION
1 hereby .1finn that I an, licensed inuhr om,mina, of Cli.,tvr IT
(commencing with Saturn 7000) cif Division 3 of the Business and
lindflimons Cunic, And my far". is III fall force and iquat.
Liaroa,Cb,s Lie. Number
D.I.-Ciantra,w,
ISSUANCE DATE
ELECT.
PLG. MECH.
Vji,-iV"BLIIL!OING PERMIT i
�INFOFIII,114TION
OWNER-BUILDERD17CLARAIVON
I brueby alum Out I Sri, exempt hour tirvC.Ruiuctin" License
Law for the fallowing .1kRiving tv.surn. (See. 7031.5, Business and professions
Code: Any city or county which requires a permit to construct, alter,
nuip,.ic. demolish, ., repair any spactrare, prior to its bi.aaa. at,
requires [lie applicant lot such puniiii in file a signed stulcracru thal
II e is licensed pursuant to the provisions of the Contracru's License
.w (Chapter 9 (cinumerrop, wars ection 7000) fDivi,uu' 3 .1 tire
L Businessand Professions Code) rurdiat he sexempt therefrom and
the basis for the divited c.eniptitur. Any vnialical .1 Sawn 7031 $
IMISC. - REFER TO ORD
PERMIT ISSUANCE600
.
VALUATION
SIFT
ELEC. CONTH. LIC. NO.
ELEC.
TOTAL
P ERMI
Tb.�L
....... 'c", ,s," a
QTY: or; -'�74V,gZPLUMBING
1-,� i IN, K1, R
STORIES
TYPE CONSTR.
by at,, applicant for a permit subject, tire applicant to a civil ,,,all,
of not more than live hundred Jollun (11500f):
ALTER -DRAIN & VENT -WATER (EA.) 4.00
El 1, as owner of the property, or my employc%will, wages a,
their sole compensation, will do the work, and the s ruclure is riot
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
-
DRAINS -FLOOR, ROOF, AREA.COND. 4.00
-
mended or rafiird For sale tSa. 7044. fhisln,,s and Pnifie"i...
Code: The Contractor's Lvap,,c Law on,, nal apply to an owner W
FIXTURES - PER TRAP 4.00
SOL FT. FLOOR AREA
TOTAL ACREAGE
.. ipr,ty w1ur bond, orimproves,aves thrucon. and does such work
property
linuielf or through his own can,hobo , ,in, idcd Ifiat such I ....... ),c -
Rivals arc not intended or .11v,ed for sale. If, however. the buRdira,
GAS -EA. SYSTEM - I INC. 4 OUTLETS 4.00
mau'Ruve ... cut is sold within unt, year of completion, tirewic -
builder will have [lie burden of proving that he did not build or in�
prove for .Ruise of sale.,
0 1, a, owner.1 tire 'N.p'n, ant ... lu,ii,ly contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 1.00
BUILDING USE
RES IND PB 00...
❑ E] El El
- INDUSTRIAL WASTE INTER. 20.00
licensed c .... Im't.. In au'l'u'l III, project tsa7044, 1Iu,ia,,v
and Prod'visvi,us Cod,; The Can merit's I -recuse Law rise, mol apply
to an owner of propcoy who builds or improves dercon, and who
LAWN SPRINKLERS- I INC 5 V.B. 5.00
-
LAWN SPRINKLERS - OVER 5 (EA.) im
A5SL55Ur MHCkL NO.
contracts par such pv.jats will, a ann,orow li,cowal pursuant I.
tire Con I ... in,', laan, Law.
SEWER -SANITARY -STORM EA. 20014/8.00
TRACT NO,
PARCEL NO.
0 Ion c.cropt for this
reason
WATER HEATER W/VENT 4.00
Ow.cr Date
WATER SYSTEM 4.00
ACC.DATE
ACC.FILENO.
WATER TREATING EQUIP. 4.00
WORKERS'COMPENSATION DECLARATION
I hemby of firm that I have a certificate of consent poscir-m'unc,
or A arld.c.l. of Workers' C ...... cosainal Insurance. cur a "Ripi,r]
ZONING
ENG. SITE NO.
eLpy thereof (Svc. 3HOU, Lai) C.).
P.lic,N..-Con
Cl CcrktIn cup, is I I
0 Ciy ji'dL"Y' it lion
ApiIlio:A
FIRESPRINK
Y ❑ N❑
ENERGY T-24
Y Lj NL]
MISC. - REFER TO ORD,
11171CA[FOF EXEMI'llON FROM WORKERS'
PERMIT ISSUANCE 6.00
FLOOD ZONE
A,I_.U.C.
CO�PENSA 6ON INSURANCE
(This ectiour need nW be com,leled it the Permit is for or,
y ❑Y
❑r
PLG. CONTH. LIC. NO,
I
PIED,
TOTAL
OTY' �
La: A;
akla
f�l I; 'IFP' 1,
'10 41FE
-��) E ,
.......
q-
�4,W SUMMARY
hundred d.11 ... IS 100) or, less.)
I evilly far in III. cUl.ru .... ve .1 fire work for hi,li this Per-
mit is issued, I shall "or corpl., any Person ons amyl so., 1.
be,umv,ulaat 1. tire W.RkvR'C.aNpC,Oafl.p Law, fC.lif.,ni,.
Dane-A,micaul
NOTICE '10 APPLICANT': 11, alter making thisCerlit!"re .71-7
BUILDING
/
ALTER OR ADD TO MECH. 4.00
ANCE 4.00
APPLIANCE
PLAN CHECK
FEE
eniption, you should become hubjeel In the Workers* Cuililivinsalson
provisions of [lie Labor Code, you must forthwith comply with
such provisions or this perani(strall be deemed revoked.
AIR HANDLING UNIT (TO 10=C.F.M.) 3.00
AIR HANDLING UNIT (OVER ICIAMC.F.M.) 5.00
SEISMIC FEE
CONSTRUCT ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 2.00
tire perforouna of tire work for windi this pernip is issued tSee.
3097, CR,C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name
Leader's Addle,
HEATING UNIT (OVER 100,000 B.T.U.17.50
ELECTRIC
I certify that I have read this application and star, that tire above
VENTILATION FAN (SINGLE) 3.00
information is corral. I agree to comply will, all city and county
ordinances and state laws relating to building construction, and
PLUMBING
LER - COMP(3 H.P.or100,0008.T.U.) 4.00
BOILER -COMP (Over 100.000 BTU) SEE FEE SCH.
MECHANICAL
,'ucrvlby antionve representatives or this city 10 enter Ilion the
. ..... city for inspection purposes.
MISC. - REFER TO ORD.
(We) agree to save, indcaully and keep lariness the City of
IsTWvp against liabilities, pubruents. Costs a'.. ex.......v v wi.Lu
in try , y ., roc
,a. f Zg
Lop.ir . said City in ansecuence of the
CONST. TAX
PERMIT ISSUANCE 3.00
MECH.CONT. LIC. NO, MECH.
�4 ?141eet-a41
Nal -/ -8
TOTAL
In, .1 A,,Ii,.RUCmRua,I., Date
OFFICE COPY