C 8202�`APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
OFFICE COPY
BUILDING ELECTRICAL- PLUMBING - MECHANICAL
C -A202
AD on "
C. Los
ELECTRIC PERM 'FEE:As
DATE OF APPLICATION
CONTRACTORS
2VU4,06II&O671,�,1�!5
APPLIANCES - RESIDENTIAL 4.001
PANELS 10.001
ARCHITECT
OR
ENGINECR
RAN ESLST (OV E� 200 AMP) 20.001
PLAN CHECK FEE P.C. NO.
ARCH . OR ENG.
ZIP
5.00
PERMIT VALIDATION
LANCE DATE
TEMP. METER OR POLE INS. 20.00
APPLICANT S
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
I hereby offiom tit., I in licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
TEMP,POLE 30.00
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License
Code: Any cilyorcounly which requircau permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed Pursuant to the Provisions of the Conpractur'� Lianse
Law (Chapter 9 (commencing with Section 7000) ofDivision 3 ofthe
Business and Professions Code) or that [to me.cropt therefront and
the basis for tire alleged exemption, Any violation ol Section 7031.5
by any applicant for a permit subjects The applicant too Civil Penalty
of not more than five hundred dollars (S500).):
0 1. as owner 0 f the property, or my employ.s will, wage, a,
their to conipeme lien, will do the work, and the stiocton, is not
intended or ffe'o d to, sale (Sec. 7044. Bmsinesi undaProfc,,imn,
Code: The Contractor', License Law does not app y to n owner of
property who , oulds -1 411111.1cs thereon. and .110 does such wcok
himself or lbio.gh hon own empficyt,", Provided that 'Dol unp,.�r-
Trem, are not intended or offered for Sale. If, however, the building
1 ropravement is Sold within one year of completion, the owner.
older avJI have the burden of proving that he did not build or in.
prove for purpose ofsalc,),
0 1. as owner of the property, am exclusively contracting with
licensed contractor, 1. construct the project iScc. 7044, Business
..it P,.IcSat.D, Code: The Cm-locim's License Law does ow apply
to an owner of properly who builds or impToves thereon. and who
contracts for such projects with a ccoareetcatsi licensed pursuant to
the Contractor's License Law.
r.,..
BUILDING PEFIMIT'.��ii�',�
'5',,k' INFORMATIOIiiI
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00
ELEC. CONTR. NO.
ELEC.
TOI
PERM T TO
66_�_ I
PLUMBING PERMIT,,,A) FEEV
t
STORIES
TYPE CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 5.00
-
- BACK FLOW PROTECT. DEVICE 4,00
OCC. GROUP
RES. UNITS
DRAINS- FLOOR, ROOF, AR EA, CONIC. 5.00
-
FIXTURES - PER TRAP 5.00
-
GAS - EA. SYSTEM - 1 INC. 4 OUTLETS 6.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
-
GAS - EA, SYSTEM - OVER 4 (EA.1 2.00
BU I LDtNG USE
RES IND \CAN PS Other
El Ig 0 1:1
INDUSTRIAL WASTE INTER. 30.00
-
LAWN SPR INKLEAS - I INC 5 V.B. 6.00
-
ASSESSOUll PAHCE1. NO,
LAWN SPRINKLERS - OVER 5 MA.) 1.00
SEWER -SAN ITARY-STORM EA. 200ft/1 0.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner ])are
WATER SYSTEM - 5.00
WORK E RS'COMPENSAI ION DI'CLARA'l ION
I thereby Affirm that I have a certificate fco.s,ni to elf-insme,
or a certificate of Workers' Compensation Insurance, or a certified
copy thereof (See, 3800, Lib.C.).
13 field
A I
pp
ACC.DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO,
FIRE SPRINK
ENERGY T-24
misc. REFER TO ORD.
;� ?TIl;IC'A,1 1"1�01` EXEMPT ION 17ROM WORKERS'
(This Section need not be v ... npleted if the permit I, In, one
hundred dollars is 100) or less.)
I cerflly that in the perlorniance of the work for which this per
become subject to theWorkers'Comptusation Lawsut Calilmnia.
D.te-Applic,int
PERMIT ISSUANCE 10.00
FLOODZONE
Y El No
A.L.U.C.
Y C] NE]
'TAL
's
BUILDING
ALTER OR ADD TO MECH. 5.00
emptimn. .. Should become subject to he Workers' Compensation
such provisions or this permit shail be devoted revoked.
CONSIRUCTION LENDING AGENCY
I hereby eflinn that there is a construction lending agency for
the 1,e,f..an,c of the work for which this permit is issued (Sec.
Lender's Name
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=CF.FA) 4.00
PLAN CHECK
FEE
;704-
AIR HANDLING UNIT (OVER 10=11F.M.) 6.00
SEISMIC FEE
EXHAUST HOOD IWITH DUCT) 5.00
MICROFILM
Lc.dc,'s Address,
H EATI N G UN IT (OV ER 100,000 B.T.U.) 9.50
ELECTRIC
I clItify that I have read this applic.t ion and late that the above
information is correct. I agree to comply with all city and county
ordinances and S' ate laws reliving to Imilding construction, and
hereby authorize representatives of this city to enter upon the
at,ove-mentioned property for inspection putpose,
We) agree Us Save, indemnify and keel, harnile,s Ole City of
C'pe'lino Against Inil,fla, S, . d I I , ., and expenses which
VENTILATION FAN (SINGLE) 4.00
BOILER - COMM H.P. or 100,000 B.T.U.) 6.00
PLUMBING
BOI LER-COMP 10a., 100,000 BTU) SEE FEE SCH.
MECHANICAL
VISIC.- REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 10.00
TOTAL
�TO
OFFICE COPY