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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BAI ' POINT PEN ONLY
BUILDING PROJECT I OENTI FICATIOI.
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
6234
BUILDING
$
M41]5
OWNER'S
NAM 45TEa {OZ
PHON
� s C L C T
LtiCTRICP.ERMt PB
) i Fy. d:Y .y1. • •Y^.}6'f". .F al! ..
ROW,
PLAN CHECK VALIDATION
CONTRACTORS 1
OUTLETS - SWITCHES - RECEP 5.00/1.00 3 01
c. No. Q
LIGHTING FIXTURES 5.00/1.00 _
CONTRA oRs
DRE 1
PPLIANCES-RESIDENTIAL 4.00
5.00
JPANELS
DATE OF APPLICATION
ARCHITECT rII' ^ /1A/
ENGINEER {A/ Ii
uc. No.
SIGNS 6,UO
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
aoo 'Ess ERG.
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 15.00
ZIP
APPLC ANT
ODRE55
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
LICENSED CON TRACTORS DECLARATI
1 hereby affirm Ihat I am licensed under pruris' of Cha pt r 0
Icommrnring with Section 70001 of ❑ivisi.m 3 BuSIR, anJ
n) -is . l x 19 my I'; is in full fore 1 -
icenm Cls`)s (f se I Number
Dale i Clmlfae'IOr
ISSUANCE DATE
- (`
BLDG. ELECT. PLG. MECH.
❑
BINON PERMIL" �.
•. INFORMATIONS-'
N. OWN:R-BUI L11IR DF.0
I hanby affirm that I am exempt f rt�
Lawlor the following reason. (Sec. ]0 .. tl
Code: An 't' or count I ocPERMIT
Any city y wha:h rot uiresa iit
improve, demolish, or repair an structure, prior to its issuance, also
I p' Y
requires the applicant for such permit to file a signed statement that
+�s'fif+
MISC.- REFERTO ORO
ISSUANCE 6.00 `
VAL, AT,O ,-
�� r•..,
- $/FT.
net{�"
ELEC. CONTR. LIC. N0.
ELEC.
TOTAL �Q 6
-
he is licensed pursuant to the provisions of the Contractor's License
,
CITY: - PLUMBING PERMIT ' . - 'FEE':
Law l Chapter 0(commencing with Section 7000) of Division 3 of the
Business and Proe,,mms Code) or that he is exempt therefrom and
eWr e
STORIES
YPE
the basis for the alleged exemption. Any violation.) Section 7031.5
by any applicant for a permit subjects the applicant toa civil penally
.f not mare than five hundred dollars ($500).)
4NSTR.
ALTER -DRAIN -WATER (EA.) 4.00
❑ 1, as owner of the property, or my employees with wages as
[tie it sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044. Business and Professions
Code: The Contractor's License Law does not apply to an owner of
properly who builds Or improves thereon, and who does Such work
himself or through his own employees, provided that such improve.
ments are not intended or offered for sale. It, however, the budding
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
�.
RES, UNITS
DRAINS -FLOOR, ROOF, AREA, GOND. 4.00
FIXTURES - PER TRAP 4.00
SO, FT. FLOOR AREA
avey
TOTAL ACREAGE
GAS - EA. SYSTEM - I INC.4 OUTLETS 4,00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not builds ins -
prove for purpose of sale.).INDUSTRIAL
❑ h as owner of the property, am exclusively contracting withQ
GAS - EA. SYSTEM -OVER 4 IEA.1 100
.
fiuILDING sE
RES IND CO PB Omer
11 El
D
WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
...tracts In, such projects will%a c.ntmctons) licensed pursuant to
the Contmoors License Law.
SEWER -SANITARY -STORM EA. 200ft/8.00
TRACT NO.
PARCEL NO.
❑ I am exempl under Sec B.&BC, for this
ca\l)n
WATER HEATER W/VENT 4,00
Owner -,� Date
WATER SYSTEM 4.00
ACC, DATE
ACC. FILE NO.
WATER TREATING EQUIP. 4.00
WORKERS'COMPENSATION DECLARATION
1 hereby altum that have a cenjficate of consent to sel&insure'
UT a rCflll ).ale UI WO IS CO Sa11Un Insurance. Or a certified
ZONING
ENG. SITE NO.
Lupy
I.ah_policy'cop'
_❑
FIRE SPRINK
Y ND
ENERGY T44
YD NDXEMPTION
he - ed.
❑ t e city inspection division.
Applic
MISC.- REFER TO ORD.
W��FROM WORKERS'
PERMIT ISSUANCE 6.00
FLOOD ZONE.NSATION
PLG. CONTR. LIC. NO.
PLG
TOTALhndrOr
INSURANCE
be completed if the permit is for one
Yfhot
"a 1D,e y-. Y -i' - -. - .'
\T `+;:`r 1 't 7 a '-'4
>�. T a k q'MECNANICAL- - 1,T, .r B 'S x„FQQS.+
-
-
fKN �"t) BUMBfUNY
-
.
less.)
I certify that in the performance .f the work for which this per.
Ont is issued. I shall not employ any person in any manner So as to
become subject to the Workeri Compenwtion Laws of California.
I3mc ApplicantALTER
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
BUILDING
3 3
OR ADD TO MECH. q,00
APPLIANCE 4.00
PLAN CHECK
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code. you must forthwith comply with
such provisions or this permit shall be deemed revoked.
FEE
AIR HANDLING UNIT (TO 10=C.F.M.) 3.00
AIR HANDLING UNIT (OVER 10=C.EM.)5.00
SEISMIC FEE
CNI
CONSTRUCTION LENDING AGENCY
1 hereby atfinn that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work I'or which this permit is issued (Sec.
3007, Civ.C.L
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 4.00
HEATING UNIT (OVER 100,000 B.T.U.P.50
ELECTRIC
/O 6
Lender's Name
Lender's Address
I eerily that l have read this application and stale that the above
VENTILATION FAN (SINGLE) 3.00
information is c rrecL IIre to comply with all city and county
ordinances a late I s relating to building construction, and
PLUMBING
BOILER -COMP (3 H.P. or 100,000 B.T.U.) 4.00
1301 LER-COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby au U ze re se atives of this city to enter upon the
above -m• T to a for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
(W t a in I' and keep harmless the City of
Cup 1j mems, costs and expenses which
m' I ind said City in co sequence of the
PERMIT ISSUANCE 3.00
MECH. CONT. LIC. NO. MECH.
TOTAL
_
TOTAL'
n 1
C //
icant/Contractor ate
OFFICE COPY