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6296 -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT P*ON4Y a BUI LDI NO PROJECT I DE TI FICATION' - '+` .~ PERMIT NUMBER r BUILDING, . APPLICATION & PERMIT 6296.^ ^ ICAL=PLUMBING-MECHANICAL B vacs bG b BUILDING-ELECTR ' awNER's- - PLAN CHECK VALIDATION ' NAME '' DTV. ELECTRIC PERMIT FEE ' L6�' CeoKr ' PHDNE 2 NOMEnncron's ' • f L' 7Q. UTLETS-SWITCHES-RECEP 5.00/1.00 / �jJ✓ - .sea 6 Z LIGHTINGFIXTURES 5.00/1.00 CONTRACTOR'S c6 •..� APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE -" c�Z .._.PANELS ' 5.00 DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 ENGINEER LIC.No.. SIGNSTRANS.' " 3.00 ARCH ENG. �• PERMIT V ATION ADDRESS CH - - SPECIALCIRCUIT '5.00 ZIP i- - EMP.METER.OR POLE INS. 15.00 APPLIT CANS_ `- MOTORS . SEE FEE SCH. ADDRESS 6 COLA il I5 Tam '. -=SERVICE CHANGE-' wO LICENSEE)CONTRALTO 5 DIiCLARATION;. r , ai I hereby affirm Alai I am licensed under provisions of-Chapter 9 A ISS CE DATE w a w (comostneing with Section 7000)of Division 3 of the Business and b BLDG. L CT -PLG MECH. H.N i Professions Code��v���',,,,,,ayyyyyyl y license rs m full fo ct _ z o w- Lmcnsc Cl+ss �qr Lic Number `�Y rEl 0, GO r w Date Contractor 1. .. - 0 i D OWNER-BUILDER R.BUILDI.R DCCLAR ON•c t ��. - B-INFORMATION IT F g -I- I hereby affirm that'l.am exempt from the Contractor's License` MISC.-v REFER TO ORD - VALUATION SIFT. I-.LL m . Law for the fogowiog reason.(Sec.7031.5,Businessand Professions pERMIT ISSUANCE .6.00 ,A> Code:Any city or county which requires permit to construct,alter, - 2 6 < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. w ¢ requires the applicant for Stich permit lD file a signed Statement that 0/'r r'�-G•�l]Imo.-.-�� TOTAL �O PERMIT TO .m he is licensed pursuant to the provisions of the Contmcm}s License "Y T�'G l�-1 fz> Law(Chapter 9(commencingwith Section70000 of Division 3 of On { F.i o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT M I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by anyapplicant]or a permit subjects the applicant toacivil penally ALTER-DRAIN -WATER (EA.) 4.00 of not mom than five hundred dollars(5500).): 0 I,as owner of the property,,or my crop[,) with wages m BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP REB.UNITS Side compensation,will do.the work,and the structure isnot .intended or offered for sale(Sec. 7044, Business and Professions DRAINS_FLOOR,ROOF,AREA,COND. 4.00 Code: I'he'Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00sa FT.PLODR AREA TOTAL ACREAGE • himself or through his own employees.provided that such inmrove- _ mems a re not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-111NC.4OUTLETS 4.00 nr improvement is Sold within one year of Completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE - builder will have the burden nfpmving.ilia(he did not build or in prove for purpose of Sale.). - INDUSTRIAL WASTE INTER. 20.00 RES IND C PB Other 0 I,as owner of the Property,am exclusively contracting witll 13 Q. 11:1 licensed CnnImCt0M to construct the project(Sec. 7044;Business LAWN SPRINKLERS+'1'INC 5 V.B. 5.00 - .ASSESS S RCEI.NO. and Professions Code:The Contractor's License Law does not apply - - to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for Such projects with a Comraetor(s)licensed pursuant to - - - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. . PARCELNO. 0 I am exempt under Sec. '7B,&1'.C.for this WATER'HEATER W/VENT' 4,00 �1.1 reason ' 'f5 Owner Dam WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO: WORKERS'COMPFNSA1'ION DECLARAt'[ON WATER TREATING EQUIP, 4.00 I'V` Creh ­ afford "'allhavc acetlilicatc ofconsent to cell-insure, ZONING or a c ' bate of Workers'fompenwlion Insurance,ar a certified ENG.SITE NO. Llpy 111, it '(Se 3800 Lab.C,-i - ' _ I rfcy N t Compan N• - ' 0 0 Cull lied Lrpy is lmrehy_lurnlxlred. ." FIRE SPRINK ENERGYT-24' Z Z Ce t 0e op Ix fl w�1 /11�m1 Ira a lion division. p rC pTiulnl��y:So'� i�r -=T'Q MISC.- - REFER TO ORD. YE] NF] y ❑ N❑ CCR1I FIC T OF IFROM -WORKERS' PERMIT ISSUANCE 6.00 W > COMPFNSAION INSURANCE , FLOOD ZOrvE A.L.u.C. - ., � PLG.DONTfl. LIC.NO. PLG. - CL CI( Phis section need not be completed if the permit is for ane TOTAL Y❑ N❑ V❑ N❑ hundred dollars IS 100)or I,,,G) 0 O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to - 0 w become suhjecl to the Workers Comperisal ion Lows of Calll'orme. a Date Applicant ALTER OR ADD TO MECH. 4.00 'BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emption,ymt should become Subject to the Workers'Compensation APPLIANCE - - 4.00 PLAN CHECK - provisions of the Labor Code, you must,forthwinl comply with FEE such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 CONSTRUCTION LENDING AGIiNCY' AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 ' the performance of,the work for whichthispermit is issued(Sec. - ,MICROFILM 3097,Civ.(:.): HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name - HEATING UNIT 100,000_B_.T.U.)7.50 - 'ELECTRIC Lender's Address r w 1 certify that I have read thisapplication and state that the above VENTILATION FAN (SINGLE) 3.00 , . inl'onnm1011 is ccRmct. I agrcc.to comply with all city and coanly PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,000B.T.U.) 4.00 here abby auove-mentioned property for inspection purposes.tllnrue representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) a rBe to save, indemnify,and keep harmless the City of MISC.- - REFER TO ORD. Caper' against liabilities,judgments, costs and expenses which - - - CONST.TAX ma n ny way accrue a in Said City in consequence of the PERMIT ISSUANCE - 3.00 nti oflihs rmiL MECH.CONT. LIC.NO. MECH. t D12 - TOTAL TOTAL S' nature ul' pplicant o raclor ale OFFICE COPY