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12325 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION - PERMIT NUMBER aUILOINc APPLICATION & PERMIT' ' �•- ADDRESS ' h BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 12325 4,/, OWNER'S lJPLAN CHELK VALIDATIONNAME R6b DTV. ELECTRIC PERMIT FEE: .. PHONE caRs NAMEME ,OUTLETS 10.00/1.00 6 ChJV ua No. � LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S g�N� APPLIANCES-RESIDENTIAL ;'.4.00 t. ADDRESS -5 �f�(APIIONE '�� PANELS - ` 10.00 DATE OF APPLICATION ARCHITECT pANELS'(OVER 2 O�AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER • uc.No. SIGNS TRANS. 3.00 AllH.OR ENG. - SPECIAL CIRCUIT - S.00 PERMIT VALIDATION ADDRESS zlp EMP.METER OR POLE INS. 20.00 _ ) APPUCANrs MOTORS SEE FEE SCH. fj. l/.�.o,•',� — ADDRESS •• ' SERVICE CHANGE', '20.00 D -,-2 LICENSED CON'IRAC'1'ORS DL'CLA RATIONP,eJv.. < u 1 hereby affirm that I um licensed under provisions of Chapter 9 gni ISSUANCE DATE _ N a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H Professions Cso and Vny license is in full fuber r�yy An L ❑ © ❑ z0 License Clas _Lie.Num _k5—�� 9 w Date Cmuraotor_ of cuo"a6 BUILDING PERMIT ¢ S, w OWNER-BUILD17R DECLARATION ' INFORMATION w0 u H I hereby affirm,that I am exempt from the Contractor's License MISC.— REFER TO ORD ' - H O a Law for the following reason.(Sec.7031.5,Business and Professions _� MALUATION SIFT, F _ PERMIT ISSUANCE: - 10.00 la Code:Any demolish, county which regairesap rioromeonsuance,also c ¢ 0 o improve,demolish,or repair any structure,prior o its issuance,also ELEC.CONTR_; D LL rl'llalfCS LM1E apphCanl fOr SIICh pCtlllll tO PIC a SIg11Cd SIBICmeN that , TOTAL V( / PERMIT TO n w 9 he is licensed Reinstall to Ilse provisions of the Contractor's License HiQLaw(Chapter 9(commencing with Suction 7000)of Division 3 ofthe 0" 4 o Business and Professions Code)or that he is exempt therefrom and CITY. -.PLUMBING PERMIT FEE the hasis for the alleged exemption.Any violation of$ection 7031.5 STORIES' TYPE CONSTR. s- by any applicant for a permitsubjects the applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.)'5.00 of not morc'than five hundred dollars($500).). ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the,structure is not intended or offered for.sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cade:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sd FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments arc not intended or offered for sale. mprove-mentsurcnotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS' 6.00 or improvement is.sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- provefor purposeofsale.): INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar ❑ I,as owner of the property,lull)exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-t INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:I'lie Contractor's'License Law does not apply to ml owner of property wllo builds or improves therron,and who LAWN SPRINKLERS (EA.I, 1.00 - cammets for such projects with a eonlraclon s)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 ' TRACT NO. PARCEL NO. ❑ I mm exempt under Sec. .B.&P.C.lilt tiles WATER HEATE 1986 6.00 • reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPF.NSA'I''ON DECLARATION WATER TREAT5.00 I hereby affirm that I have a certificate of consent tO saelf-inaare, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance;or ecertified copy lhereof(Sec.3800,Lab.C.). Policy No. Company Cl Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z-Z [I.Certified copy is filed with Ila city inspection,division.. REFER TO ORD. Applic:ur _ MISC.-t w Y ❑ IN V ❑ N 2 CERTIFICATE OF ExEmp rION FROM WORKERS' PERMIT ISSUANCE 10.00 Q — FLOOD ZONE' A.L.U.C. LUQ_ COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. /!T/Z' Y❑ NE] Y ❑ N❑ CL 0 (This section need not be completed'if the permit is for one TOTAL kU1 Z hundred dollars IS 100)or less.) - U O I certify that in the performul cc I f the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL J. mil is issued,I shall not employ ny erson in Fly manner so to U becogq sliyyct�j We Workers'Ci 1 w 0 aft y 1) c.(,/ -t g "Appllcum c ALTER OR ADD TO MECH. 5.00 BUILDING } US NOTICE TO APPLICANT: If,' I making this Celli cute o :x. 'F, Z caption,you should become SL jut. ID tm WOfkers:Compensation APPLIANCE 5.00 PLAN CHECK pr visions of the Labor Code yo must forthwith comply with FEE U such provisions or this permit sh II c deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 - _ CONSTRUCTION LIENT]NG AGENCY Is AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEI SMIC FEE I hereby affirm (hal there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued ISec.. .MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) . 8.00 Lender's Name t Lender's Address _ HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 3 f" I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �, .. information is correct. I agree to comply with all city and county PLUMBING /U ordinances and state laws relating to building construction,and BOILER-COMP(3H.P.Dr100,000B.T.U.) 6.00 hereby, t,sorize representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL above a tinned property for inspection purposes. _ (We) a Fee to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cuperto age i t liabilities, ' gments, costs and expenses which - - PERMIT ISSUANCE 10.00 CONST.TAX any in ny w accrue ug 1 mill Ci ly.in consequence of the grnmin• f lies Rall. r MECH.CONT. LIC.N0.'- - MECH. TOTAL '. TOTAL �3 _ ig I ire n A nl/ ntr Date - ' OFFICE COPY - -