15150 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
1 FLUILDING ___„APPLICATION & PERMIT
ADDRESS 11663 WALNUT SPRING COURT 151 50
BIOT '214 413 UILDING - ELECTRICAL-PLUMBING-MECHANICAL
°wNERg Gregory Group, Inc. PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
}� Abmanson Dev. 46mrG595-2100
NAME ncroRs UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc. LIC.NO.B-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR 9 9120-C -Twin D 1p h D WC PPLIANCES-RESIDENTIAL 4.00�6abrv �5 LrIO� PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR Aram Bassenian, AIA-A AApoc PANELS (OVER 200 AMP) 20.00
ENGINEER 88
uc.rvo. SIGNS TRANS. 3.00
ARCH.OR ENG. ��1 DD PERMIT VALIDATION
Sana Ana S.Otrlar�29�7 SPECIALCIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS - Win 0 p In r. MOTORS SEE FEE SCH.
ADDRESS
94065
SERVICECHANGE 20.00
o ac
r
02 I.ICENSI'.11 CONTRACTORS DECLARA'f1ON
Fz w 1 hereby affirm that I am licensed under provisions of Chapter 9 �LU ISSUANCE DATE
a (commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH.
Professions Code,angmy license is in full for m avfA
Date Co
Z z=a License Cie.. Lia Nmnher_ J U7 'y O �u �ln
O LA
F ntractor_
`a y s BUILDING PERMIT
ca a OWNER-BUILDERDECLA ATION o i U INFORMATION
w ; 1- I-hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u U. VALUATION S/FT.
O a Law for the following reason.(Sec.7031.5,Businessund Professions
PERMIT ISSUANCE 10.00
� w0 Cade:Any cilyorcounty which requires a permit reconstruct,alter,
194 540
re Q D improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.ND. ELEC.
La
W m LL requires the applicant for such permit to file a Signed Statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's Lieunsc
Q
Law(Chapter 9(conrmencingwith Section 7000)of Division 3 of the SFDU
E i O Business and Professions Code)or[hat he is exempt therefrom and OTY. PLUMBING PERMIT FEE
W H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e- by anyapplicant for it permit subjects the applicant to it Civil penalty WATER (EA)
of not more than five lumdned dollars($500).) ALTER-DRAIN&VENT- . 5.00 2 5NHR
❑ I,as owner of the property,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, 5.00 R-3 1
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S°.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS 6.00 marts are not intended or offered for sale.IL however,the building 3047
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM.OVER 4 (EA.) 2.00 BUILDING USE
h wilder will have the hurden of proving that lie did not build or Im
P
rove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON Pa Grid,
❑ I,as owner at the property,am exclusively contracting with . .
e 0 0 ❑ 0
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The who
buidsContractor's License Law dues not who t/
to tr owner of property who builds tr improves thereon,ruminant
who LAWN SPRINKLERS-OVER 5(EA.) 1.00 Y
contracts for such projects with a coniraclmlU licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00
23
[he License Law. TRACT NO. PARCEL NO.
lamexe
❑ lam exempt under Sec. ,B.&P.C.for this
IC ISOs WATER HEATER W/VENT 6.00 8098
Owner Dale IWATER SYSTEM 5.00 ACC.DATE ACO.FILE No.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby uffirin thin I have it certificate(it consent In self-inach,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.C.). United Pacific
Policy No. Company
❑ Certified copy shereby furnished FIRE SPRINK ENERGYT@4
Z 2 X] Certified copy is it with the city inspection division.
O Applicant g MISC- REFER TO ORD. YQ" NY NE]
CC �+ PERMIT ISSUANCE 10.00
LU - CIiRTIPICATIi OPIAX II'TINS PROM WORKERS' FLOOD ZONE A.L.U.C.
W � COMPIiNSATI(1N INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Cl❑ (This section need Dor be completed if the permit is for one TOTAL Y N� Y [] NC]
hundred dollars(5100)or less.)
U O I certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL b- mit is issued,1 shall not employ any persno in any Fulmer so as Ia
O U become suhjecl to the Workers'Compensation Laws ol'California.
Is. DALTER OR ADD TO MECH. 5.00
ate Applicant BUILDING 972.��
} IC NOTICE TO APPLICANT: If,after making this Certificate of fix-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
Provisions of the Labor Code, you must forthwillr Lvni Ply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IQWOCF.M.) 4.00 FEE /energy 62.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 13.65
1 hereby affirm that there is F construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance QQf'ti,e work for which fly loth is issued(Sec. MICROFILM
3097,Civ.C.). J C r t P C1fP1 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name �p�y�ry1- ly-f-1-r- HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address - 111 ELECTRIC 73.13
1 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 73.13
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby autilmed representatives ec this city to color upon theOK BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 73.13
above-m Crooned properly representatives
rvespof this
purposes.
(We) agree 10 save, indemnify and keep harmless [he City of MISC.- REFER TO ORD.
upertin0 against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranting of this pert ,r MECH.CONT. LIG NO. MECH. .
G TOTAL TOTAL
Signature Of App to Gourd r I Da[
OFFICE COPY