Loading...
13946(APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 1361 LD1 NG PROJECT 1 DENTI FICATION APPLICATION &PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 13946 aDILDING ADDREaS �ES,��,GC T nL 4- OwNEIi'S NAME OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE DATE OF APPLICATION CONTRACTORS �^�� , � X-Ag41C Iw. UTLETS- SWITCHES -RECEP 10,00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS aooR u BGAIS�fCe'/�N^ ( //II I.APPLIANCES 4.00 PANELS 10.00 �PH ONCHCH E�� � CA r& 6 V Vo PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.F NO. SIGNS TRANS. 3.00 LIC.No. ARCH. OR ENG.- ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 SEE FEE SCH. t ZIP ADDRESS APPLICANT S20.00 / 1 SERVICE CHANGE 20.00 ` •�1 :ISSUANCE DATE LIC17NSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, 1 I y ansa is in full for License Ch ✓ Lic. Numbe BLDG. ❑ ELECT. PLG. MECH. ❑ ❑ Date Contmcm BUILDING PERMIT INFORMATION p/J,s, I OWN .R -BUILDER DECLARATIONAt c 1 herebyaffirm that 1 am exempt from the Contract rTss'Clemse P Law for the following mason. (Sec. 7031.5, Business ad Professions Code: Any city or County which requires permit to conSUUCL.Im" 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 Contractor's License MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. N0. ELEC. TOTAL RMIT,TO QTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section7031.5 STORIES CONSTB. ALTER -DRAIN -WATER IEA.) 5.00 byanyapplicant foraperrnit subjects the applicant to a civil penalty of not more Ihan five hundred dollars (5500)): ❑ I, as owner Of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds Or improves thereon, and who does such work F IXTUR ES - PER TRAP 5.00 s0. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building GAS-EA.SVSTEM-11NC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that be did not build or im- prove for purpose of sale.). C11, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB 00R, ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCE L 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 contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. EE I am exempt under Sec. _ .B.&P. C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 PCC. DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofcomenl to self -insure, or��77 certi(icafe 0' Workers' COm ensation Insurance, or a certified 99�1TTrwwl99S3f„X�TT�d RROmpan, �i3�.lG i!✓Q cylyytl 4i mtdS$;,d'os ZONING ENG. SITE N0. ❑ ertl led copy is hereby famished. hereby CertjfJ}y f lad i e c'ty inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T24 V' [D N E] MISC. - REFER TO ORD. CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG, CONTR, LIC. NO, PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y❑ NE]Y❑ ry❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (4100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ uny person in any manner w as to BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate Of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shut be deemed revoked, APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4,00 AIR HANDLING UNIT (OVER 10l00DC.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, CIv.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC a Lender's Name Lender's Address I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county ordinances and slate laws relating t0 building construction, and BOILER-COMP13 H.P. or t00,000B.T.U.1 6.00 PLUMBING BOILER -COMP (Over 101)X10 BTUI SEE FEE SCH. MECHANICAL hereby authorize representatives Of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Capetian against liabilities, judgment Ats and expenses which may an way aceme age' y in consequence of the gra ing Of 1 Is pllmiL PERMIT ISSUANCE 10.00 EACH. CONT. LIC. NO. MECH. oCL�Ot� O TOTAL TOTAL Signature of Applicant/Contractor Dale OFFICE COPY