17560 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
Yo°Es° �9- APPLICATION & PERMIT 7560
I� ��3 �QL)F�re� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL -
OWNER'S J PLAN CHECK VALIDATION
NAME SS 2! CITY. ELECTRIC PERMIT FEE
PIIUNE
\ CONTRACTOR"S
`- NA"'SH
E OUTLETS-SWITCHES-RECEP 10.0011.00
SHOW PLA LIC mo. LIGHTING FIXTURES 10.00/1.00
o.TR.TOR'+ ` [7���'h�.y�1 C'rl�.Z' (419 PPLIANCES-RESIDENTIAL 4.00
11 IJPQ JQQrLyyr y PHONE '���� PANELS 10.00 DATE OF APPLICATION' -
ARCMTECT PANELS (OVER 200 AMP) 20.00 -7 PERMIT
P.C.NO,
OR
ENGINEER
OC,No. SIGNS TRANS. 3.00
ARCH.OR ENG, 5.06 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
z,P EMP.METER OR POLE INS. 20.00 `
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE IO'YfF00 IO.O
0 It z /J
r o o LICENSED CON I RACI ORS UECLUt,\'P[ON J
1 u u I hereby afEnicII.' I am Incensed under p,.,wons of Chapter 9 ISSUANCE DATE
N a w (commencing,lith See'
7000)of Divis mI 3 ul lhr Business and - SLOG. ELECT. PLG. MECH.
m z P,weomus C.Jc,and Illy'license Is in lull Hrl111 W ellbel. ❑ ❑ ❑ ❑
z O m License Class Lie Nuutl,er
g z r Date Qmlractor
'^ city 0f Caper W BUILDING PERMIT
¢ Q wa O\YNIiR-BUl1dR:R DECL\RA'l'ION INFORMATION
F REFER TO ORD
u u 1 hen'by uliinu lhv I am cselnpt Imm tlm Qnvnnur:Liccnsl1PERMIT
- VALUATION S/FT.
Law for the lulluwinp moron.(Seel 7031.5,H.TsinV%aand Plot...ion, 12.
Cute:Any'city'of.oun'y which renUires a pvrinit to Ctvell.et,abet.
¢ ¢ O improve,deiindid,sir repair any structure.Prior to its isxlanec,tabu LIG NO. ELEG 2J/1 Or/1O LL leyaire the'aPPlievnl for suel,panni'to Ill,a signed sl:d,lnmnl that TOTAL i'2l 0 T �RMITTO _he is licensed pmntnn''o'hc Provisions ol'he ConnaI torts Ucanse ���EaseIChapter•11.uuunencing w it h S,n ion 7000lal Di,is ion 3 of the E
Business and I•rofeselons Code,sir Iliac he is escogn 11,areli.n,and BING PERMIT FEEthe basis lot the alleged encnlloron. kny 11011lion o1 Section 7031.$ STORIES TYPE CONSTR.
w. � by any applicant hlra pani'subject%Ihc:Ipplicanno a lie it peicidlyVENT-WATER (EA.) 5.00of normo..than Inc hundred doll c,($500)1',m uwWr sit n„Ptop,tly,l'1(cry ymldoy,cs with wages asTECT. DEVICE 4.00 oCC.GHOUP RES.UNITS
their sets rotnprnsWiun,will Jo tlm work,1110 [lie s'nmwre I,net
intended or.11e..•J for sole IS,,. 7044. tlminc» and Pro, ..I....s DRAINS-FLOOR,ROOF,AREA,CONO. 5.00
Code:Tire Contractors Liecroe Lw does not apply loan usurer or
property who builds or improve thereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FT,FLWH AREA TOTAL ACREAGE
hlnuclf or'htougb his own enlpley1e.'11.11,1101111.1 sac It i-1pmvo- GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00
n ants arc not intended or oRcred lorsale,it,howcseq'hc building
'•�. or impinsemem is old Within on,year ul'cmlBd.lnun,(lie ow _ GAS-EA.SYSTEM-OVER 4 (EA,) 2.00 BUILDING USE
builder will have the bD1Je.of proving 11.1 he dill nit build sir it RES IND CON PB Omer
prole for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of it,,property,am eselusiscly cuntru:ting with
licensed contractors to construct (lie project tSec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and vnde...um Code:'I'h,C'onlmetor'r Li ten, Law Juts not apply
to an owner.(proPeny who builds nr innolls s 111¢11-1,,and will' LAWN SPRINKLERS-OVER 5(EA.) 1.00
m,Nacts lar such Projects with a .ntractor,I licensed )aro$JIR to
[lie Contractors License Law. SEWER-SANITARY-STORM EA.200fU10.00 TRACT NO. PARCEL NO.
❑ lam cr.engn'Inde"Sec ,BAP.C.11.1n, WATER HEATER W/VENT fi.00
reason
Owner Dan' WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORKIiRS'COSIPEN'SXI'[ON DECLARAI ION WATER TREATING EQUIP. 5.00
I hereby alftnn 'hw l have a veno icat,.f cnrocnno sal-inurte, ZONING ENG.SITE NO.
or a certificate or Workers Collpuuation Insurance,or a ecnilied
copy flieRO((See,3800•Lal,C.).
P.1iy Nn__C. any_
Q ❑ Ccr'i1:1 L% n m_h hcJ. FIRE SPRINK ENERGY TQ4
Z Z ❑ Cc o n Illy d,llsiolL MISC. - REFER TO ORD. Y ❑ N❑ Y ❑ N❑
Applic nt.
F p0- 4/ �LN PERMIT ISSUANCE 10.00 FLOOOZONE A.L.0 C.
CC - CI.R1'Il'ICA'I'Ii OPI.. :111'fIUNWORKERS'
W > CU\II'BNSA'I'ION INSURANCE PLG.CON 111. LIC.NO. PLC. Y❑ N❑ v � N❑
CL 0 ('Phis section need not be cmnple'ed it the Penni' is lar one TOTAL
D Z hundred della,,IS 100).1 less.(
U 0 1 cenily that in the perionnanev of the Work lit which this Per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall nut erns loyany person in any'tnanner sum le
Ow bec.mesubject to the W'orktrs C.nlpenvoon Laws of CAIRTRia' BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00
} tan NU'11C1[ 10 AI.1'LICAN'1: it,'stmt making this CeItlticale Ill I.,-
H Z emPtion,you short[,[beeunla subject t.the Winker+'C-1mnms.nion APPLIANCE 5.00 PLAN CHECK
pruri>ion, of the Labor C'odc, y.0 nm>1 I..1hwi'h mmPly with FEE
U such provisions or this permit shall be deemed ray.ked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION I.ENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is A C.ns'rualon lending uuency ti,1 EXHAUST HOOD(WITH DUCT) 5.00
tic, pc,l.rn,an:l of 0m w.rk for which this permit is i»ucd(Sec. HEATING UNIT (TO 100M
8.00 MICROFILM
3097,Ce C.I.
Lender's Name HEATING UNIT 1 .)9.50 ELECTRIC aa. oO
Learl Addr.»
I cenity mal I have read tills upPil,mmn and sone 00, lie uh.,1 VENTILATION FAN (SI4.00
y� inlorina(iun is eurrce'. I agree m colli Ply with all city'and roullly PLUMBING
urdinan:es and state laws relating to building corouuni.n, and BOILER- H.P.or 16.00
Leleby zulh.ru, H,preen'a'ive> et this sly to Ili,, upon the BOILER-COMP fOVar 100.0EESCH. MECHANICAL
abuse-mentioned property for inspection purposes.
(Wel agree to save. InJenutify and keep hannless 'he•City of MISC.- ORD.crtin. ngu'ns1 abil'aicx,it 'In.• uses and ca pcnscs whleh CONST.TAX
may in u a n e t y iia :aux, Ice,' tai me PERMIT ISSUANCE10.00
nanlil f s cilli MECH.CONT. I.C.NO. TOTAL
}� gTOTAL OFD
Sinn: u' I Apt 1 gni unll: a.I /-
OFFICE COPY