5808 ! APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 0
ADDRESS O/�3 Al, jOL� ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL a '
1. OWNER'S I - i - . - PLAN CHECK VALIDATION
Zoe" OTY. ELECTRIC PERMIT FEE
OT
PHONE
CONTRACTORS- I'� E n UTLETS-SWITCHES-RECEP 5.0011.00
S C.N S LIGHTING FIXTURES 5.00/1.00
r-oNgEasrDRs PPLIANCES-RESIDENTIAL 4.00
sPHON „ PANELS 5.00 DATE OF APPLICATION
OORRcurtECT - SIGNS 6.00 '•PLAN CHECK FEE• P.C.,NO:
ENGINEER - -
uc.No. SIGNS TRANS. - 3.00
ADDDRESS E"G' SPECIAL CIRCUIT '5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE.INS: 15.00
ADDRESNr's MOTORS, SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00 8/S�Q�
woo LICCNSEU CONTRACTORS DECLARATION O
a i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
s- (commencing with Section 7000)of Division 3 of the Business and
a Q BLDG. ELECT. PLG. MECH.
F O Professions Cod• nLi is Nin full fu
O i L e. icen Ia Lic. umber ❑ ❑ � .❑
Q n j Date Cont.cIm%;ierdIgl 000
¢ n ¢a
OWNER-BUILDER DECLARATION Pi ID BUILDING PERMIT
opo INFORMATION
ww I hereby affirm 1 am exam t from the Contractor's License r' MISC.- s REFER TO ORD
3 u Y P VALUATION -$/FT.
.e-u o¢ Law for the following reason.(Sec.7031.5;Businessand Professions PERM IT.ISSUANCE 0
Cade:Any city or county which requires permit to construct,alter, �oa-o
Q Q¢0 67 1
Improve,demolish,or repair any structure,prior to Its Issuance,a[,o ELEG CONTR. LIC.NO. E G AP.- /
C¢ requires the applicant for such permit to file a signed statement 11,31 TOTAL PER IT TO
Inp
e w m w be is licensed pursuant to the provisions of the Contractor's License.
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