0542 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI.POINT PEN ON
pr
IT NUMBER
BUILDBUILDING PROJECT lDENTIFICATION ING APPLICATION & PERMIT O� n
ADD Ess "- T
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S _ PLAN CHECK VALIDATION.
-
NAM .-Meir OTV. ELECTRIC PERMIT FEE
/'M'LJ PHONE
CONTRACTOR'S
N E JJ �+ �. OUTLETS-'SWITCHES-RECEP 5.00/1.00 1 c'!!; •
�Jk+ �(�� uc,N rj' LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S Ag7lPPLIANCES-RESIDENTIAL 4.00
A ORES j/���i C 1 -
�/!✓�+ PHO E _5bVv PANELS 5.00 DATE OF APPLICATION
AOR
RCHIT T SIGNS - 6.00 PLAN CHECK FEE P.C.N0.
ENGINEER
' - LIC.No, .SIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT - - 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS
SERVICECHANGE - - 10.00
�
'oo LICENSED CONTRACTORS DECLARATION - z' / //
a i I hereby affirm that 1 am licensed Under provisions Of Chapter 9 - ISSUANCE OAT9/ Y
w commencin with,Seclion 7000)of Division 3 of the Business and ,
Q vAi ( g BLDG. ELECT. PLG. MECH.
F O a Professions COd an m license is in ft
z O N - License Class gg,, Lic.Nu be Iy
O � w
Date_/ '1Contract - '-t'
a y f
rc Q OWNER-BUILDER DE RATION BUILDING PERMIT
a o d ° - REFER TO ORD INFORMATION
X c- 0 04 I hereby affirmthating reason.I (Sec.
7 from the Contractor's License M ISC:-
w VALUATION $/FT.
Fuyj Law f rthe Any
following requires a permit Business and Professions PERMIT ISSUANCE 6.00 ..
2 m � Code:Any city Or county whiny Cinctesap riot t oconsuanc alter, -
w Q Improve,demolish,or repair any Cincture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O.O
wG u requires the applicant for such permit to file a signed statement that TOTAL - PERMIT TO
Re m he is licensed pursuant to the provisions of the Contractor's Cicense
rza- Law,(Chapter 9(commencing with Section 7000)of Division 3 of the
Q Business and Professions Code)Or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
E x O
IS r the basis fpr the alleged exemption.Any violation of Section 7031.5
malty STORIES TYPE CONSTR.
of any applicant for ummilne dollars the 0).): ant toacivil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(55001.1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00
their sole compensation,will do the work,and the structure is not OCC,GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,EA,CON D. 4.00
Code:The Contractor's License Law does not apply to an Owner of
property who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself m through his own employees Provided however,
such improve 1
meals o nhrough dad or employeeffered far sale.lf,ed that such
building GAS-EA.SYSTEM-'11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-:EA.SVSTE ,4 �
builder will have the burden Of proving that he did net build or am- O BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. RES IND CON - PB Other
O 1,as owner of the property,am exclusively contracting with 20'00 .❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(See.-7044,Business LAWN SPRINKLER 5.00 ASSESSORS PARCEL NO.
and Professions Code:Th
e Contractor's License Law does ,at apply -
to anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
'contracts lot such projects with su
a ennlractons)licensed pennant to '
the Contractor's License Law, SEWER-SANITARY-STO 00ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. -,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Date Owner_„_ WATER SYSTEM 4.00 ACC.DATE ACO.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4,00
I hereby affirm that I have a certificate of consent to self-insure,ora certificate of Workers'Compensation Insurance,or o cert'I'd ZONING ENG.SITE NO.
copy thereof(Sec,3800,Lab.C. _ -
Policy No. Company'
Q ❑ Certified copy is hereby furnished. _ FIRE SPRINK ENERGY Ty4
Z Z. . Certifi d copy is (((Iled.with the c1ly,inspection division. MISC.- REFER.TO ORD.
O APPlicant �-1�/,vn___,_____6e-"# v ❑ N❑ Y ❑ N❑
CC rO /Y, II►►F EXEMPTION�CRON WO PERMIT ISSUANCE 6.00
LUCERTIFICATE, H EXEMPT INS PROMWORKI>RS' FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. - PLG. '
I not be completed if the permit is for One - TOTAL v❑ N❑ Y ❑ N❑
D' o (This section
=) Z hundred dollars IS IOD)or less.)
U O I certify that in the performance'Of the work for which this per' OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit Is issued,I shall not employ any person in any manner so as to
O W become subject t0 the Workers'Compensation Laws of California,
St. Date Applicum ALTER OR ADD TO MECH. 4.00 BUILDING
>- N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
I.. Z emption,you should become subject to the Workeri Compensation APPLIANCE 4.00 PLAN CHECK
previsions of the. Labor Code, you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000QF.M.) 5.00 ,SEISMIC FEE
I hereby affirm that there is a'construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance-ol'the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Nddr HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
ordinances n correct. I agree to comply with all city and county BOILER-COM
H.P,or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorizerepresentatives of this city to enter upon tire-
above-mentioned property for inspection purposes.
'BOILER-COMP Oe.,100,000 BTU)SEE FEE SCH. MECHANICAL
We)I agree to save. Indemnify and keep harmless the City of MISC.- REFER TO ORD.
up rtino a liabilities,judgments, casts and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way c ora against said
-City In consequence of lire
on
ng Of th per iL MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
i Stun Of pp cant/Contractor Date
1Vibitii1il ,0✓d.0 #*A G-jv'$/ OFFICE COPY