7016 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
SR LOING APPLICATION & PERMIT 7 016
AUOPE55
a/ + �•, { e-F BUILDING - ELECTRICAL PLUMBING MECHANICAL
OWNEllS C• ,lL)!/ AVS 'tW 1 lA+ .q yIL ��111 fa �• PLAN CHECK VALIDATION
NAME / Uq/_''/<� �J _ DTV 1'gi'4 ' +IGS IdLECTRIC'PElilf�I A? i
e.A V
PHONE
1p LJ C_ 1✓^l ,+ti' L i4 V.fl to .i�
1_., CON
TRACTOR s CZZ) C p UTLETS-SWITCHES-RECEP 5.00/1.00
M
NAE
t/O,S //7 uc.nD. �(J��P ' LIGHTING FIXTURES 5.00/1.00
CONTHACIOR'a APPLIANCES-RESIDENTIAL 4,00
A...I as SLlnn k`I n.
(tan cio G Pooh 1 PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS 6,00 PLAN CHECK FEE P.C.NO.
on
ENGINEEn
NO. SIGNS TRANS. 3.00
ARCH.on LNc. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
nInm E55
ZIP TEMP.METER OR POLE INS. 15.00
A"PLICA TS MOTORS SEE FEE SCH.ADDRESS
SERVICE CHANGE 10.00 .
oo LICENSED CONTRACTORS DECLARATION
a U I hereby Minn that I am licensed under provisions of Chapter N ISSUANCE DATE
Q H (coonovocing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. M
F Z Prolessions Code.and my license is in full force and effect. El E] ❑
012, - hiaena Class__ Lic.Nanlber
Z
H w Dale - (onlm.tmr
BUILDING PERMI :G
0 w OWNER BU1LDIiR DLCLARA HON .:..INFORMATION!'-`i,
o A MISC.- REFER TO ORD
S LL N I hereby allinn first )art;exempt from the CoNmclars License VALUATION S/FT.
w o e Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
-+ ('Ade:Any city or aounly whichterp;ires4 permit toconstrucl,aller.
2
Q 2O ,a ,pnc
in;prove,demolish, repair any structure, to its issuae,also ELEC.CONTR. LIC.NO. ELEC.
O ¢ enoi...the applicant for such permil to file a signed statement that iOtal PERMIT TO
,, m w he is licensed pursuant to the provisions of tiro Contractor's Licensein //
a Law(Chapter 7(commencingwith Seclion70001of Divisiom3of the 'T.,^r^x ' '+"s• ✓+"1+1.(t •^•"'w c-#'
F Business and Professions Code)or that be is exempt therefrom and GTV:,: PLUMBING PERMIY si_Qt 1'-.'n„ i JkEE
o rhe basis for the alleged exemption.Any violation of Seclion 7031.5 ^+•- R3 .r.•s^ r' - "). STORIES TYPE CONSTR.
d ; m by any applicant for a permit suhjects the applicant to a civil penalty gLTER-DflAIN&VENT-WATER (EA.) 4.00
of nor more Ilan live hundred dollars($500).1:
u I,as owner of Rse property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their wle compensation,will do the work,and the structure is not
intended or ollered for sale(Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
(lurk:1'he Contractor's License Law docs not apply to an owner of
properly who builds or improves thereon,and who does.such work FIXTURES-PER TRAP 4.00 SO.FT.FLoon nnEA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
- menta are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 4.00
or inhproveanenr is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4(EA) 100 BUILDING USE
builder will have the burden of proving that lie . . .
e did mol build or im' RES IND CON PB Other
fur purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
LI I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contactors to construct the project(See 7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and I'nsfcssions('ode:'I'lie('on l TaeRR's Lielm.Law docs not apply
to an owner of property who builds or improve,there mI.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contra.is for such Projects with a eonrractud')licensed pa,sRant to
the('ontmoor'x License Law. SEWER-SANITARY-STORM EA.2006/8.00 TRACT NO. PARCEL NO,
D 1 con exempt under Sec. ,BAPT.for this WATER HEATER W/V ENT 4.00
rraam
owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO:
WORKERS'COMPENSAIION DE('IARA'I ION WATER TREATING EQUIP. 4.00
1 he¢by allinn that I have a crdilic.(c of(onsee'to sell insure. ZONING ENG.SITE NO.
rr actrl ifcalke of Wurkets'CoolPcnsal�i000 Insurance as �rHi�ficd
I„IliiylNlaI53t♦nPa�yy�CF.CLN=L-1/7./-Y-_ ^
Q 11 Ce,filled 'npy is hrveby fmrnisbcd. FIRE SPRINK ENERGY T 24
Z 2 C;tdrer I1!e (will; yLy}/iI I� �Jiwj'siml. MISC.- REFER TO ORD.
O Appllcanl _ fUln _-i/-/J7.7YJ-/!f-C/.n�l Y❑ N❑ Y ❑ N❑
S- y PERMIT ISSUANCE 6.00 FLOOD ZONE A.LU.C.
(', ' FICA'I'I,01:EXEMPT ION PROI.1 WORKIi K.
W COMPENSAIION INSURAN(T PLG.CONiR. LIC.NO. PLG.
(1 O I thi, Mctinn nred not be completed if the permit is for one tOTAL Y❑ N❑ V ❑ Al
� 2 hundred d.11 ..IS 100)or lcss.) ' r I y
U O 1 Lerfrl (flat m the performance of 1hL work for wh J;this ter '' i r nYttb s r t 1+H++ t 1 k {+ ¢ FEE;�bUINMAItY
LL f- mit is issued I shall not employ an person in an manner so as to GTV 9 ' MecddNICAL�ERfs�lT4 tt7 _ r nS
U hs,mnnre sublcU to the Workers'Croo,nsat on La sof Cain"..ia ^;f s . I,re +•,.,h,i T ;,.t,�tis '�21 T AiT.' ty; N.rcA
n Date- Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} m NO?ICF TO APPLICANT: If,after making this Ccrlilicate of Eli-
♦- ? eopto 1,you<t oold became subject to(lie Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provision, of the Labor Cade. ran matt forthwith comply with FEE
U such provisions or Dais permit shall be deemed revoked. AIR HANDLING UNIT C.F.M.) 3.00
(.TINS I ROCUON LENDING AGENCY AIR HANDLING UNIT(OVER 1 .15.00 SEISMIC FEE
I brief, allinn That no,o, is A con.Rl¢tino lending agency for EXHAUST HOO H D I 2,00
tire pet onoancc of(lie work for which this..Uoi. Ls Issvud ISca. HEATING UNIT ITO 100,0 0 4.00 MICROFILM
3007,Civ.('.I.
Lcndrl's Namc HEATING UNIT(0 { B.T.U.17.50 ELECTRIC
Lender's Address
I celtil, that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00
imlunmdion is correct.I agree to comply with all city and courtlyBOILER-COPiA(3 H.P. r 100000 BTU) 400 �^ PLUMBING
ordinances and state laws relating to building construction, and . , . . . .
/�
hereby awu0noive representatives of this city to enter upon the BOILER-COMP (Over IBQBBOBTUISEE FEE SCH. MECHANICAL 7�V
- xbovoontnncd propctw
y for inspection purpos.
(We) agree to save, indemnify and keep harmless the City of MISC.- R ER TO. RD.
('nperlinu against liabilities,judgments, costs and expenses which / CONST.TAX
in
may any way accrue against said City in em,serlueace of the PERM I SUA C L 3.00
granting Ibis Ile nm it. ./ MECH.CONT. I(,( NO. r
_ 7��S �/ TAL 7aa TOTAL '
Si, a n
,if p cant Contractor Dale ^
OFFICE COPY