18314 (3) APPLICANT-TO FkL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.1.Y -BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
A 18314
OOREss
t! 7 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
E/m rd
OWNER'S J PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
• N ePHONE -/
CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00
rz LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR ADDRESS
NTRAOR�s
APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ORCHITEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c._No.
EN INE
LIc.No. ISIGNS TRANS. 3.00
ADDRESS E 1 SPECIALCIRCUIT 5.00 PER MIT VALI DATION
,,IP TEMP.METER OR POLE INS. 20.00 7
APPLICANT s MOTORS SEE FEE SCH. I ��
/7 4m ea( e - SERVICE CHANGE FAInoo 111
F O o LICENSED CON'T'RACTORS DIiCL. RATION � _ J1 �,.TD VWGG/
Q i w 1 hereby affirm that I tors licensed under pHomons of Chapter 9 11 11 -� p 7 IISSSUANCELLDATE
y a w (commencing with Section 7000)of Division 3 of the Business and t Pa SLOG. ELECT. PW. ECH.
F y z Professions Code,and my license is in full force and effect � �L ❑
z o m - License Class Lic.Number (�yl
2 x o Date Contractor CHI ot
M ¢ w a OWNER-BUILDER DIiCLARATION BUILDING PERMIT
w 3 LL t- 1 hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
u o j Law for the following reason.(Sec 7031.5,Businessand Professions VALUATION SIFT.
- PERMIT ISSUANCE 10.00
Cude:Any city or county which requires a permit m CUnftraCI,alteL
¢ Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELIC. '
O¢ requires the applicant for such permit to file a signed statement that TOTAL
' w$" he is liccirsed pursuant to the provisions of the Contractor's License CO '17 TA C,
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe 7�C
¢ o Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE -
¢ r m the basis for the alleged exemption.Any violation of Section 703 LS llE V_YIE R.
u _ by any applicant for a permit subjects the applicant to a civil penalty
l
ofnol more than five hundred dollars(SSOORJ ALTER-DRAIN& VENT-WATER MAJ 5.00 lo�� Sit
❑ I,as owner of the property,or my mnployees with wages es BACK FLOW PROTECT. DEVICE 4.00 ocCGEDUP RESUNITS
their sole compensation,will do the work,and the structure is not . .
intended or offered for sale(Sec. 7044, Business and Professions 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 dues such work FIXTURES-PER TRAP 5.00 SO.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 budding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of'complction, the owner- GAS EASYSTEM OVER 4(EA) 2.00
builder will have the burden of proving that he did not build or im- - . - . BUILDING USE
prove for purpose ofmlc.)' INDUSTRIAL WASTE INTER3000 RES IND CON PB other
. .
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
toanowner of property who builds or improves thercon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorls)licensed pursuant to
the Conrractoh License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lame cmpt under Scc. ,B.&P.C.fur this WATER HEATER W/VENT 6.00
reason_
ow"e`- Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKER: 'Oh1I'F T'1 N I LARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent tnsdGin.wre.
or v certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.CJ.
Policy No. Cion,any
O ❑ Certified copy is hereby furnished FIRE BPRINK ENERGY T-24
z Z ❑ Certified copy is filed with the city inspection mvlsiou. MISC.- REFER TO ORD.F" 0 Applicant Y ❑ N❑ Y ❑ N❑
jr to CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 PL000 ZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL 0 ('Phis Section need not he completed if the permit is for one TOTAL Y E] N[DY E] N❑
Z hnndreddollars(StOO)orless.)
U 0 1 certify that in the performance of the work Thr which this per- GTV MECHANICAL PERMIT FEE FEE SUMMARY
LL I- ITO is issued 1 shelf not employ any Person in any manner so as to
O W become subject to the Workers''Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 500 BUILDING
>_ to NOTICE TO APPLICANT'. II',alter making this Certificate of Ex-
.
Z H emprion,you should become subject to the Workers'Cmnpensation_ APPLIANCE 5.00 PLAN CHECK
Provisions the Labor Code, you mm
Ernst forthwith comply with
FEE
U ouch provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10p00GF.M.) 4.00
CONSTRUCTION 1.1'NDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
I 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(Scc. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U-)9.50 Lenders Address ELECTRIC
Ic,rtity that lhave read this nPidicution and state that theabove VENTILATION FAN (SINGLE) 4.00
. information is correct. 1 agree to comply with all city and county PLUMBING .
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authors, representatives of this city to enter upon the g01 LER-COMP(Over 100.000 BTU(BEE FEE SCH.
above-mentioned property]or inspection purposes. MECHANICAL
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperfino against liabilities,judgments, Costs and expenses which CONST.TAX
may in tiny way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
Conlin of this permit MECH.CONT. LIQ NO. MECH.
TOTAL TOTALqO
Signature of App' nt/C tract Dare 3 /i I
OFFICE COPY