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2334 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATI ON FERMINu BUILDING - APPLICATION & PERMIT A ffy ADDRESS `f 18922 Forge Dr. . BUILDING — ELECTRICAL—PLUMBING=MECHANICAL OWNER'SPLAN CHECK VALIDATION Memorex-� NAME CITY. ELECTRIC PER FEE ' PRONE NONEHACTOFS UTLETS-SWITCHES-RECEP 5.00/1.00 06 Caw. N373138 Caw. o. LIGHTING FIXTURES 5.00/1.00 CONTRACTORS (_406,1 APPLIANCES-RESIDENTIAL 4.00 ' IV✓' VL r-E.,gfflJek1 PANELS 5.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE .G NO, i OR SIGNS 6-00 ENGINEER yr�.�/'�/�/�/ sec NO. SIGNS TRANS. 3.00 ADD ass aces SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 APPUCSANTS S ADORE55 MOTORS SEE FEE SCH. SERVICE CHANGE - 10.00 wo Of LICENSED CONTRACTORS DECLARATIONCITY / 8/�� .Q MNO u H I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE H z"' (commencing with Section 7000)of Division 3 of the Business and¢ c SLOG. ELECT. PLG. MECH. F i Professions Coda,urpps n Licenu is in full furggd ai ❑ ❑ ❑ z olessl��Lia Numha �J !J AUG N O w = � Uulc 11 Contractor—� a y _ BUILDING PERMIT in ¢ ¢ OWNER-BUILDER DECLARATION o a u INFORMATION e, ; " I hereby affirm ilial I am exempt from the Contractors License MISC.— ER TO ORD r �.oa law for the following reason.(Sec.7031.5,Businvssand Professions pERMIT ISSUANCE 600 VALUATION S/FT. Code:Any city or county which regniresa permit to construct.alter. 3836 Q Q Q Q improve,demolish,Or repair any structure,prior to Its IS maree.8150 ELEG CONTR. LIC,NQ ELEC. ' wO LL requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO $ he is licensed pursuant to the provisions of the Contntetor's License H z i Law(Chapter 9(commencingwilh Section 7000)of Division 3 oftlm Modify Fire Sprinkle 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE MI- the basis for the alleged exmnption.Any violation of Section 7031,5 STORIES TYPE CONSTR. n ; by any applicant for a peril subjects the applicant to ucivil penalty ALTER-DRAIN -WATER (EA.)of not more than five hmtdred dollars . . (S500)J'. > ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS 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. 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 SG_IT.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 building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is sold within one year of completion, Die owne- builder will have the human off,roving that he did not build or im- rGAS-EA.SYSTEM-OVER 4 (EA'.) 1.00 BUILDING USE proveOn,purposeofsalc.l. INDUSTRIAL WASTE INTER. . 20.00 RES IND CON PB Other ❑ 1,as owner of rho properly,um exclusively contracting with ❑ ❑ ' ❑ ❑ licensed contractors to cowruct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 . ASSESSORS PARCEL NO. and Professions Code:'I'he Co Nructor's Licenu Law dues not apply to an owner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5(EAI) 1.00 - contracts for such projects with a contractoris)licensed pursuant to ' the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 . TRACT NO. PARCEL NO. ❑ I am exempt under Sec. .ILaP.C.for this WATER HEATER W/VENT 4.00 reason Darn O.Re, WATER SYSTEM 4.00 ACC.DATE ACO FILE NO. WORK V RS'CO,HPENsnnON DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affmn that I have a certilicale of consent or seIFinmre, ZONING ENG.SITE NO. or a certificate of Workers' pe Contnmtion Insurance,or a curllfied copyt r Sc o C.j.�,�. 16N � T . U ❑ CerufieJ copy is hero furnished FIRE SPRINK ENERGY Toa Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.O Applicant Y NE] Y ❑ N� CC va PERMIT ISSUANCE 6.00 Lu — CERTIFICATE01;I A% I%ipTION FROM WORN ERS' FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE the PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ ❑ CL O nPhis dollars need not be completed if the peril is for one - TOTAL N � 2 hundred dollars($100)or less.) U O 1 certify that in the performance of the work ties which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY U_ H mit is issued,I ,shall not employ any person in any Inunner so as to - U L) become subject to lite Workers'Compensation laws of California. D, Dmc Applicant BUILDING44-50 11�� } to NOTICE TO APPLICANT: If.after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00 4•5� F 2 sorption,you should become subject to the Workeri Compensation APPLIANCE 4.00 1 PLAN CHECK provisions Of the Labor Code you must forthwith comply with U such provisionsor this permit shall be deemed revoked. 'AIR HANDLING UNIT ITO 10p00C.F.M.) 3.00 FEE 28 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE •50 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,C,C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 Lendeh Address ELECTRIC Icertlfy,lhal-I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00 information correct rre 1 to comply county with all city and cou 'PLUMBING ordinances and state lawss b relating to building cont ruction, andmy BOILER-COMP(3 H.P.or 100,0000.T.U.) 4.00 hereby authorize repretematives of this city to enter upon the above mentioned property for inspection purposes. BOILER-COMP (Over 600,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. Cu Lino againstAC biI t judgments, is and expenses which PERMIT ISSUANCE 3.00 CONST.TAX m any is a Inst y Inconugucncc oftheng of thl � MECH.CONT. LIC.N0. MECHX` 1 GZ DTAL TOTAL —I U 73.93 SINn41n [Applicant Cnnl tactor Dolc OFFICE COPY -