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10087 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFIC & PE T BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER /� 10087 -BUILDINGAPPLICATION AORF DC7 r OW ER'SPLAN NAME y- QTY. ELECTRIC PERMIT FEE CHECK VALIDATION PHONE pA�p - NAME+AcroRs OUTLETS -SWITCHES -RECEP 10.00/1.00 ' uC. NO. 1 N 3 1986 INJAN " ~ DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00 ADDREACTOR (]'s e[ 6� JYri Lj /A." F- PHONE - -44# APPLIANCES - RESIDENTIAL 4.00 10.00 ogCH ECT ENGINEER LIC.NO. PANELS (OVER 200 AMP) 20,00 Pj`�[j 101 F � P.C.NO. Vr�), 0��I SIGNS TRANS. 3.00 ARCH, RENG. ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP ('' �p IR fjlu't.� ' ^ _ . - APPucANT's AGGRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION . TEMP, POLE 30.00 I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code d my ]seense is in full force en f e t License Class Lia Number 15SUANCE DATE BLDG. ELECT, PLG. MECH. ❑ ❑ Dete_f_1 - Contractor BUILDING PERMIT INFORMATION O N R-BUILDFift DELLA ION 1 hereby affirm that I am exempt from the Contractors License Law for the following reason. (See. 7031.5, Bisinessand Professions Code: Any city or county which requires a permit loconstruct, alter, improve. demolish, or repair anyslructure, prior to its issuance, also requires the applicant for. such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that lie is exempt therefrom and MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION nn (JDO.r $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL QTY. PLUMBING PERMIT FEE PERMIT TO lFt the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.1: STORIES TYPE CONSTR. _ gLTER-DRAIN-WATER IEA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves (hereon, and who does such work himself or through his own employees, provided that such improve. ments are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 IGAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 SO, FT. FLOOR AREA TOTAL ACREAGE or improvement is sold within one yen, of completion, the owner- builder will have the burden of proving that h e did not build or int- prove 1'or purpose of sale.). ❑ I, as owner of the property, sin exclusively contracting with - . .. GAS EASYSTEM -OVER 4 IEA) 200 BUILDING US RES IND CON PB Other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the proicct (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who bonds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractors) licensed pursuant to the Contractors License Law. ❑ l am exempt under Sec.-, BAP.C. for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of c.nwRt to self -insure. or a certifu:ate of Workers Compensation Insura r a cert'fied copy thereof l Sec. 3800, Lab.C. 1. ZONING ENG. SITE NO. Policy No. Company ❑ Certified copy is hereby furnished. Certified copy I 1 d th tum vjfy.. upectiOR div sum. A plicin(__t[1� y FIRE SPRINK Y ❑ N ❑ 'ENERGY T-24 Y ❑ N❑ MISC. - REFER TO ORD. C1 RTIFI E OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section need not be completed if the permit is for one PLG. CONTE, LIC. NO. PLG. TOTAL Y ❑ NC] Y ❑ N ❑ hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING / vh become subject to the Workers' Compensation Laws of California. DaleApplicant NOTITO APPLICANT: If, after making this Certificate of Ex- CE ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emplion, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or (his permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 101300C.FM.) 6.00 SEISMIC FEE t CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 6.00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. MICROFILM Lender's Name HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC _ Lender's Address VENTILATION FAN (SINGLE) 4.00 I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building conslru011o0, and PLUMBING BOILER-COMPI3 H.P. Or 100,000 B.T.V.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. gOILER•COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of C Perrino against liabilities, 'udgment. osis and expenses which Y i any w' accrue a in i y inconsequence f c g 1 of this -r sit. N� aTOTAL MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL I as a of planar/Clint actor Dale V OFFICE COPY