14324 (4) P,1'I'I_ICAN f -1-0 FILL IN INFOKIVIA 1 IUIV VVI-1-1-11N IiLD LINOS - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
pOILDINr., APPLICATION & PERMIT A n A
ryo7RLss 4 2 4
//``tOCSI I't'�S\� IJ 1J(. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNF.N'S /1 _ _ '�
NAMI J PLAN CHECK VALIDATION
• Nvyl AA , I73_61 YS TV ELECTRIC PERMIT FEE
' U ' ul PHONL O /J
CONTHACIORI
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 12 -
LIC.
-LIC.NO, LIGHTING FIXTURES 10.00/1.00 O -
IAOONESSIORs PPLIANCES-RESIDENTIAL 4.00
TA-RPHONE PANELS 10.00 DATE OF APPLICATION
0. PANELS
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
LNGINEER
LIC.No. ISIGNS TRANS. 3.00
ooRE55 errs. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
41P +'y EMP.METER OR POLE INS. 20.00
APPLICAMUDAESS L MOTORS SEE FEE SCH.
I SERVICE CHANGE 20.00
,00
00 LICENSED(ON'I'RAGTORS DECILARAI RUN
2 u U I hcrcby;JI un Ih,I I Jun linmud under p,wi,ron,ul'Chailer u 1 ISSUANCE DATE
m 1 u Ittnumm�teuµwill) tieelian 780(11 ul'Iliv,ion 1 ul the lousiness all d�LU]BG pti n PIG. MECH.
D i i"o e"ian>C'od"'und Icy lincmv is in Tull fume and'It"L
Claw- e'Ly I� UI
a o N Li.ense Cw b
Lie.Ner_ ll N
O m - at ITelc (bnlraclul
`a y f ' BUILDING PERMIT
er ¢ w a
OWNER-BUILDER lilt-IIIIILUIiR DECLARA'T'ION INFORMATION
w ;a U I hereby'affirm tial I am exempt liom the Cuntranor.License MISC.- REFER TO ORD
a. a-
LuW Or III[IUI uWIu' ALUATION $/FT.
A reu>ull.1S".7011.5,B.,me,,n 11'rul'esslon>
r- - PERMIT ISSUANCE 10.00 O &0.0
Cn,R.Any nilYor c,,re, which,.ruinsa permit Toconsuacalto,. /
¢ a o improve,dcnwli>h.lar rcPair any structure,Prior to its issuance,alio ELEC.CUNT... LIC.N0. ELEC. �1
D LL reclaire>the afvlwant lin such permit to Iilc a>iguen Slalellueni ilm TOTAL 2Y -' PERMIT TO
a w m he is li..n,.it punu:np to the prwisio ,of Ill,Cunmatorl Linens. f�
F i i Law(Cupleru(eununencillg with Seeliun70001 to Division iol the q�er�Q l�-�
a Omincu and 1'rofnJons Code)or Olvl he I,c,xn,,t Ihcuo roll and QTY. PLUMBING PERMIT FEE (( `�" o
¢ r o the b'ari,our the allegoJ exnnptiun.A'ly violJliun ul Seel ion 7011.$ STOHIES TYPE CONSTR.
A i ° by JIIY alildicalll l r a Ilcr11111 subjects the applicant Ilia cord......ally
of nal moa than five hundred dull a..(SSOol): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,a ..suns•,ciI me prupcny' cit is,cagrluyce,wish wa);c,a> BACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP RES,UNITS
their Sala canplasati.n.will dr,Ola work,unit the slr.,t u:a nal
intended or offered ku sale (See. 70,14, lousiness and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Coda The Contractors License Law does not apply to an owner of
progeny who build,,),improse,lhereml.and Who dors suc0 work Z FIXTURES-PER TRAP 5.00 U - Sa FT.FLOOR AREA TOTAL ACREAGE
hinuch or Through his own vii,loyces.Provided that such int novo.
meals are our intended or unFred lot sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or inprruvenmat i, .litwithin cine year of emnpleliun,lie owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the Mullen or proving that he did mH build or int- BUILDING USE
Ilwve for purpow'of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB 0rn.r,
❑ I.as owner OI thc Properly,ale exclusively contracting with ❑ ❑ ❑ ❑ Cl
licensed con Naetors in couturier the project IS,,7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL CEL NO.
and Profession,Code:"I'Ile Contruetols License'Law docs net JPPIY
Ill an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
on lmc is Inf suds project,,wjtll a cant...let(,)liauseJ pureuum tD
the Cntr:Ictat's Llccn,e Lew, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am r.,,un under Sec. ,B. P.C.lir Illi, WATER HEATER W/VENT 6.00
reu,nn
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W0RKERS'(0hIPI:NBA'I'I0N DECLARATION WATER TREATING EQUIP. 5.00
1 hereby Afrin Thal l have arerlifeate el'canscut lu sit ifinsure,
ortilieme of Wtikeis'Cum Peue.niuu Insurance,or a aaRilieal ZONING ENG,SITE NO.
copy Ih.....I(See..1800,1,1'.C.).
lic
Poy No.-Col.PauY
O ] Ccrtillcd copy i,hcrcby ItiouSllcd. FIRE SPRINK ENERGY T-24
Z Z ❑ Cenilied ropy i> Tiled with the city in"i"tiun division.
� p Applicant MISC.- REFER TO ORD. Y ❑ NE] YE) N❑
M w CIi R'I'IPICA'I'1'01:EXEMPTION 17RONI WORKERS' PERMIT ISSUANCE 10.00 O FLOOOZONE A.L.U.C.
LU > GOMITNSADON INSURAN(T PLG.CONTH. LIC.NO. PLG, �j
IL a I'I'his xetian l'.1nut be completed it the pencil i, lot one TOTAL 3s Y❑ N Y ❑ N❑
::) Z It ndreddull:uslSloulur It,,.)
U O I ceRity Ileal in Ilia•perharaance ill rbc work lin w)1' this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL y- mil ',issue J,I 1 all uR employ airy nun in�' mr w a,w
U bncu1nc>ylrl �y {/d/r�Wnrkcn't lilumia.
wa D°lyt=�ll�� 7 a '\PI'IinJ"1 !1 "3a ALTER OR ADD TO MECH. 5.00 BUILDING �.�
} w NUl lI'1'LIC'AN I': II,alter rocking this Cerl ilicum of li x
F- 2 "'photo you ,"It bceanne suNecu lathe Wmkeri('ompansa0al' APPLIANCE 5.00 PLAN CHECK
pnWiio
sns Elle the Luber Cute, you $trust furillwilh coulply with 7S
U nth pRwi,r.R,or ON pencil,flan be decnlad revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE
CONSTItucrm LENDING.AGENCY AIR HANDLING UNIT(OVER 10J100C-F.M.) 6.00 SEISMIC FEE
I hereby al inn tha( There is a construction lending agency fur EXHAUST HOOD(WITH DUCT) 5.00
the lucrfonnance of Ihn work lot which this pennit is issued ISac MICROFILM
1097,Civ.C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nanlc HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's All,].... HEATING 3f`Qv-
I cerlity that l have read tltis applieatiun and state Ola)lire above: 2 VENTILATION FAN (SINGLE) 4.00 ,Z--
inlonumion i, correct. I uprce to eonfly wish all city unit cowltY PLUMBING 3J
urdinanee, and slate laws ..'Lan" to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby xu0uriee represemtator, of this city to enter upon the BOILER-COMP (over 100,000 BTU1 SEE FEE SCH. MECHANICAL
-, ahyn
o ... nioncd pn4uny far inspection pugsous.
(We) agree to save, iadenmily and keep harmle, the By of MISC.- REFER TO ORD.
ICuperlinu agamsl liabilities,judge cots, costs and expelnoS which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue µ al vml City in couscyuenne of till' O
Igraulingol'I hi, Iq y n/ MECH.CONT. LIC.NO, MECH.
:L/[1 r11 TOTAL /� TOTALU o'
�Siguature ul.\pphc.ull l'untraAur le
OFFICE COPY