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BU LDI NG PROJECT I DEN11 TI FICATIONAPPLICATION & PERMIT PERMIT NUN14EN
' - BUILDING
nDDnnESa ___ 12'12 5
'�L,B LJ L.Ij .- .r p BUILDING - ELECTRICAL-PLUMPING -MECHANICAL
owlvER'$ 1ICl 140& ELECTRIC
PLAN CHECK TION
NOME (�
RRTtIILR HR(iA2 OTV. ELECTRIC PERMIT FEE
PIIUNF
f.DNT11nC1U11'S
rvnme OUTLETS-SWITCHES-RECEP 10.00/1.00
14-A'S 5 N uc_No.. ���`/ LIGHTING FIXTURES 10.00/1.00
CUNTRACIOR'S
AODREsis �/ PPLIANCES-RESIDENTIAL 4.00
J 1\ PRONE 1�' PANELS 10.00 I DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE Y.C.NO.
ericmeee PANELS (OVER 200 AMP) 20.00
LOC.No. SIGNS TRANS. 3.00 / G-
ARCH.ORENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
All, TEMP.METER OR POLE INS. 20.00
I
APPLICANT
MOTORS SEE FEE SCH.
y ESS
APPNA D
SERVICE CHANGE 20.00
F O o
LICENSED CUN'I'14\CiORS DECLARATION
a �+u I hereby affirm than I ant licensed under Provisions of Chaplcr'I ' ISSUANCE DATE
„ , u Ieonunrncing wt.Seen..,7000)0l'Division 1 of the Rusincse amt tlLOC. ELECT. PLG. MECH.
h i Prufessiuns Co"e,and lily license is in tall force and et fen. :I ❑ ❑ ❑
o 0,AW Li,vRw Clan I.ic.Nwnber_ J
f Dan - Contractor
M¢ x ` J I�¢ ¢ a (IWNIi R-II I111.UIiR DIiCLARAI'ION BUILDING PERMIT
o u INFORMATION
w ; „ I hereby 1'I'inn Ilial I um excugn front the Contractors License. MISC.- REFER TO ORD ;1
u 0 ¢ Law lar line following re:uun.(Sac.7071.5,Bminess and Profess...... VA wAMON 3/FT.
r - PERMIT ISSUANCE 10.00
Cole:Any city or counly
re,which squirese pennil toconsttan,,also
F n G innProva,"emoliab,err rcp'aih any atn¢'lurc,Prior ler its issuance,u(1. ELEC.CONTH, LIC.NO. Y
¢ n O
O¢ rrq uires the uppliomu I1.such permit w lilt a signed.wlanuat trial 1 11 TOTnL /
n w m he is licensed Pursuant to the Provisions or the Contractor's L cents' ��// TTPERMIT TO
r z s- Law(Chapter)(cononencing wilt Section 70001 of Uivisiun 3l,(the TYJ lJ�7L p�V
Y ¢ o Business and I'mtesslons tomo of Ilial he is violation
em...170 ud QTY. PLUMBING PERMIT FEE
¢ H o IIIc basis fm Inv ullek'c"eunl Plian.Any viul'at ion of Seel ion]U1 .5 SrORIES TYPE CONSTR.
A ? by any applicul Iorl Permit subjects the uPplicanl to a civil Penalty
ALTER-DRAIN& VENT-WATER IEA.) 5.00 1;
l,f nut limn•Wan live bund¢"lunars(o,'in):
❑ .Ice owner ,n Ibc will do(t,imy Band file with woI,R. BACK FLOW PROTECT. DEVICE 4.00
their sole cuiupenvtion,well Ju the wad,and the struelurc i.nut ,I OCC.GROUP RES.UNIT
intended or utivr,d for sale (Sec. 7044, Business and Prufellion. DRAINS-FLOOR, ROOF,AREA,COND. 5.00 1'
Code:The Connac Wr', Lleense Luw does it.,apply to an owner l,1
properly who builds or improves thereon,and who docs such wurk FIXTURES-PER TRAP 5.00 $0.FT FLOOR AREA IOTAL ACHFAGE
hinudl re RH Intend,,]
his awn emp;u lo, all.
1i, that such ila......fr,
menell. Mol inwn Jedvon lfemd ler sulc.N,ed(bal such
building GAS-EA.SYSTEM-11NC.4OUTLETS 6,00
imProvemuv is 1.111 within 111 Teal of I npletnn,the owl In GAS-EA. SYSTEM-OVER 4 IEA.) 2.00
builder will have the Broken of jolting Dml be di"nut build err IIIP BUILDING USE
luove lar pugmu ul lade.). IT 5 IND CON PB Umn
❑ I,as owner ul Ihr pmpuly,cent exclusively cul,ening with INDUSTRIAL WASTE INTER. 30.00 ❑ E3 1:1 ❑ ❑
licensed cantrnetors 10 Construct the project(See. 7044,ISrshic s LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 1!A55LtCi RSYARCELNO.
and 1'1061113.11 Codv:'I'll,Can tractor's License l.uw does nut ap Ply
In an ownar of properly will,builds or innproro thereon,and who LAWN SPR INKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractuts)licenuN punuaol to SEWER-SANITARY-STORM EA.20011/10.00
Ile Contractor's License Law. a TRACT NO. PARCEL NO.
❑ I um exempt under Sec..,B&P.C.fur this
naw WATER HEATER W/VENT 6.00
_ f
Own -�..�(,L.._- Rate /_/ WATER SYSTEM 5.00 i' ACC.DATE ACC.RILE NO.
WORKERS'COM TzNSn1'ION oT:CLARn1ION WATER TREATING EQUIP, 5.00
I hereby alliin) that I have a cerlilicaln ul cunxml m selGinsurc,
or a uti0cwe of Wurkeri Cu m pcnsd;un Insurance,uI 'I ccRil ted ZONInG ENG.SITE NO.
c."y`Wurcut l Sec..1800,
I'nliey Nu. Cutinlwny
O ❑ Cenihed ropy is hereby llnnixhed' FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is Bled with the city inspection division. MISC.- REFER TO ORD. I
O Applicant Y ❑ N E] Y NE]
� LA CERTIFICATE OF I iXENIPTION FROM WORKERS' PERMIT ISSUANCE 10.00 1 FLOOD ZONE A.L.0 C.
LU > CONfI
II'I:NSA' UN INSURANCE PLG.CONTH. LIC.NO. PLG. I OL v N Y
Z N(This section need not be cunhpleted it the Permit is m for mTOTAL
hurried d.Ik rs(S 10(1)err less./
U O 1 certify Ih t in the perfurmanee ul the work lin which Itis p1 r- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- Ionil iss sed,I sluts not eli lity any pmn
person in ahoy annco as ler
U w bccanaatoned thr A
ler e Wncri Cuum
gensalion Laws it Califniu. Z
o, Lime APplloun BUILDING
�- to NUI ICI '1'0 APPLICANT: 11,ager making this Certificate of Lx- ALTER OR ADD TO MECH. 5.00 G.'K
F Z empliun,you should becun¢subject to the Workers'Cohnpensalimh APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Colic. you In B,l lon1twilh cunhply with FEE
U .oilprovisions or this Perini,shall be deenwd revoked. AIR HANDLING UNIT ITO 10,000C.F.M.) 4.00
CONsTRUCl'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE �U
r
I lIalor affirm blur Were is a hick this p ilii is s ed I lip EXHAUST HOOD IWITR DUCT) 5.00
the per NC.)ntt of elle work for which this permit i.issued ISec. MICROFILM
3097.CNC.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 H
Lender',Name
LcnJcri Ad"Mss HEATING UNIT(OVER 100,000 B.T.U.)9.50 _ ELECTRIC
I certify Iba(I have rend this application and stale that Ibc above VENTILATION FAN (SINGLE) 4.00
mtornmldir is correct. I agree to conhply with All city and cowry PLUMBING
ordinances and state laws relating; to building construction, and BOILER-IbMP(3 H.P.or 100,000 B.T.U.) 6.00 I /
Ileleby oulhoriec representatives of this city to enter upon tire BOILER-COMP (Over T00000BTU)SEE FEESCH. MECHANICAL
abovcnemioned progeny tar in,"tir,p.,,o.s.
(We) agree to save, mdendi y and keep hamtess the City of MISC.- REFER TO ORD.
CuPenino against liabilities,judgnents, cults and e.apenses which CONST.TAX
11 n vly way accmc ger nI said City in conscquclal of the PERMIT ISSUANCE 10.00
lilt
anlin of Ibis Penn it. / MECH.CONT. LIC.NO. MECH.
� h;ll;7 TOTAL t TOTAL .
. ,L2 1
1 Ignalurc ul dPpbcunl/l'outruelur1 Dale