Loading...
C 7217 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NO PROJECT IDENTIFICATION MIT NUMBER ILDING APPLICATION & PERMIT 0217 ADDREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL --> z A" OWNE - a d�A, A Y^" R PLAN CHECK VA61DATION NAME �/ / L - o ir,�.� e EeyT<Ai v(eaMi � ` G PHONE AYi nb "Mv...'^"T fJ' "i'+d.i 'VPr '�y..•-.... CON oRs UTLETS-SWITCHES-RECEP 5.00/1.00 w�4t- JZkf uG.No.//p 1?Z LIGHTING FIXTURES 5.00/1.00 CONTRACTOR' /1 ��� PPLIANCES-RESIDENTIAL 4.00 ADORE ` PHONE 7 GATE OF APPLICATION �a L PANELS 5.U0 ARCHITECT SIGNS 6.00 PLAN CHECK FEE .C,NO. OR ENGINEER -' uc.No. SIGNS TRANS. 3.00 ARCH,OR ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 APPLICANTS MOTORS F SEE FEE ADDRESS (� SERVIC ANGE_ 10.00 / w a o LICENSED CONTRACTORS DECLARATION -� a u I hereby affirm that I am licensed under provisions of Chapter 9 L&CiAi4CE DATE n a N (commencing with Section 7000)of Division 3 of the Business and LI :❑y BLDG. ELECT. PLG, MECH. H z Professions Co Own cow is in full fore .fes z o m - Licel'k�Lic.Number -� '❑ © KJ 9 m r w Ualc Contractor a w OWNER-HUB-DER DECLARATION IgFpRMA 10 �. w ;LL I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LLov, Law for the followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION SIFT. Code:Any city orcounty which requinsa permit toconstruct,alter, 5'� _9s . "_ �. improve,demolish,Dr repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. `'l D ¢ requires the applicant for such permit to file a signed statement that TOTAL n w m" he is licensed pursuant to the provisions of the Contractor's License PERMIT TO ria Law(Chapter 9 fcommencing with Section 7000)of Division 3 ofthe Nb--Ai ' "d'< '^-' °.'v' 3 e'r"! 1 S`WG,yv`1/z1/C z D Busmesa and Professions Code)or that he is exempt therefrom a d CTYy Y�} PLUMBING PERMIT ' �PQEy R F ❑te basis for the alleged exemption.Any violation of Section 7031$ '3i':wT'Y. Il , ,? ,1N':Y.•1u�-.i• SYi'! �C'%' �=.mN51. tI STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) Cut not more than five hundred dollars . (1500).1: 0'"z/•✓ ❑ ],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 SO.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- TrentsarenOtintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 4.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 7.00 BUILDING CASE builder will have the burden of proving that he did not build or im- proveforpurposeofsale.). INDUSTRIAL WASTE IN'[ER. 20.00 RES IND CON Pe Om., ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner o;property who builds or improves thereon,and who LAWN SPRINKL .-.OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. SEWER-SANITA V-STORM•EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ tum exempt under Sec. ,B.&P.C.for This WATER HEATER W/VENT 4.00 Owner Date WATER SYSTEM -D k" ' 4.00 ACC.DATE ACL.FILE NO. woRKF- s'c PENSA'rloN DECLARATION WATER TREATING EQUIP. 4.00 1 hereby atllrm the have a certificate of consent to self-insure. ZONING ENG.SITE NO. nr a certificate%o' rkers'Compensatio Insurance,or a certified copy therm 3RW, 'b.C.l. �o1],,fy N y' Col ny O yJ Q ed Jap is re FIRE SPRINK ENERGY T 24 Z 2 rr'LLL444 Cr a Ico Y I- i 'vision. F- O Applicxl MISC.- REFER TO ORD. Y[3N❑ Y ❑ N❑ L5 PERMIT ISSUANCE 600 '! FLOOD ZONE A.L.u.c. X - CERTIFICATE OF EXEMPTION FROM WORKERS' . LU > COMPENSATION INSURANCE PLG.CONTFL LIC.NO. PLG. 'i Y❑ N❑ Y❑ N❑ CL a (This section need not be completed if the permit is for one TOTAL 6. Z) Z hundred dollars151001 or less.) . + Jr, tae rt 4y u It, �+ ` �{ U O I certify that in the performance of the work for which the per DTY. -! MWHANIDAL PERMiT y' ++��V, /PE 4.f.L'P-FEE iBUMMABtl.,33 LL H mit is issued,I shall not employ any person in any manner m as to s�S(f 'F,„f sikt!ir5.5°3i�.r��Ls9`x A`..x`vp'- -i y`, w„*, r Q w become subject to the Worken'Compensation Laws of Califamn. 4D a Date ApplicantALTER OR ADD TO MECH. 4.00 BUILDING } to NOTICE TO APPLICANT: If,:Ifter making this Certificate of Ex. F ? cinption,you should become subject to the Workers'Compensmiun APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IO=C-F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVERIOADC.F.M.) 5.00 SEISMIC FEE f •� 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,Civ.C.). HEATING UNIT(T 100,000 B.T.U.) ;4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 / Lender's Address ELECTRIC I Jerliry that 1 h ea is application and state that the above VENTILATION FAN(ISINGLI, Ieltit 0300 information is rrecl. I agr a to comply with all city and county PLUMBING , ordinances a stale'laws lat"S to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 herebyau[ rize repre tatives of this city to enter upon the bove-r caned pr y r inspec 1 BOILER-COMP IOwr 100,000 BTU(SEE FEE SCH. MECHANICAL a fopurposes. (We) ee Save, indemnify nd keep harmless the City of MISC.- REFER TO ORD. , Cupertnit Bad" s,judg not, costa and expenses which CONST.TAX ma anyac a gains id Cit 'n consequence of the PERMIT ISSUANCE 3.00 gr g of This ' MECH.CONT. LIC.NO. TOTAL MECH. S GO �./gna rc � r OFFICE COPY '