13882 (2) APPLICANT TO FILL IN INFORION WITHIN RED LINES - USE BF' POINT PEN ONLY
BUILDING PROJECT IDENTIFICATI - PERMIT NUMBER
ADDRESS �A,� APPLICATION &.PERMIT
. ���^
ADDRESS G
21130 ei�,n l3ow AL BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S -, PLAN CHECK VALIDATION
"arae CITY.' E. j ELECTRIC PERMIT FEE
Gfl"p6uA GI PHONF 595 .2100.
CONTRACTVR's UTLETS-SWITCHES-RECEP 10,00/1.00
NAME
G v UCNO LIGHTING FIXTURES 10,00/1.00
o
CONTRACT 'sZ - w1ti - - APPLIANCES-RESIDENTIAL 4.00
ADDRESS.
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT �}IA PANELS (OVER 200 AMP1 20,00 PLAN CHECK FEE P.C.NO.
OR -_,
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT
5.00 PERMIT VALIDATION
AOORESS
ZIP TEMP.METER OR POLE INS. 20.00 .2w
ADDRESNrs MOTORS SEE FEE SCH. „y-
SERVICE CHANGE 20.00 /s )
'0FoF_ LICENSED CONTRACTORS DECLARATION
Q U U 1 hereby affirm that lam licensetl under provisions of Chapter 9' ISSUANCE DATE
n (commencing with Section 7000)of Division 3 OC tire Business and L BLDG. ELECT. PLG. MECH.
H 0 w Professions Code,and my.license is in full force and effect El El' 0. -. Licens��f)�''�''-����--Lic.Number 0 r 0 Da[eEContractor
BUILDING PERMIT
L wu OWNER-BUILDER DECLARATION INFORMATION
W 0 e H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO,ORD,=Tt1110
3 u y P VALUATION $/FT.
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