15372 (2) APPLICANT TO FILL IN INFORMATION WITHI"N'RED LINES`= USE BALL P8' 1 NT PEN ONLY
' .:'BUILDINGPROJECTIDENTIFICATION' ' " - `PERMIT NUMBER
aUILDING APPLICATION.&PERMIT. -
ADDRESS
.;,. 15372-
i BUILDING —ELECTRICAL—PLUMBING—MECHANICAL � "
I PLAN-CHECK VALIDATION
,_�M DTV. ELECTRIC PERMIT FEE' ..
PHONE JR. -
CON gCTnR$
NAME �( e `OUTLETS SWITCHES-RECEP 10.00/100'
_ A4 iJC!N.Q LIGHTINGFIXTURES • 10,00/1.00 _
+ ' no cess rollsAPPLIANCES,-.RESIDENTIAL':" 4.00 ,
4 1�
jy PHONE ,.PANELS ' - n. 10:00 PATE OF APPLICATION '0
ORCHrtECT .
OR ` " PANELS (OVER 200"AMP) 20.00 '
PLAN CHECK FEE PENO.
ENGINEER
• 'I'Lic.No - SIGNSTRANS rx - _ 3 00 .'
ARCH,OR ENG. r' ., SPECIAL CIRCUIT' 5.00
_ AOORE45��' '.' 1 r- ' " PERMIT VALIDATION.
IY - •, CIP 'EMP.METER OR POLE INS. ` !V, 20.00 '.
APPLICANT'S. -
ADDRESS _ ^ MOTORS '. .SEE.FEE SCH. ,
J ' SERVICE CHANGE ' 20.00
a
o ¢ z- - ..
F
0.2 ;iLICENSIiD CONTRACTORSAECLARATION
al v I hereby'aftirm that I are licensed under provisions ions of Chapter 9 ^ '
G T. (Emmeneing-with Section 7000)of•Devismn 3 f lire Business and u , ISSUANCE DATE
E,O i Professions C tie, 1 'y I -• s I. m fall C ,y� fJ�p �' BLDG. ELECT.'. PLG. MECH.
' 0. - Lweree las(�_� Llc Numler, L {cH b� - ❑• ❑ ❑
o p Dam Contractor. -
am Ed I I BUILDING PERMIT
¢ ¢ w a OWNER-B UIbDC,R DECLARATION
w ;.a H,` I hereby mine that am exempt from the Contractor's License MISC.— "i REFER TO ORD INFORMATION
li0 ¢ Law"forthe followingreason.(Sce,703 1.5,Business and Professions VALUATION $/FT.
r - Cod .An PERMIT ISSUANCE .,
y;mty xcounty which mqu¢esa permdta conelrucl,alter, 10.00
¢ at 4 O Impro e,dwnolisli,o[repair any rtrpchme prior to ds Issuance,also ELEC.CONTR. ." L c LIC.NO:. ELEC a '
o u ¢quires the uppllcanl for such p nil to(Ile a sign d s[a[emont tlial ^ TOTAL ,PERMIT TO
w
d w m he is licwised punuanl90 the pr Ilio is oCthe Contri-lor's License. - i.
H z i
Law(C
9( ommencing with Section 7000)0(Division3of the' a - - - -
i o Busmetrysa and,1'rt Rssions Code)pr that he is ezuip ttliereGom and DTV. PLUMBING PERMIT FEE '
.¢ H S the bases for"the alleged exemption.Any violation of Section 70315STORIES - TYPE CONSTR-
u3 by aidmpplieant Core gerniit subJects the applicum toacivilpenatry ALTER-DRAIN "
of not morethan five hundred'dollars($500)x): (EA.) 5.00
❑ 'l as owner oC the.property or my cntploye s with wages as BACK FLOW PROTECT'. DEVICE 4:00
'
then
sole ai off shoo,will do tlm work,and tu.sUuclu[e n not OCC.GROUP -RES UNITS
intend d or off red'for sale (See 7044, Busnuss and.Pmlessioas DRAINS-FLOOR,ROOF,AREA,COND:' 5.00
lv+L y Code The Cnntr I for s Lmenee Law docs not apply t r an owner of - - -
�x. c
Property,who builds or improves thereon and wh< ams such work FIXTURES`PER TRAP 'c'`= 5.00
himself orithrongli,his own entpl yces provided that such Improves - ' SO.Pr.FLOOD AREA TORAL ACREAGE
5, tocols are not intended or DO ..if for sale'If,however,the budding G'AS-EA.SVSTEM-11NC.40UTLETS 6.00 . -
a.-
or improvement is sold'wlthin.on year of completion the owner-
±• buildcrwil)have the burdenof proving that he did not build or nn- GAS-EA.SYSTEM-OVER 4(EA'.) 2.00 BUILDING USE
-
proveforpurposeofsale.). ., - - RES ^ IND CON E Omer
❑' I;as use, f the r INDUSTRIAL WASTE INTER. )`.30.00 . ❑ ❑ ❑
p operty,am exclusively a ntruclieg with "
liamsed contractors to 'construct the proieel(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 fessiV.B: 6.00 ASSESSORS—PARCEL No.
- and Proons Cnt
Code oractor's License Law reciter apply, - - - '`
to an owner of property who builds or improves Iiereon,and who LAWN SPRINKLERS-OV ER 5 (EA.), 1.00' -
c " i
contracts for such projects with a contraclogsl licensed pursuant to -
the Comraclors License Law.', I Y-$ R A. 0.00 TRACT NO. PARCEL NO.
❑'.I ani exempt under Sec. �B.'&P.C.for this, i
reason AT R H JY-SRR
/ 6.00
,1
Owner. . .;Dale' q 5.00 - -
ACC:DATE ACF FILE N0.
` N'ORKI RS COA1PENSATION DECLARATION ^'
`- - WATER TREAT,IN E IP 50
I hereby affirm Ihnt I have a certificate of con ent to s,Ipi l,a,u,
or a certificate of Workers'Coral ensation Insurance,or a certl Cled ZONING ENG.SITE NO. ,
copy I rep (S La 0 .L J
Policy NoJ� r�rtp -
`_ 0 ❑ ,Cerldaccl copy:,herehe famished.
Z,Z , ❑ ;CertificA`mpyT iso Bled with"the`cily"inspeclion dlvisi mi. - FIRESPRINK 'ENEROYT"24'
'AOpheant ^ ' - e - MISC. REFER TO ORD. "v[] 'N� v0 NO
~ O - PERMIT ISSUANCE
LUN °CIiRt'IFICATI3OPSAIION INS PROMWORKERS" - 1000 FLoo3 ZONE-, A:L.U.C.-
CL COMI hNSAT'IOM1'INSUItANCI •• pLG.CONTR. LID.ND. PLG. - '
CL O (Ills Section mied not be cOmpleled'lif the p rmlt is for one TOTAL +-iY.❑ L N�'. Y .N�
-�� Z hundred oollars(S100)orlexs.)' -
U'O 1-c6rtify that in the perfRon iance of the work r whioh this per-' OTV _
ILL.I'_, :" run is issued, I shall not'oulploy qnMECHANICAL PERMIT FEE, FEE SUMMARYy person in any manner so as to 'x+- .
_0 W become subject to the Workers'Compensation Laws of California,
G. Dar Applwnnt` ALTER OR,ADD TO MECH. 5A0 BUILDING
tl
`} m NOTICE DO APPLICANT- IC after making this C 'fi u0.of Lx
entpt on,you should become•subject to the Work s C.... c salioo APPLIANCE - 5.00 -PLAN CHECK• - _
prsions of the Labor,Code, you must forthwith comply-with
U
so provisions
provisions or this permit shell be d"El revoked. 'K - AIR HANDLING UNIT(TO 10,000C.F.M.) *00 FEE
-; ' CONSTRUCTION LiiNDiNG AGENCY.',-" AIR HANDLING UNIT(OVER 10=6.F.M.).6.00 SEISMIC FEE "
I hareby'affirm II&t there is,a construction landin u+enc for. _
g' g Y EXHAUST (WITH DUCT) 5.00
the performance of the work for which This permit is issued(Sea MIC F
3097,CidC:). .1` HEATING UNIT(TO 100,000 B.T.U.) - B: "
_ Lender's Name
Lembei- "Addhess - '+ - HEATING-UNIT(OVER 100,00013.T.U.)9.50 E T
x iv I icrtify'ihal I have ed this apple 'lion and stale that the above - VENTILATION FAN (SINGLE) 4 00
info'mlion,is correct:I ig •e to Comply with all city and county P+
ordman es'and stale laws rePLUMBING
is building construction, and BOILER-COMP(3 H.P.or 100,0006.T.U.) 800 y t '
hereby authorize r presentatives,of this'city to enter upon the
alRrerhioned property for inspection purposes, . BOILER-COMFU(Ovei 100,000 BTU)SEE'FEE SCH. , MECHANICAL
(We)'.agree to save,'indemnify and keep harmless the City oG MISC '7. ' "`- REFER TO ORD
�- ul ertino against liebihhes,judgments costs and expenses which -
CONST.TAX
-
Day in,any way'Secure against said`City in consequence of the i- ti'v ' PERMIT ISSUANCE 1 p
'ranting oG[his'permit MECH.CONT LIC NO.. MECH: "
gnature
09 L' r "
Siof Applicant/Contractor. "a are A TOTAL
= -. L' Y
a
OFFICE COPY.' `t,.