8319 (2) APPLICANT TO'FILL. IN INFORMATION WITHIN +RED,LINES - USE BALL POINT PEN ONLY ,
BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
BUILDING APPLICATION &,PERMIT ^ ^
N
aooREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I y
ANF PLAN CHECK VALIDATION
AM `i Y. ELECTRIC PERMIT FEE
PRO
44 7
NA Ra ons OUTLETS-SWITCHES-RECEP .10,00/1.00
' uc. LIGHTING FIXTURES 10.00/1:00
-CONTRACTOR S - APPLIANCES:RESIDENTIAL 4.00
AD RE 5
PHONIQ
- / PANELS 10.00 DATE OF APPLICATION
ORC rtECT 'PANELS (OVER 200 AMP) 20.00 .PLAN CHECK FEE P.C.NO.
ENGINEER - -
• uc.No. '- SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG, , SPECIAL CIRCUIT 5.00PERMIT VALIDATION
Zlv EMP.METER OR POLE INS. '20.00
ADDRESS MOTORS ' SEE FEE SCH. /� ,
• SERVICE CHANGE' 20.00
0 0 o LICENSED CONTRACTORS DECLARATION .TEMP.POLE .30.00
a o u I hereby.affnm that I am licensed under provisions of Chapter 9
a a (commencing with Section 7000)of Ln,",o 3 of the Business and ISSUANCE DATE
BLDG. ELECT, PLG. MECH.
H N i Pirofess
ceionsCla C license is in fiat' ❑ ❑ � ❑
o im m o Lnse Lic.Nw¢ -
a 3 J Dule Contractor
¢ w a.
OWNER-BUILDER DECLARATION BUILDING PERMIT
I'xu ;u a 1 hereby affirm that I am exempt from the contractor,License
MISC.- REFER TO ORD INFORMATION
u o a Law for the tidlowing reason.(Sec.7031.5,Business and Professions
QpQ �
PERMIT ISSUANCE
VALUATION j E/FT.
Code:'AO city orcountyrequires my ed to ol@q .
00
Improve,dtmaI151,arRpllir any SlrlCtnle,prior tU,1151S5uanc0,
also ELEC.CONTR. LIC.NO, ELEC.
So m LL requires the applicant for such permit to Ne a signed statement that - TOTAL
a. whe is licensed pursuant to the provisions of the Contractor's License PERMIT TO
iii
Law(Chaptel'9(Commencing with Section 7000)of Division 3 ofthe
4 z o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE •E]Is
M 1- $ the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant for a permit subjects the applicant boacivil penalty STORIES TYPE CONSTR.
of not more than five hundred dollms(S5001.): ALTER-DRAIN& VENT-WATER (EA.) 5.00 -
❑ I,as owner of the property,or,my employees with wages as BACK FLOW PROTECT. DEVICE 4t .00 - OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is no
intended or offered for,.IS(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND- 5,00
Code: The Contractor's License Law does not apply loan owner of
property who builds or improves thereon,andel to does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve.
mimprovnot intended oroffered
onefor year
arof Lhoweveq the the o ding GAS:EA.SYSTEM-1INC.4OUTLETS 6.00
or)der will
is sold within one year of cord diet ion,the o r am-
builder will have the burden of proving that he did not build or am- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with _� �"
IicensCd contractors to construct the project(Seo. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ' 6.00 ASSESSORS PARCELNO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
Put Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO..
❑ Iumexemptlmder See. ,B.1,P,C.for this WATER HEATER W/VENT 6.00
f
Owner Ocawner Uare WATER-SYSTEM ' 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPFNSA1'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm thai I have a certificate ofconsent luxel Gin ore,
or a certificaall---of Workers'Compensation has n ace I 1 ZONING ENG.SITE NO.
Polic
Q ❑ Certifiedcopy6 le yfumished. FIRE SPRINK ENERGY T-24
Z Z ified Copy ed it the city inspection division.
� O Ap ant ,.I ,/� MISC.- - REFER TO ORD. Y.0- N'� v❑ N�
CC - CERTIFICATE OF EXEMPTION FROM WORKERS' • PERMIT ISSUANCE 10.00 G FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE . PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y❑ NC, Y [] N[3
::) Z hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this y F per- DTV - - MECHANICAL PERMIT FEE FEE SUMMARY
ILL mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Cert ificatc of lix-
? enlplon,you Should become subject m the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE I
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00 -
CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 - SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ.CJ. - HEATING UNIT(TO 100,000 B.T.U.). 8.00 -
Lender's Name
Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above3VENTILATION FAN (SINGLE), 4.00
information n correct. I agree to comply_wilh all oily and county PLUMBING .
oNinmatio and stale laws ml.ting building construction, andILER-COMPI3 H.P.Or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city to enter upon theILER-COMP (DVB(100,000 BTU)SEE FEESCH. MECHANICALubove-mentioned property for inspection purposes.e agree to save, indemnify and keep harmless the City ofSC.- REFER TO ORD.
Cape 1 o al, Cut liabilities,judgments, costs and exPclises which PERMIT ISSUANCE 10.00 CONST.TAX
may i any w Came
against said Cil in consequence of the
gr,, t le 1 Pe 'L MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
ata a of Applican Cmumclor Date - -
- OFFICE COPY ,