14430 (6) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADDRESS APPLICATION & PERMIT 3.�
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
_ NA.0 • PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE
` PHONE
CONTRACT
r OUTLETS-SWITCHES-RECEP 10.00/1.00
¢.No. QLIGHTING FIXTURES 10.00/1.00
noon ncrols - APPLIANCES-RESIDENTIAL 4.00
NEFIVPANELS 10,00 DATE OF APPLICATION
ARCIIITEC
OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. ILM
3.00
ARCO.OR ENG.
ADDRESS 5,00 PERMIT VALIDATION
11P POLE INS. 20.00noorisssTs SEE FEE SCH.E 20.00 o o LICIikSLly COKE kAC'fORS UECL.\RATION
I hereby: fmi that I ani Iicen.ad under prnvisioiu of Chatter9ISSUANCE GATE
ilh Stow. 7000)of Div6ion 3 0l Ih'Raciness andBLDG. ELECT. PLG. MECH.
z on" Pmlessions Co�I, tay y fleiue is in lull fU C• 1
m Lieeusv Class G_O_EOy -Lie Number.` 1/�� ❑ ❑ ❑
N r- w D'J I2��=�� •$�(-0111 r:Ir1Ur- _
Qy t J
¢ ¢ w u OWNER-B UILUHIL DE('Ln kA'I'ION BUILDING PE MIT
w ;LL n I hereby altirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
LLoa Law for Die FdIowinsrauun.l5ee.7031.5,uminvaa and Prulnsloln PERMIT ISSUANCEvnwnnoN 5/Fr.
� -
Code Art city or county which requires uires a pennil w construct,alter. 10.00
y
¢ R a improve,d'uwliah,or mpuir zny stniclu¢.Prior to is iawuner,alto ELEC.CONTR. LIC.NO, ELEC.
E m, tt4uires Ili'aPPliCanl IUr Such Prnnil 10 file a ai,Ii,d aaemenl liar TOTAL PERMIT TO
a w he is licensed punuum w Om prurisiuna ui Ibr Cunv:rcWrl Linn>c
HiQ L,w(Clujoe,9(cOilliill'111111,with Sc111u117000)HI Division 3 ofrha
i r O Bulla"and Pmlkmlom Code)or that h'i1 exempt tbcra4Nan and DTV. PLUMBING PERMIT FEE
¢ Ola basis for the alkgoJ a'umpliun.Any'viuim inn of SCcriun 7031.5 STORIES TYPE CONSTR.
i3 �2 by any apSf,,,oIli,a pernlit'Uliccrs the xppliaunt In a civil penalty
Of ALTER-DRAIN& VENT-WATER IEA.) 5.00
not nmm Ulan fila hood"d dullurs(SSUIJ.1:
❑ o a owner of the lW ill 0 II C 011 ct»plo IC wish wagca:ra BACK FLOW PROTECT. DEVICE 4.00
weir ed compos d Iol, II(S the ui k. ,i mr sl ruclu to a sal OCC.GROUP RES.UNITS
innndcd or ontr cJ lar sale tSoo. ,does Hot ipss and PrmtsJo"s DRAINS-FLOOR,ROOF,AREA,CO D. 5.00 O
Cole:'fb.Contractor's License Law Juca nor apply lU mi owner ut
Properly who builds ur Ingnmes lhrrnnl,and who Joca au,h W olk F IXTURES-PER TRAP 5.00 S $o.Er.FLOOR AREA TOTAL ACREAGE
himself or tluough his own.HnpIoyaos,provided that 11116 inglmse-
1^`'ata arc sol intoidcJ or olfercJ int sale.if,however,the huildF, GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
OF improvaomnt is old wilhin unc your ulcooiplelion,die own r
builder will have the nurdnl of proving Dot he did nal huild or ilii. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING 115E
prove fur pugwu ola;dr.). INDUSTRIAL WASTE INITER. 30.00 RES IND CON PB CHIP,
❑ L as owner of Ih'properl',he acdueivcly contra, ing as'iIh O ❑ ❑ ❑ ❑ ❑
licenxd <ontranod ro 111 eruct the pwjen tu. 70ee,Itiuinca LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
unJ I'rofassiuro CoJc'I'hz Conlrunnr3 Licriuc Law duo nal apply
In an owner o1 propory who builds or inglrova Iherron.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Ctutlmols lUr such pmjena with a unWaCWn.1 iC I d par.11111 Iu _
Pie Conuacmr'a 1-IVL•nu Lu W. SEWER-SANITARY-STORM EA(MM/10.00 U TRACT NO. PARCEL NO.
❑ 1 a uangn malar See ,ILA)tC.lite glia WATER HEATER rr:Iwu / 6.00
Ow n.r Dat`' WATER SYSTEM5.00
\ ACC.DATE ACG FILE NO.
N'okkliks rmlPliNs,crloN uECLn an'I'1°N WATER TR EATIII�G EQUIP. 5.00
1 hereby affirm But I Bale a eriHlme of ronsant w arlhinvil.•,
or a erldicitc al Wulkers'('oinpouat ion Illulmlllc,or a cerlilim r' - ZONING ENG.SITE NO,
X rola'Olenvl 1$11.3Sd0,LA,C.l'
O 0 C erhiiNlJP.'is b lrrby'Iund h,d. �1 'Jere FIRE SPRINK ENERGY TQe
Z Z ppl C til 1 mpy lil.•J with Dr ctp' ins . lion Jirisium REFER TO OR D. ❑ ❑ ❑ ❑
� O
APPIIcan MISC. - (.'s�V v N v N
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PERMIT ISSUANCE 10.00� CIiNTIII('TfIi UP IiSI`?II'll(1N FROM15'UkK1iK5' O'-' FLOOD ZONE A.L.U.C.
LU > CRMI'Ii NSAI'ION INMMANCL 0 CONI i. ' Llc PLG,
CL Z Il'hil xllion nal tit-
"I'd ronipklN it Ili, pennil ie lar unc TOTAL OY E] N❑ Y [:] ry❑
(.1 O Iwndred d011ers t S 1001 or ko.l -
I .emit, that m Iha perlunnuncc of din work Iiv which Ihls to OT MECH ICAL PERMIT FEE FEE SUMMARY
LL U I'll[ is oltald,I .ball nut employ any porion it alp'nmnner xI as le
O m become subject to the WorkeW Conipcm:oion Laws of Colilurnia.
a Uel. APpinanl ALTER OR ADD TO MECH. 5.001BUILDING
} w NO I'ICIE '1'O APPLICAN"r: Ii,alcor making this CCHilicam of I:,.
F E eoiPtiml,You should benrol'.xibjcl(In rhe W,Rkc'rl Comp,u.nlon APPLIANCE 5.00 FEE PLAN CHECK
prosmios OI the Labor Code, ynu nuol fnrlhwilh comply with
U such pmvisioro or Ili,pennil shall be deemed reroked. AIR HANDLING UNIT(TO 10,000CM4.0
F. .) 0
CONSTRUCTION LEN'DIN'G AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.001 SEISMIC FEE
I hereby afdnn that mere is a 101ot"'I tot le'Wiilg agency for EXHAUST HOOD (WITH DUCT) 5.00
the pedonnanee of lila work for which Bds,wrioH is iouoJ ISCc' MICROFILM
3097,Ci,C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Nonce
Lenderi Address HEATING UNIT(OVER 100,000B.T.U.)9.501 ELECTRIC
I Verify thm l hav'read Hits appl,Vul.On and veva that IIIc shove VENTILATION FAN (SINGLE) 4,00
mdonnalwit is mrrecL I agree ro emnPly with all city and county PLUMBING �a0
urdinancn and slate laws rFlalirg w building 1muU.Ct ion, and BOILER-COMP 13 H.P.or 100,1 B.T.U.) 6.00
hereby aulhorid oOpeR,Falives of this city to enter upon Iha BOILER-COMP (Over 100,000 BTU)SEE FEE SCN. MECHANICAL
above-mrntioneJ property for inspection puryuxs.
(We) agree va save, indemnity ;mJ keep harmles.v the City oI MISC.- REFER TO ORD.
uI"Ito" aguinsl Banililies,judgniame. Is and rxpcnses Which CONST.TAX
mar in ons' way a11r1 a Hi, surd ('��LL}} "I 'I,
quu�1Er1�he PERMIT ISSUANCE 10.00
and ul'lhialel til. \\ ,`^ V MECII.CONT. LIC.NO. MECH.
Da �1V( TOTAL TOTAL
' ore of Appbcunl/C� Dale
OFFICE COPY