14560 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY C."l
'BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ' -
AELG
DDRING APPLICATION & PERMIT A b^ O
AooREss
S i i r w -- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL (�,
OWNER'S
NAME PLAN CHECK VALIDATION
DTV. ELECTRIC PERMIT FEE
i'(FrL
so NAIVE CTORS
NAIVE jOUTLETS-SWITCHES-RECEP 10.00/1.00 j -
n3
LIGHTING FIXTURES . . 7
ADDRESSGOHTHACAPPLIANCES-
C�*� PPLIANCES-RESIDENTIAL 4.00
3393 f �( ? ��✓ MONIS Jv-Jyyy PANELS 10.0D lloPLAN�Q DATE OF APPLICATION
ARCHITECT CHECK fEE P.C.NO.
ofl 3Z PANELS (OVER 200 AMP) 20.00
NGINEER
LICrvo. SIGNS TRANS. 3.00
ARCH.OR ENG,
ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
bP EMP.METER OR POLE INS. 20.00
ADDE55Ts MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 J
r o o LICENSIiU CUN'I'I<ACl'UI<8 DECLARATION -FH�• ^ To I DNP. no'L/ } 3/"
aU 1 herrb)'affirm Thal I illi licensed under prurisiu is of Chapmr 1) R-S$-31r N Q L�1155UA/NCE DATE
z m - - Ile H 1-Ib-faloN CuP
m a A Icummenemy with Seel inn 70001 Of Di,most 3 of the B.,b so and BLDG. ELECT. PLG. MECH.
D Ioside"ms Code and n Inc t D-31 �O NP' - 6Jyo 00 -/pl eNP,
I- i >' u is in lull lu 111J yh.fl.�
Om Linase Claa.__C_I_Q e1Lic.Nunlhrr �$.b73_-
Dafe GDIltmctDr_ u.L((a�r_CLdeAlRT i o 7�+ ❑ ❑ ❑
Q u
I, A
¢ ¢w OW'N I.RB UI LI]IiR DECLARATION BUILDING PERMIT
w g N I hereby'affirm lino I aI I cacnlpl from the Conlrmwr'.Liccn.c
MISC.- REFER TO ORD INFORMATION
! 00 Law fur the Gl luwinN le:uull.lSrc.7031 S,Il u.incsvdnJ l'rolcrinn. VALUATION
t - PERMIT ISSUANCE $/FT.
10.00
Code .Any Illy ur county whicll rcyuiw.x Pannif m aon.bucl,idler. /V
¢ ¢ Q O impinve,Jclllnliah,al re,co any allurrurr,Prior to its ivuUn;e,alio [ EC.CONTIi. LIC NO, _
o as
I, rryuacs The al,pi caul fur ouch Permit In file o signed sl:Renlrnt Illy 1. �f ELEC. ] ( L
a w m Ile Is licensed p,I esu and lu Ille provi5iulb V Iht'('011leti lur'1 Lirclla[ 11„ ^C/R� .3 TOTAL 3,5 V J PERMIT TO
� zrt Llw(Cllapmr y(culnna'Iming x u ll S,,Iion 7000)u f Dwi.iun 3w Ole
s z o Business and Prntbsslon.Code)or root hr is vsenya tllaelium and OTY. PLUMBING PERMIT FEE
I. r$ the balls HH tilt alleged""Him...t.Any'talar moll is S"tiun 7031.5 STORIES TYPE CONSTH.
u 3
if
note[hil1rise undreddojeAsl hcappli:unnua resit pe Holly ALTER-DRAIN VENT-WATER (EA.) 5.00
of an more Than rise LumOeJ Julian U.i001di
❑ I,us owner of fhr pr.Nrl or my enyslo,ec.with wage.as ggCK F LOW PROTECT. DEVICE 4.00
their sole Conlpen.al ion,will to Ihr xurA,olid its,alrucl ore is nnl OCC.GROUP RES.UNITS
Inlnuild or oObr,d lin A, (Sec. 7044, Hu,H.... and PoH,aaiuns DRAINS-FLOOR, ROOF,AREA,CON D. 5.00
Code '1'b.•Conlurrur i Li;nec I.a.dues uoI apyly la on ux'nel nl
Propertywins builds ur ingnova Ihc«un,and who Aue..0;h suck FIXTURES-PER TRAP 5.00 so fT.fLooR arpa TorAL ACREAGE
Ilinsell or Ihr..,h Ili,own cn,d........... A Ihnl such sae
mens are liar intended or uf4•rrd til at,.If,hoxevar,the huilJ11Ig GAS-EA.SYSTEM,1 INC.4 OUTLETS 6.00
improvvnmol s wdd within one year of emn'Her
I.,;,,
.n,Ibc a GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
bum Wer will have the burden of prising that he did nut build or inn- BUILDING USE
prove for purpoe oI sall.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON pe Orrle+
❑ I,a,owner ul the Properly,ant...I.,vel)'con Nunillg witll ❑ ❑ ❑ ❑ ❑
licensed contractus to construct the project IS,,. ]Day,Ilusitn'ss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Cnnlracun's LiaMx Law dues nut apply
In an owner of property who built,or Improve.Ihereun,and who LANJN SPRINKLERS-OVER 5(EA.) 1.00
1.HHacn for xmh projects with is cuntraclorl s)licensed pursuant to
the CunOxclorl Llovmc Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO. PARCEL NO.
Cl I alit eacmpf under Sea On this
lire son WATER HEATER W/VENT 6.00
Owner Ulnc WATER SYSTEM 5.00
ACC.DAT[ ACG FILE NO.
x'O kKIikS'('OMPEN'SA"PION DI.('LAWYIION WATER TREATING EQUIP. 5.00
1 hereby shirt, Ihat I hive a certifieam of cHHwHi In scl,in.um,
or a cerllficule of Worker.Cnnlpenaatian Inwrunec,or a e,,Iiti,d ZONING ENG.SITE NO,
cup,thereof(Sec.3800,Lah.C.I
Policy h'oQDD_QConlpany_CJTetiiva
O ❑ Ce•rtated up) is hrroby lunl'belf, FIRE SPRINK ENERGY T@A
Z Z ❑ Lenilirll-mop 111eJ I�/ he rily inspvcliun Jivi.iun.
P: O Applicant ,L� 1 `'ya y/�(, MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
CC H C'ERTIPIC\TECIF EXEMP•HON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COAIPENSA'1'ION INSURAN(F PLG.CONTR. LIC.NO. PLG.
CL 0 ('Rhin section nerd nal be eurn,focd if IM Penlut is int' oI TOTAL Y❑ N❑ V ❑ NE]
:) Z hand«d dollars IS l U01 ur lc...)
U O I certify that in file perloHnince of the work Ibc whicll til is per
DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued, I shall not cmpluy any penml in any Ino neeror m w
bore subject m Wel,licasri Cmnpusvion Laws ul Culilumi.I.
0.W Dale ICANI': 1 ALTER OR ADD TO MECH. 5.00 BUILDING
} 2 NO1lCli'f0 ,\I'1'LIG\Rete: II',alter making firma Cenil'ieate ul'li"-
I- _ anPlion,you should become subject to file Worker.Compensaliun APPLIANCE 5.00 PLAN CHECK
pruvisiws of it,, Labor Codem
, you nit Ii6lhwifh comply will,U FEE such provisions or This permit shall be deenmd revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONsfkUCl'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE
I hereby afl'irnl that [hue is a culut,u,,iun [coding agency lilt EXHAUST HOOD (WITH DUCT) 5.00
The perforinunce ulGlr work for whin III,permit is i....I(Sec. MICROFILM
3097,Cv.C'). HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lc.Jrr',Add.... HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC 3 fz(y'Ico
I "'Mill that I hove read ollsuppli'Ami and.Iatc owl the above VENTILATION FAN (SINGLE) 4.00
nfOnnalitHi is correct. I agree IO comply with all city and county10 PLUMBING
oudinanees and .tate laws Wiling m building eonstruninn, and BOILER-COMP(3H.P.or100,0008.T.U.I 6.00
hereby aulhori,c represenlaiYes of This city ID enmr upon the BOILER-COMP (0vm 100,000 BTU[SEE FEE SCH. MECHANICAL
uboveanenliuned property for inspection purposes.
(We) agree m save, indenmiiy and keep harmless the Clp of MISC.- REFER TO ORD.
upenino against liabilities,judgmmrl.. cuss mHIT rxprnw,which CONST.TAX
May in -try way accrue against vid City in cunxyuenn• of lire PERMIT ISSUANCE 10.00
Tng ul this pennfl' MECH,CONT, LIC.NO. MECH.
TOTAL TOTAL
nature ul Applies
Kiss,or a role-
OFFICE COPY