15418 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• SU I LD ING PROJECT I DENT I FICATI ON .PERMIT NUMBER
SoILDINc APPLICATION & PERMIT 15418
ADDRESS
/G';,.5w J / 1C�C(i(ti��/ i - BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
/ OwNER'S IPLAN CHECK VALIDATION
alE }r �y CITY. ELECTRIC PERMIT FEE
PHONE
usCONTH ACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
N E _,/y
-it, 62-L CSG LIC.No. ���+L��� LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
_ aooness _-ARi3 ARCHITECT
ONE/��T1�S PANELS 0,C0 DATE OF APPLICATION
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE v.c.No.
OR
ENGINEER
uc.No. ��y SIGNS TRANS. 3.00
PERMIT VALIDATION
AHC",OR E.G. ,/ SPECIAL CIRCUIT 5.00 0 -
ADDHES$
zip EMP.METER OR POLE INS. 20.00 n
APPLICANT MOTORS SEE FEE SCH.
ADDRESS /\ ill---✓✓✓LLLEE(IGGGG `/.
SERVICE CHANGE J 20.00 /�1H
er o LICENSISD CON'I'RA(TrORS DEC L\RA'fION
" D
a u u I hereby affirm Ilial I atn Ii under prm'isioun of Chillier er'I - DANCE ATE
a n (,omnu•n,ing with Section 7000)el Ui ,ilio 3 of the llmme',and BLDG. ELECT. PLO. MECH.
w i Profusions C'o .,Tji ,I,hiwense iv in full lixly' J'ty0 ❑ ❑ ❑
z o m License C _ Lie.Number
r ° Uwu �^rf -Contnclur/=/;02�CC�'-z= BUIL ING PERMIT
i `¢ a OWNER-BUILDER DECL RA no N' INFORMATION
'"" MISC.- REFER TO ORD
K 3 a " I here D)'af�i�n Ota I am exempt tions the Contranur i License I VALUATION S/FT.
" LLoa Luw fur th.fallowing reusun.(Sec.7031.5,lfusinca and Pod,,00n.v PERMIT ISSUANCE 10.00 0
Cute:Any'city or county which requires a pennit to con,vuct,alter,
¢ Q 0 improve,Aenulkh,or repair any structure,prior to its issuance,ulw ELEC.CONTR. LIC.N0. ELEC. ((•p
- °R requires the applicant for xuel,Permit IO file a signed Ilaletnent 11W TOTAL p20 PERMIT TO
n w m he iS licensed pursuant to lire Pr om.ns of the Cunlrlator i Licene
La.(Chapter')(counu'ncing with Section 7000)of Ulvisimt 3 of the
a Business and PrufenionS Code)or that he is esemo fit...iarn and OTY. PLUMBING PERMIT FEE
4 ¢ O lire basis lar the aIle J escHI f h \n lion of Section 7031.5 STORIES TYPE CONBTR.
¢ I- m Fv P tot., Y via a
Ea 1,2 by.,I,applicant for a Terror subjects life appuuuu to a elvll penalty ALTER-DRAIN -WATER IEA.) 5.00
of out marc titan❑vc hundred dollars(5500),C
❑ I.us owner of the prupelly,or I,y auphry«s with wake..+. BACK FLOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS
their ole conqummtiuu.,will Ju the work,and the suum""nut
intended or offered for .vale ISec. 7044. Itusines and Prole»ions DRAINS-FLOOR,ROOF,AREA.COND. 5.00
Code:The Qnuractor i I...cn..Law dues nalapply to an owner ill
properly who builds or improves thereon,and wC dues such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
hients re riot
ince hid awn llered for sale.H.ed)hal suw11 ibuildE -
nunta are nbou,if deJof.,Ie,cord ,,,prl6d,nwl:attthe......Jing GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or intprovemmtt n sold within enc year ut cumPlenun, th.,iwncr- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILOING USE
builder will have life burden of proving that he did nal build in II HES IND CON PB Omer
Prove farperpo,eof Yalcl. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ I,a,owner of IIIc ".p.'ty.ant enwhrtiv.'lY':hntrawliug wiW
licerocd eromaaan to mnatrun th, project tSee.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code'.'I he Contractor:Licenx Law dues nut apply
to a,,owner of properly Jr.wbuilds or improves there....,and who LAW N SPRINKLERS-OVER 5(EA.) 1.00
woidra,t,for such projects with I,contraclurbr licensed pursuant ui
tie Conuactur',Lwin,,Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam.'u'mPl under Sew. ,B.KP.('.ba Illi. WATER HEATER W/VENT 6.00
reason
Owner Uac WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0.
WORKERS'CONIPBNSAI'ION UEC'LAHA'IION WATER TREATING EQUIP. 5.00
1 hereby Alirn, thin I Lave a cemri,,de of....sent w ,It in.....` ZONING ENG.SITE NO.
or a certificate ill Wcirkeri Cotnpan,miuu Inwratn',in,a cmil,eu
copy lh.rcai(See.3x00.La h l.1. 1
Pnuwr Nn. rampant'C-L(F l_(o.1-t•
O O Certowd com i,I....hy urni,hed. FIRE SPRINK ENERGY T-24
Z 2 ..tt�� Crnd� I '` ldcd '0 he .Iy$iyt,lacct�on dicuien. MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑
O ApIT+ltt/�:. v.L'y�'tliiiC .> //��
CCN l'I[R'I'll4('AI'F OF I.XF%til1'ION)'ROM WORKERS, PERMIT ISSUANCE 10.00 FLOOOZONE A.L.0 A.
LU > COMPENSAHON INSURANCE PLG.CUNT... LIC.NO. TLG
OTAL r❑ N❑ v ❑ N❑
d ❑ I'I his xatlan need not be eotni'lcled it the "I'LIt 's for of
Z IHuo,,Jdulla,(SHARoi I-.)
U O 1 certify that in the pelimuance of the work till which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not ent"I", an)' Pwrani II u,,, mann..u.+,to
Ow bcconm sebj„1 to tire Worker,'Cbtnpcn,mlun Laws of california . BUILDING
Date Appli,aln ALTER OR ADD TO MECH. 5.00
6
tD NOTICE 'IU AN II,after making Ilii,('ailiwan,ill I:,
f" Z c,,dior,you should hcant...ubjeet to the Worker,'(......eroutiun APPLIANCE 5.00 PLAN CHECK
"o'won' of the Labor Code, you root turOtwitII , wp1, with FEE
U suwlt provisions or this permit shall be deemed marked. AIR HANDLING UNIT ITO 10)000C.F.M.) 4.00
CONS"rKUCrION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000C.F.M.) 6.00 SEISMIC FEE
1 hereby afdrnt that there i, a e.rsmmtion boding a,anwy for EXHAUST HOOD (WITH DUCT) 5.00
the perfornunce of the work for which this Permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT ITB 100,0000 B.T.U.1 8.00
Leader%Name HEATING UNIT(OVER 100,000 B.T.1-1.19.50 ELECTRIC p20 Pt7
Lends',,W dress
I eerily that I h'me mud this zppdcwlon and slate Iliad the above VENTILATION FAN (SINGLE) 4.00
infunnatiun is correct. I agree in comply with all city and wnlnny gQILER-COMP 13 H.P.or 100,000 B.T.U.1 6.00 PLUMBING
ordinances and slate laws relating w building "n"lruc Den, and
h,ob, amhonm reprocnmlives of Ih6 city to enter alien IIIcgQILER-COMP (0.,,100.000 BTU)SEE FEE SCH. MECHANICAL
abuse on,intionell pr......H,lar)holo.,tIonn Pumo,e,.
IW.O agree w w,e. indenuify' and k.eP larndes, (1h, ('ity'of MISC.- REFER TO ORD.
upcnino agaut,I habilaic,,jrdgnuouts. ,oats and .....nx,whish CONST.TAX
may41r'o'
jy a nt ' ilial said ('it, in mn>.'queu,e of the PERMIT ISSUANCE 10.00MECH.CONT. LIC.NO. MECH.
w. rOTALTOTAL
nppli:anUCunuanur U.Hc
OFFICE COPY