11121 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
lr BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
r ILDING. APPLICATION & PERMIT 11121
3 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
NER'S PLAN CHECK VALIDATION
A ELECTRIC PERMIT FEE
'M PHON
C RACTORS OUTLETS-SWITCHES-RECEP 10.0011.00 /0 —
° _
LIc.No4f7z LIGHTING FIXTURES 10.00/1.00
.ONTRACTOR's APPLIANCES-RESIDENTIAL 4.00
ADDRESS I . 1 7 /
J✓ ONES- Yf Nf�Pjh{ J'f���� PANELS 10.00 O— DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 26,06 PLAN CHECK FEE P.C.NO.
OR
O
ENGINEER
LIC.No. SIGNS TRANS. 3.00
Ano'Ess ENG, SPECIAL CIRCUIT 5,66 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
fe.
APPLICANT
s MOTORS � � ! $ ' SEE
ADDRESS y/
SERVICE 4CHANIGE1 20.00
.w o o LICENSED CONTRACTORS DECLARATION C 1•:i �/ r
< U w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r O Professions Codevvud jU license is in full form fee ❑ O ❑
Z O ,"li License Class LE.•::.• Lic.Number
o m— Date 9 Contrucror
a x L � BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILD17R DECLARATION
E. ¢ w u INFORMATION
aas ;LL y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
a- E, J Law for the following reason.(Sec.]031.5,Businessand Professions PERMIT ISSUANCE 10.00 �. VALugTION $/FT.
Cade:Any city or county which requires a permit to construct,alter,
pLa Q improve,demolish,or repair any structure,prior to its issuance,also EC.CONTR. LIC.NO. ELEC.
y D¢ requires the applicant for such permit to file a signed statement that O�ifl/r.. TOTAL J Q/- PERMIT TO
E
m u he is licensed pursuant to the provisions of the Contractor's License `9E'u"ry
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