14270 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
13UI LDI NG PROJECT I DENTI FICATIONPERMIT NUMBER
BUILDING ` _ APPLICATION & PERMIT
ADDREss. ` J'b BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14270
E.YlA1L. <lt-
O 'S 1 L PLANCHECK VALIDATION
NAIVE DTV. ELECTRIC PERMIT FEE
1" "ONE 3 L c -Uv
c
AI.TnACTOR' S It) rfCn OUTLETS-SWITCHES-RECEP 10,00/1.00
Qy`{--{:dc' j Q (fl-C uc.No.4l1147 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
AOOREss
S A �v`Ln"ON,4&?,7a. PANELS 10.00 U DATE OFAPPIJCATION
AHCHrtECi
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS . 1 pp SPECIAL CIRCUIT 5.00
,\ N A ZIP EMP. METER OR POLE INS. 20.00
ADDRESS rs 1 MOTORS SEE FEE SCH.
ADDRESS
U x >- 'r;( r SERVICE CHANGE 20.00 ' 41Ee 7L✓
r
' ¢� ,
Hoo LICIiNSE CONTRACTORS DECLAR,\TION %(/�j
Sv 0 1 hereby affinn II'm I ant licensed under...visions of Chapter`I ISSUANC.GATE
N <w (contorting with SeClir t 7000)of Division 3 of Ihp Bltllllbf unJ BLDG. ELECj PLG. MECH.
N z PrOle ssiu -CoJ r rid n license is in full for y-kc
0 2 w o LixnscFrsy �Lic.Is'umbcI I 7 ❑
F L H j nallal iRl J canlruelor/-,(`J['���_• '-
¢ m ¢ a OWNER-BUILDER V.-ARATIONVVV BUILDING PERMIT
o Eau INFORMATION
W ; LL y 1 hereby affirm that I um exempt train the Contractor's Licensee MISC.- REFER TO ORD
w04 Law for the following reason.(Sec.7031-5,Blninessand Profc,,RR,, PERMIT ISSUANCE 10.00 / VALUATION S/FT.
Code:Any city or county which requires a permit to COtutnml,ilmq
2 G Improve,demolish,ar repair any structure,prior to its issuance.also E0.DDNTR. LIC.NO. ELEC.
y w m u requires the applicant for such permit to fill a signed Staicmcnl that iY .- •14 / 241
TOTAL eye RRM'IT TOO
he is licensed 9(colon to the provisions of the Contocmr's License ( V
Hwa Buwwssand Procasions Code)
with Sceli ie 7000)of Dtheren3ul the
m 4 0 Business end is alleged Code)or thus he is cion of Ibemlrom and DTV. PLUMBING PERMIT FEE
¢ F-$ the basis pli IIIc alleged exnnplibje Any violph,a of Sec tion anally STORIES TYPE CONSTR.
by any applicant lure undo,subjeasal$500).licumtoueivilprnully ALTER-DRAIN -WATER IEA.) 5.00
of not marc owner
five hundred dollen(S$BBL I:
❑ 1,as owner abbe prowill do t or my,and the
rust wages islot BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sok compensation,will do Ih.• work,and the senators is nm
intended or otlered t'or sale (Sec. 7044, Business and ProfeSSO114 DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlmcmr's License Law does cul apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided thin such iclprovo-
ments are not intended or offered fursalc.If,huwevac the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 .
or impruvemem is said within one year of completion, the ownCl- GAS EASYSTEM OVER 4 IEA ) 2.00
builder will have the burden of proving that he did art build or in - . - .
r BUILDING USE
prove for purpose of sale). RES IND CON PB Omar
❑ 1,us owner of the Property,wn exnusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
Mnsed contractors ID construct the project(Sec. 7044,Businces LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
Professions Code:'fhc Contractor's License Law does riot apply
to an owner of property who builds or improves Ihcleon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
mmruns
lheewithucmnranolullieensed'11111U11111 to
the Contractor',License Law. SEWER-SANITARY-STORM EA.200f /10.00
TRACT N0PARCEL NO.
❑
lam exempt under Sec.-,BSP.C.tar this
reason WATER HEATER W/VENT 6.00
Owner U:Ite WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'CONIPBNSATION DECL\RA'I'[ON WATER TREATING EQUIP, 5.00
1 hereby xll'irm that 1 have a certificate of consent to ,Rt inalrc,
or a certificate of Worker;Cfnpensalon Insurance,or a cert itiN ZONING ENG.SITE NO.
copy thereoffSee 3800,LablE.).
Policy No. Conmm y
Q ❑ Cerlilte cupyis here 'furnished. FIRE SPR INK ENERGY T94
Z Z Cerli(i opY i fi d ilh the city inspection divill0a
� p A icanl T - MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
���61 PERMIT ISSUANCE 10.00
Lu y CP TI PICA :PE EXEMPTION PROM WORKIi RS' FLOOD ZONE A.L.U.C.
W � COMPIiNSATION INSURANCE PLG.CUNTII. LIC.NO. PLG.
1L O (This section need cat be completed if the permit is fur one TOTAL Y❑ N❑ Y ❑ N❑
::) Z hundred dollars IS 100)or less.)
U O 1 certify that in the perturmance of the work lar whioh this par CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued, I shall not naploy xi, ..scat in any'manner so as w
become subject to the W'orkeri Cwnpensanon Laws of Calitornin.
ED Uale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE '10 APPLACANI If,alter nakiog this Certificate of Ex-
LZ emption,you should becume subject to the Workers'ComPc'nsatian APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you mint forthwith comply with FEE
U - such provisions or this penia shat;be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCT ION LIiNDING AGENCY AIR HANDLING UNIT(OVER 10)DOOC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency hir EXHAUST HOOD (WITH DUCT) 5.00
the performance at the work for which this permit is issued(Sec. MICROFILM
3097,CiaC). I H EATI NG UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UN I T(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I Certify that l have cad this application and state that the abuse VENTILATION FAN (SINGLE) 4.00
in10rnmion is rorrect I agree In comply with all City and county PLUMBING
Ordinances and slate laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
�
hereby authori
er/rc esentalives of this city to enter upon the BOILER-COMP IOvm m100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentiom•d nro erly for inspection purpwes.
(eindemnitkeep h
y RIJ armless the City kit MISC.- REFER TO ORD.
Caper no age'm li:(hilitws,Jaln s, Costs anc
d ", ues whidt CONST.TAX
�
clay- an ) ,ru aOR st sid CIE ' Con "I'll"I'llat the PERMIT ISSUANCE 10.00
gra m Iit, e f MECH.CONT. LIG NO. MECH
TOTAL.
/
Ir ' ��i'2it •� nsTOTAL
ul'A p,-ntlC'ontrunur D Ie
OFrIL'c COPY