14318 (2) y✓'- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBER
ADDRESS APPLICATION & PERMIT
316 ADDRESS
/ Ap, BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 14318
�� OWNEN's PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
//%-A PHONE
CONTRACTON£
NAME OUTLETS-SWITCHES-RECEP 10,00/1.00
• y1�'/�-G / . .No. C LIGHTING FIXTURES 10.00/1.00
ADDRESS r/olbs '( APPLIANCES-RESIDENTIAL 4.00
L0�C/VL/I✓0GJ-G� S.J+'HONE' � jk
PANELS 10.00 DATE Of APPLICATION
OnNcHlrEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE v.c.No.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH,OR ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESSTs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
° � _ /Y3� �
F o O LICENSED CONTRACTORS U[CLAIL\TION 7
v I IN,N,by Rill.... llD 1 ant licensed under Pmvixious of Chapter 9 ISSUANCE DATE
w a n (1nnnnancing with Section 7000)of Dim,l.... 3 or he Business and BLDG. ELECT. PLG. MECH.
D'v' I'ml'essions Cod. and nn license rein lull liu}'y: tl' t ❑ ❑ ❑
oi= License CI .-��/ Lie Number_(.-� al
H m r w Date y7 Comra,tDl_�±Ly (�
a x E A I ION BUILDING PERMIT
/g •
Q w a DINNER-R UILDIiR UC('L,\RATION
° u INFORMATION
w ; n In I hereby allirnlh that I.,it exenml linnh llc Cnlll fBCtor s Lia'roMISC- REFER TO ORD
c ATION
u04 Law for the followingreason.(See,7031.5,ItminvsYanJ 1'rul'vaium PERMIT ISSUANCE 10.00
VALUS/FT.
i "' > p Code:Any city or county which myuirosa Penult Rcuir,ruet,xher,
IS a Oinhprovc,demolish,or ",it any stnnclu H',prior lu its isaunn•,'also ELEC.CONTR. LIC,NQ ELEC.
° LL rcyuires the applicant lar such peat
permit 1. ill asigncd stenRmt Ill.[ TOTAL
a w he is licensed pursuant to the provisions of The Cumruclor's License PERMIT
z a Law(Chaplcr?Iconnmcncingwith Svdiun7000lnf Divivion3ol'the ✓=
E i ° Business and Professions CoJaq or Dot In,is e,,D it the,efroln and QTY. PLUMBING PERMIT FEE
a:f es the basis for Ibe alleged eaenlPliun.Any viululi ul of Section 7031.5 STORIES TYPE CONSTR.
n by any applicant tie apermit subjects lhv eppllmuuo a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollar,(55001.1:
L-i Las owner of Ili,pro Pert Y.or my, Anlages ,u,t wages an BACK F LOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS
their sole catnprnsatian,will du the work,an plc Wn¢nIn is nwt
intended Or offered for at, (See 7044, It 8111 and I'fofvestms DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlruclor s License Law due,not apply In am owner of
property who builds or improves Ihereon,and who does sudl work: FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own cu l o,ev,pmeidvd Ilial web intpmue-
�• mems Ale'lot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or inspruvemem is sold within one year of centric lion'the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the holden of proving lilt Ile did nal build m id,- BUILDING USE
prow for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB oat.,
0 I,m owner of the pronely,our exclusively Contructinh with . .
1:1 El
❑ ❑
licensed cumraclnn m cons0un the project(Sec. 7044,Ominess LAWN SPRINKLERS-1 INC 5 V.B. fi.00 ASSESSORS PARCEL NO.
and Professions Code:The Con Ouaorl Li n•nse Law Joe,not apply
to an owner Of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
eon Vacts for S¢h project,with a c.uHrunoH,)liarvs,d pursuant to
the C'ontractor's License Law. SEWER-SANITARY-STORM EA.2006/10.00 TRACT NO, PARCEL NO.
0 IDA exempt under Sec. ,B.hlt('.for thin
rcasan WATER HEATER W/VENT 6.00
Owner Dun• WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'CO.MPENSAI[ON DECLARA IION WATER TREATING EQUIP. 5.00
I hereby affirm )hal I have a ecrtiliaul,of c do"it to eclLin sure,
or a cerificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy ill erten ft See.3800,La4C1.,
Poicy N.11 Ae C'um pan) /Q//xm/-`4f-1��
Q 0 Certified copy is hereh)'lumished' FIRE$PRINK ENERGY T Z4
Z Z ,* Certified e.", is 171. y'i)h 0y v iIU1a.�iu l�. d"Ri.,
p/ !\pplicun' `/j4a4E/{'l.�f� IFL. MISC.- REFER TO ORD. r ❑ N❑ Y ❑ No
� T C:RIIFICATE 01'Ii XEMPI'ION'FROM WORKERS' PERMIT ISSUANCE 10.00 FLOoO zoNE
W > CCI.MPENSn'fION'INSURANCE PLG.CON1
CL 'H. LIC.NO. TOTAL Y❑ N❑ Y ❑ N❑
O IThi, -,Iran nccd not be cumplenvl it 0.n Pcnuil i. tie un,
Z hLuDIIJ dollars IS 100)or lcm.l
C.7 O_ 1 candy (hut in the Petfonuuna' it the lark Inn which thi,Per
MECHANI + RMIT FEE FEE SUMMARY
LL H mit is issued,I shall nm uupl.y.any' Pcrsu..in an, nBnu,r, ao u>to �'
Ow become bj,n In the Worked Compvusa tion Law,of Califur u. BUILDING
y Dala' Applicant ALTER OR ADD TO ME Hl ,00
} 2 NOTICE 'IU AI'I'LICAN'1`. II,alio making this('crl ificwe ul Lo
I- _
colloids,you should became subject to the U orkers'Cmupa•nsatmn APPLIANCE �. J x
uch .00 PLAN CHECK
U ss onts f the hor Code, you null bodiwith cungdy wi11n
p this permh shall Incby deemed re'soked AIR HANDLING UNIT( 10 .M.) 4.00 FEE
CONSTRUCTION LEN 111NG nGIiN(-y AIR HANDLING UNIT(OVEQ0,000GEM.) 6.00 SEISMIC FEE
I hereby affirm that there is a con,dr.mon IvnJinp agency for EXHAUST HOOD (WITH DUCT) 5.00
the perfunnanee o1'the work for which this permit is ivucd(Sec. MICROFILM
3097,civ.c.L I // HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender,i Nunn(AI✓1N1�
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
I eeridy Ihal I have read this application and nate that theubos, VENTILATION FAN (SINGLE) 4.00
boonnuliun is correct. I agree to comply with all eily and county ' PLUMBING
�' • ordlnoIKES and 1111, lows relating In building coustrnmimt and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby au Ron, representatives t,1' Ibis city It, enter upon the BOILER-COMP (Over 100,0000TU)SEE FEESCH. MECHANICAL _
a buvv<ne Banc IpSSLLLLfffjjj,,hhhupe t I'or inslive Tun Purposes.
(We) a8 'eve, inJenmity ad keep harmless the City of MISC.• REFER TO ORD.
per m aF it bibilaw,,judgments, lusts and expenses which CONST.TAX
may t, w erne t,6' 1s, sail City' in comc4ucnee of tic PERMIT ISSUANCE 10.00 w
at n n i Onit. .G MECH.CONT. LIC.NO. Nip
,V �l AL
TOTAL
16 nature of Al lieaut/Commewr I on. 4s�� f
OFFICE COPY