6726 (2) APPLICANT TO FILL. IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'%UI LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING " APPLICATION & PERMIT
ADOREss '
A�Gir�v!/r/Q(� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 6726
OWNER'S PLAN CHECK VALIDATION
""m, fi�^V �` dow
-PNoxe
CONTRACTORS r G•��l .04 QTY: &w"?t'- ELECTRICiPERMITi F,EE `
UTLETS-SWITCHES-RECEP 5.00/100
NAME.
SpA�p
sec.xO •78`{/! LIGHTING FIXTURES 5.00I7.00 1
CONTRAc OR's - PPLIANCES-RESIDENTIAL • 4.00
ADOR ESS ��►►f`
nJromx -O 0 PANELS 5.00 DATE OF APPLICATION
ARCNDECT - _ SIGNS 6.00 PLAN CHECK FEE P.G NO.
OR
E GINE /�J1� uc�'`r�r✓ SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT A
ADD Ess r7 SPECIAL CIRCUIT 5.00
L o3 C�ORObN I mil�/ EMP.METER OR POLE INS. . 15.00
wPPLlcwxT's MOTORS SEE FEE CH.
yy1YY]N A
SERVICE CHANGE10.00
woo LICENSEDCONI'RACfORS DECLARATION ''��IIJJ Mfr
u U ,I hereby affrm tial 1 am licensed under provisimrs of Chapter 9 ISSUANCE DATE
w f L (commencing will,Scene.7000)of Division�q3:yof�Lt�h{ef�B..usiness and BLDG. ELECT. PLG. MECH.
F w z Professions Cod my license is in full'f76a/'93�� -
z 0 m - Li¢nx Cla Lic.Number so- Q _ ❑ ❑ ❑
0 z 0 Date Contractors
,s O< TATF� LDING PERMIT
tr s w li euaD1:R DECLARATION iNFORMATiION
w3 LL r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD A - -
HU0< Law for the following mason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE S/FT.
Code:Any city or county which requimsa permit to construct.alter, 6.00 ^t
C w Q D Improve,demolish,or Iepaw any structure,prior to Its issuance,also ELEC.CONTE LIC NO. ELEC o(Y
D LL requires the applicant for such permit to file a signed statement Ilial TOTAL • /
d w m he Is licensed pursuant to the provisions of the Contractor's License I
F i i Law(Chapter 9(commencing with Section 70000of Dlvision3ollhe lr +a+ 'y g.' s°tA s E�dL4t'
a - Business and Professions Code)or that he is exempt therefrom and a Y. �.T'r PLUMBING3PPERMIT�"'i�S',`. ,, FEE
rc 1-m the basis for the alleged exemption Any violation ofSection 7031.5 - STORIES TYPE CONSTR.
a ; � by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more titan five hundred dollars($$00)2:
❑ Las owner of tire,property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP - RES.UNITS
their sole compensation,will do the work,and the structure is not 1
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:'fire Contractors License law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 4.00 Sa FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided(bat such improve-
mentsare not intended oroffered for sale.11,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 100 BUILDING USE
builder will have the burden of proving that he did not build or im- .. .
RES IND CON PB Omar
m 0
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.0
❑ 1',as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the Prnje•Cl(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contmetor's License Lowdoes not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
contracts for such projects with a eontractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. .B.&P.C.for Iris WATER HEATER W/VENT 4.00
rcasnn
Owner Dale WATER SYSTEM 4.00 - - ACC.DATE ACC.FILE NO,
WORKE RS'COMPE NSAT'ION DECLARATION WATER TREATING EQUIP. 4.00
I hemby affirm (hat 1 have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy t �y
PLabo0 ed p -
cryy
'tied 'oy iv'h by furnished FIRE SPRINK ENERGY T-24
Z 2 Certifie copy is flid-with t the city inspection division. MISC.- REFER TO ORD.
O Applicant _ V ❑ N❑ Y ❑ N❑
y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FL00o ZONE A.L.U.C.
LU.> - ' COMPE SA'fION INSURANCE, PLC.CONTE. LIC.NO. PLG, Y❑ N❑ v ❑ ❑
CL Z (This section teed m be completed if the permit is to,one _ TOTAL N
hundred dollar,IS 100)or less.) ' - - -- n, +rs
U O 1 certify that in the performance of the work for which this per- OT;V'.' MECHANICAL PERMIT - FEE• FIR 'UMNIAHy
LL, F mit is issued,I shall not employ any person in any manner so as to ry,
U he come subject to the Workro''CompensmioI,lows of California. BUILDING - V=
��,y DateApplic'mt - ALTER OR ADD TO MECH. 4.00
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensmion APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000GEM.) 5.00 SEISMIC FEE J-0
I hereby,affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CmC.L HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information n comet.I s recgo comply with all city ucti county PLUMBING
lip ordinances and state laws relating to comply
lith construction, and BOILER•COMP(3 H.P.or 100,000 B.T.U.) 4.00
he1,n
horire mpreseNatives of this city to"enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
abToned pr crly for inspection purposes.
ea to s ve, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cugainst abilities,jtldgmenls, costs and expenses which CONST.TAX
maway ceme against vid Ci(y In consequence pf the PERMIT ISSUANCE 3.00
grahis pour MECH.CONT.'• LIC.NO. MECH.
mss/- TOTAL "hTOTAL�"y', •(�
A nt/Contracidl
OFFICE COPY