9187 (2) 4PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION _ PERMITNUMBER
ADDRESS APPLICATION & PERMIT 9187
AOOREss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS
Stu oo �vtc
OWNER'$
NAME PLAN CHECK VALIDATION
Lee. G/- CITY. ELECTRIC PERMIT FEE
'4 J PHONE
CONTRACTORS
NAME /� OUTLETS-SWITCHES-RECEP 10.00/1.00
Af(1L120 Neo*"Ec. IuUc.No.4,d`B2_43-D LIGHTI NG FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
PTD 15JEi PNONE�{�,J-67PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ADDRESS OR ENO' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 2000.
noxa SSTs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 �e��ff I
wo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
Q o F I hereby affirm that I am licensed under provisions of Chapter 9
w 4 w (commencing with Section 7000)Of Division 3 of the BUS] nd ISSUANCE DATE
F y z Professions Co al d my license is in full f no effec BLOC. ELECT. PLG. MECH.
D i m W License Cl ss ,Z. Lie.Numb ❑ ❑ ❑ ❑
w H ate C.F1111 mr
SE a OWNIi R-BUILDER DF-CLARATI ON BUILDING PERMIT
I`xu ;LL m I hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
H u D j Law for the following reason.(Sec.7031,5.BUsinessand Professions VALUATION TUFT.
coy Any y which requiresa permit to construct, PERMIT ISSUANCE
Code:An t or county 10.00
at
SE Q D improve,dmnolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ft-0
-D, requires the applicant for such permit to file a signed statement that ELEC.
u w m he is licensed pursuant to the Provisions of the Contractor s License TOTAL PERMIT TO
rz ¢ Law(Cs,and 9(cnli,ma ode) T Section is 00)exempt theon3ofthe
en 4 o Business and Professions Code)or that he is tion of therefrom and DTV. PLUMBING PERMIT FEE
w _H the basis for the allege)exemption.Any violation of Section 7031.5
a 3 by any applicant fora permit subjects the applicant to civil penalty 6TORIES TYPE CONSTR.
ALTER-DRAIN (EA.)
of not more than five hundred dollars($500f): 5.00
❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECTDEV ICE 400
their sole compensation,will do the work,and the structure is not . .
OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, and
and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP• 5,00 60.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve-
menu are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
El 1,as owner of the property,am exclusively contracting with
licensed Contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
0 El El El El
and Professions Code.The Contractors License Low docs not Ilpply ASSESSORS PARCEL NO.
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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&I'.C.for this 6.00
reason WATER HEATER W/VENT
Owner Date WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORK ERS'COMPIiNSATIGN DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent o self-insure,
or a certificate of Workers'Compens a Insurance,or a certified ZONING ENG.SITE NO.
copy Illmeof(S .3800,LahC.l.
Policy No. --T y
O ❑ Ced dud Py rs her NS LO FIRE SPRINK ENERGVT-
Z z ❑ Ce I, co wit city inspection division. Y4
Appflean Co,,,
e MISC.- REFER TO ORD. r N v NEJ
y CERTI FICATE OF EXEMPTION FROM WORK QRS' PERMIT ISSUANCE 10.00
F 1,000 ZONE A.L.U.C.
W - COMI'IiNSAI'ION INSURANCE PLG.CONTE, LIC.NO. PLG.
CL0 (This section need not be completed if the permit is for no, TOTAL V NF] V INE]
0 hundred dollars 1$[00)or less.)
1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE SUMMARY
LL U frit is issued,I shall not employ any person in any manner so as to FEE
O Ed
U become subject to the Workers'Compensation Laws of California.pplic /
M Date Aant
ALTER OR ADD TO MECH. 5.00 BUILDING 1V� 'rb
>_ m NOTICE TO AI' mfi'T: IL alter making this Certificate of Ex-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with 4S
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10 FEE Q
,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 hereby affirm (but there is a construction lending agency tier EXHAUST HOOD(WITH DUCT) 500
the performance of the work for .
iwhich this permit is issued(Sec.
3097.Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE)• 4.00 information is correct. I agree to Comply with all city and county
ordinances and Mate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100.000 BTU)SEE FEE SCM. MECHANICAL
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Culler inst liabi4li dgments, costs and expenses which
may m eny ey ac ru, ag as aid City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
gm tinge is pr I 1. MECH.CONT. LIG NO. MECH.
TOTAL TOTAL 73
Signa ureof Appl a Contractor Uate �-
OFFICE COPY