C 9180 (3) APPLICANT TO FILL IN INF M ATION WITHIN RED LINES- USE BALL POINT PEN ON;_Y
BUILDING PROJECT I DENTI FI N ' PERMIT NUMBER n
BUILDING APPLICATION & P IT
ADOREss91180
nal 8 0
BUILDING - ELECTRICAL-PLUMBING-'MECHANICAL
` OwNER'a 1/r �� - PLAN CHECK VALIDATION
rvaME /J OTY. ELECTRIC PERMIT FEE
PHONE pma
NAMEAC OUTLETS-SWITCHES-RECEP 10.00/1.00 U
uc.No, LIGHTING FIXTURES - 10.00/1.00 JUL
AONTRACTOR'S
l aoDREss APPLIANCES-RESIDENTIAL 4.00 �� /1,•
X PHONE PANELS 10.00 ' CINA/� AAI ION
ARRCHITECT. PANELS (OVER 200 AMP) 20.00 1 'PLAN CHECK FEE P.C.NO.
O
ENGINEER "
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG.r - PERM IT VALIDATION
ADOREss � SPECIAL CIRCUIT 5.00
.2 LL�/K-F-'F"`1�1J zIvEMP.METER OR POLE'INS. 20.00
APPLICANT DRPars MOTORS SEE FEE SCH. G
A
• - SERVICE CHANGE 20.00 �y//����
o o LICENSED CONTRACTORS DECLARATION TEMP.POLE •- 30.00 I
a c,w 1 hereby affirm that 1 an licensed under provisions of Chapter 9 ISSUANCE DATE
S
r
(commencing with Section 7000)of Division 3 of the Business and n< BL G. ELECT. PLG. MECH.
Professions Codd my license is in full f< ct -
D z w p .Liccns- lass_ �_Lic.Numher ❑ 0 ED
Date-{']w4_Contractor
Mm M si �' - BUILDING PERMIT.
rc o t ° ,OWNER-BUILDER DECLARATION - INFORMATION
wg LL H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD.
H ec o a, Law for the following reason.(Sec.7031.5,Bminessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
Code:Any city or county which requires a permit to construct,alter, µ�yd\
SE an¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O W(�
ca 0 S requires.the applicant for such permit"to life a Signed statement tlml TOTAL PERMIT TO
A w m w he is licensed pursuant m the provisions of the Contractor's License -
H >
Law(Chapter 9(commencing with Section 7000)o f DPisioB3 of the
io Business and Professions Code)(it that he is exempt therefrom and OTY. PLUMBING PERMIT FEE `' �' � rI✓B571
ItH $- the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
t3 by,any applicant for a permit subjects the applicant to a civil penaltygLTER-DRAIN'& VENT-WATER IEA.) 5.00
of not more than five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'rhe Contractor's License Law does not apply to an owner at
pmpeHy who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.I f howeve,,file building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS.-,EA.SYSTEM OVER-4 IEA.) 2.00
builder will have the burden of proving that he did not build or im -OVER BUILDING USE
prove for purpose afsalc.). INDUSTRIAL WASTE INTER3000 R IND CON 'PB Door
. .
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ 13 ❑
licensed contractors•to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does 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 conlractons)licensedpursuam to SEWER-SANITARY-STORM EA.200ft/10.00
life Contractors License Law. TRACT NO, PARCEL NO. '
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Uata WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
woRKliRs'conlrENSn'f10N Dfcl.nlinTloN WgTER TREATING EQUIP. 5.00
hereby vffnm that I have a certificate of consent to sell'-insure, - `
Or a certificate of Workers Compensation Insurance or a certified ZONING ENG.SITE NO.
copy Ihereof(Sec.3800,Lab.C,). CA-. f6 -
Policy No. Connpuny .
❑ CerfiI- cop shcr rn h 1, FIRE SPRINK ENERGY TR4.
Z Z ❑' s E ' ,III city inspection division:
L Team MISC.- REFER TO ORD. Y� N� Y N� -
~ LI PERMIT ISSUANCE 10,00
:RTIFICAT GOP IiXEMP1'IONFRON WORKERS' FLOODZONE A.L.U.C.
LL �' COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(This section peeel not be completed if the permit is for one TOTAL V N� Y O N�
0 Z hundred dollars IS 100)or less.)
00 I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL ♦- mit is issued,I shall not employ any person in any manner so as to -
Ow become subject to the Workers'Compensat ion Laws of California.
0. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 6
} to NO'T'ICE TO APPLICANT: If,after making this Certificate of Iix. _
Z emptier,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must-forthwith comply with - FEE
U such provisionsor fills Permit shall be deemed revoked: J AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 ry
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE L
I hereby'affirm that there is a constructiomlending agency lir EXHAUST HOOD (WITH DUCT) 5.00
the perrornance, of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.I r _ )HEATING UNIT1TO 100,000 B.T.U.) 8.00
Lendeh Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify 11,211 have read this application and sfate'thaf the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and'state.laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon file BOILER-COMP(Over 100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned property (lnspec[ion purposes. ,
(We) agr 'va de ifykeep-harmless the City of Misc.- REFER TO ORD.
In
gamma Iia gmenls, c is and expenses which' CONST.TAX -
ma m y y a i sl said'CiI in consequence of the PERMIT ISSUANCE 10.00
Ar fill M H.CONT. LIC.NO. MECH.
7 fT TOTAL TOTAL
g ' of Applicant ontractor
Date - -
•' - OFFICE COPY ,. -