11567 (4) APPLICANT TO FILL'IN INFORMATION WITHIN REDLINES -.USE BALL POINT PEN ONLY,.
: .BUI 1-61 NO PROJECT I DENTI FICATI - PERMIT NUMBER
BUILDING APPLICATION & PERMIT 11,
ADDRESS 11,567
O'aC - BUILDING-ELECTRICAL_PLUMBING-MECHANICAL
OWNER'S JJ - , PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
CONTRA CT0"' � S OUTLETS-SWITCHES-RECEP" 10.00/1.00 `
E �5Co.20'J
Llc.No. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS
a'9 O L APPLIANCES-RESIDENTIAL 4.00
ADDRESS 'p.r/ -
s PHON p / - SS� _PANELS , 10.00 DATE OF APPLICATION
APC ITECT ,
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
l.. ENGINEER " #
• uc.Nor' SIGNS TRANS. 3,00
ARCH.OR ENG, i SPECIAL CIRCUIT 5.00 PERMI1101V'
-/ ION
ADDHESs i .
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. JUL 2 ,� J
' ADDRESS -
SERVICE CHANGE 20.00 �I/ (� '
o o LICENSED CONTRACTORS DECLARATION - CI-' of�UOBftIf10
a ow I hereby affirm that I am It under provisions of Chapter 9 ISSUANCE DATE y
o, 4 (commencing with Section 7000)of.Division 3 of the Business and BLDG. ELECT. PLG. MECH.
rN i Professions Code,.ary1 y license is in full fort and effect - ❑ ❑ ❑ •
2 o m - Licensc ass 4_}_�_Lic.Numb _ -
o
.y r w Datc Contraclo '
a y - DECBUILDING PERMIT
E 2 w OWNER BUILUF.R CLA A ua['La INFORMATION
o - - MISC.- ,REFER TO ORD
E:
;°' N 1 hereby affirm that 1 am exempt from the Contractor's Licensc VALUATION $/FT.
F u_O j Law for the following reason.(Sec.703 L5,Business and Professions -PERMIT ISSUANCE 10.00
vi Code:Any city or county which requiresa permit to construct,alter, -
Qa, ¢ M improve,demolish,or repair any structure,Prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. '
_- o LL requires the applicant for such permit to file a signed statement that - TOTAL T PERMIT TO
u..w m he is licensed pursuant to the provisions of the Contractor's License 1
ar z i Law(Chapter 9(commencingwilh Section 7000)of Division 3 oflhe
a Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT •+FEE
¢ moo the
basis the alleged exemption.Any violation ofSection7031.5 STORIES TYPE CONSTR.
a'5 0 by any applicant for a permit subjects the applicant to a civil penallyALTE DRAI ENT- ATE EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 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 NITS
RES.U
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 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,wmrk FIXTURES-PER TRAP 5.00 �, SO.FT.FLOOR AREA TDTALACREACE
himself or through his own employees,provided that Such improve-
�.�,� merits are not intended or offered for sale.If,however,tirebuilding GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,Ute owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build prim-
' prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - RES IND CDN PB Omer
❑ 1;as owner of the property.am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the projecb(S'e.7044,Rosiness LAWN SPRINKLERS 1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thireon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with o contracbms)licensed pursuant to -
theContractorsLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00TRACT NO. PARCEL NO.,
❑ lasdexemphunder Sec. ,B.&P.C:lilTlllisWATER'H EATER'W/VENT, " 6.00
reason
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0: .
WORKERS'COMPENSATION Df:CLARA'I'ION' ': WATER TREATING EQUIP. - 5.00
hereby uf0mithat l hovel,ceHilicnle of consent to Fclf-iluure,
or o certificale of Workers'Con... ..,linn 1,1 r'ntV,or a earl it icd ZONING ENG.SITE NO.
copythercq (S 380 a1 ) -pJl
§Q ❑ Certified copy is hercUy(Pat Slier. FIRE SPRINK ENERGY T-24
-z ZO •'Ce d copy is d with III. city ins Ion division. : MISC.= REFER TO ORD. '❑V N C] EJ. N❑
can ;A V
M �' 'I'FIC 7 i IiXIi MI"I'ICIN I'ItO WORKEi S' PERMIT ISSUANCE g0:00 / FLOOD ZONE A'.L.U.C. .
Ill > COMPENSATION INSURANCE,•; LC.CON>j C. 0 PLG.
CIL o (This section need not he conspleled if the pennil is for one IV TOTAL V Q N❑ V❑ N❑ .
Z hundred dollars($100)or less.) -
L) 0 1 certify that in the performance of the work for which this Par OTV. , MECHANICAL PERMIT FEE FEE SUMMARY
lL F mil is issued,I shall not employ any person in any mariner.ur us,lo
U become subject to the Workers Compensation Laws of California.
But ])ate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
.} to 'NOTICE.TO APPLICANT: If,after making this Certificate of Ex.
emption,you should become subject to the Workers'.Contpensutioll APPLIANCE- s 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGI7NCY AIR HANDLING UNIT(OVER IO,WOC.F.M.) 6.00 SEISMIC FEE
1 herebyaffirm that there is aconstruction leading agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.)� - �' '_ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's'Address ELECTRIC
I Certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 -
1 information is correct. 1 agree to comply with all city and county PLUMBING
.ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 -
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property fo ection purposes.
(Wep agree to save, i ,.y nJ keep harmless lire City of MISC.- ' REFER TO ORD. -
Caper o against Bubi'ms,judg •nls, costs and expenses which pERM1T ISSUANCE •10.00 CONST.TAX
any way ace a agai said City in consap Bee o the
r(this erns" . MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL /
Signature ofApVcamIJC.GIGactor ate
OFFICE COPY