14584 (6) AYI'LICA1N I 10 FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
Bla"DINc APPLICATION & PERMIT A
�Aofless
,.C�. ) G BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 458L�
0 IVER'S
NAIVE ( IC7 PLAN CHECK VALIDATION
�,-352 ZIZ. QTY- ELECTRIC PERMIT FEE i of
PHONE (o
TRAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 ?I
NAME
uC.No. Zz` LIGHTING FIXTURES 10.00/1.00
B'S
ADDRESSREss /--�� APPLIANCES-RESIDENTIAL 4.00
AflC ) Kt�� IPHONE , 7' PANELS 10.00 DATE OF APPLICATION
HIT[Ci
OR PANE LS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,c,No.
ENGINEER
AOH ENG. LIE.NO, SIGNS TRANS. 3.00
'
ADDRESS
ESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
AnP EMP.METER OR POLE INS. 20.00 t
Wr
ADDRESS
3 MOTORS SEE FEE SCH. CL'
SERVICE CHANGE 20.00 1 r�E �t1 '
o ¢ z
00 LICHNSI(0 CONTRACTORS DECLARATION
a u u 1 hereby aIC,Nt1-1 1 on IicenmJ und.......auu of Clupmr 1)
n <w (commencing wn;I Sec l inn 70001.I DiYisiull 3 oI Ihr Business anal ISSUANCE DATE
F m 2 P ol'emil C'.d Iny Mall o is in Tull 11111)'. 1 1I,,( BLDG. ELECT. PLC. MECH.
Z z w 0 Daten.+e�/y' Lie.Number_ jam(/�% nI f IPTr pI I'll® ❑ ❑
h f UJIC L s+'Z.��'/-l� � V u
{.cif--L'011lr'JC14r. -
� eC71PERM
Q y f J
L ¢ w owNlsR-Buu.DI:R DEi'1.n RnnDN IT
BUILDING INFORMATION
w 3 n I hereby ant.... Ihat I I'll exempt Imm Ile Con racrurs Leensc MISC.- REFER TO ORD
H LL O j Law fur the I411uwi S reason.(Sec.7031.5.Busin.ssanA I'rolcs+iuns VALUATION $/FT.
Ew D
>f Lode:Arty'L'ilyorcounp'which require.saperuil to construct,alter,
¢ PERMIT ISSUANCE 10.00
¢ ¢ improve,dotnu ish, ,,repair any+H'uclum,prior lu its miancc,also ELEC.CONTR. LIC.NO. V y v v
m u requires D¢'uPPlioant for such permit In IuCLEC,
Ito a signed slucnvu bat I OTAL
o. w he is licensed Penmen to the pruvislolu ul the Cmttracmr s License PERMIT TO
HiQLaw(Chapter 9(conlmonclrtgwlth Seclion7000101I livisimt3ol the
-W/4"
Business
Business and Poll Coded nr that he is 000n,l IhnxD4nt and OTY. PLUMBING PERMIT FEE " ^ �M/')�a
in r m the beans for the alleged exemption.Any viuluriun n15ec(iun]031.5
i. 3 .- by any upplilaul nix a permit sobicca lhe;y+Plicanl III uaivll PSTORIES TYPE CONSTR.ouxlty gLTER-DRAIN -WATER
01III"'III"''lot 'lure lfive hundred doll...(S500).1: (EA.) 5.00
❑ 1,as owner of Ibe Properly,.,nl)'.'nipi as wish wagL's as BACK FLOW PROTECT. .
Illeir'.Ie Cont Pen,tiun, will do He work,and Into+IpI1n1(e Is noDEVICE 400
I,,,( OCC.GROUP RES.UNITS
intended or entered rot sale (Sec. 7044, Bo,Jr,,S and 1'mfoesioos DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Qsntr;¢(or's Licelue Law does not uPPIY l4 u,,owner ui
properly who builds or improves Ihercon,and Lou. such work FIXTURES-PER TRAP 5.00
h small nr lhrnugh hlsoWnfmplaq,".PFo'idodlh'l...It Ito Br4v e- SO.FT.FLOOR AREA TOTAL ACREAGE
moms are nor intended or offered for sale.H.however,the builJinn GAS-EA.SYSTEM-1 1 PIC.4 OUTLETS 6.00
Or bn Provcmcal is 10111 within one year of eumPlclion, Bm owner
builder will IWve the burden el Proving that he did 1101 build or Inn. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
BUILDING USE
prove 1.as Owner
of sale,il' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ L as owner of Iho pruporO',am e.d'L'((So contracting ting with ❑ ❑ ❑ ❑ ❑
licensed cornractod m curotrun tha prujcn(Sec. 7044,Ikrsin•'++ LAWN SPRINKLERS- I INC 5 V.B. 6.00
and Prol'casium CnJe'.'I'he C'un Uacl.r'1 License Lw Dues not apply ASSESSORS PARCEL NO.
to an owner of Property who builds or improves Ihemon.and who LAWN SPR IN KLERS-OV ER 5 IEA.) 1.00
co u"a"Is for still,PmjL'cls with a callrleous)Inclosed Puouanl to
the C'ontractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ I unl exempt under Sec. B.hCC.fur Illis
reason WATER HEATER W/VENT 6.00
Ower Date WATER SYSTEM
5'00 JE
ATE ACC.FILE NO.
\Co�iAERS'coAl PliNS,\"PION UIfCLARATli1'V WATER TREATING EQUIP. 5.00
1 hereby mlirm Iha1 I IWve a corlilicate 01 colulm Ie self-imun'.
or a eurliLcule of Workeri Coloper salion Insuuuac,ora«nil led NG ENG.SITE NO.
copy thereof ISec.3500,Lab C. tp
)
Policy C'onlPanY-
U ❑ ertil ied r py m b'I'
z Z C'Hil'ie yy/(J+ 111 �/,ty�ect iun division. RINK ENERGY T 24
FO PI IL'anl_j: �1�.. 4 MISC.- REFER TO ORD. N❑ Y ❑ N❑
� " n. IHFICAIFOI'ESGNIP PION fRONI woRr;Ees' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
W CONIPIi NSA I'ION IN'SURANC Ii PLG.CONTR. LIC.NO. PLG.
cl 1'fhis secllon nett] "111,
m he Com alereJ it [ha - N❑
Z I'll dollars IS 100)ur Iem.1 I 1+ennh is for one TOTAL EO) N❑ Y ❑U O 1 certify that in the perlunnmlce uI the work for which tis PerLL H mit is Mood,I shall nal rinpluy any...rsun in any nWnner su us Io QTY• MECHANICAL PERMIT FEEEE SUMMARYU wbecome uthjLal Ia Il,,Work,,,'C'on.pclH:d iunLawsoI Cuhiorniu. ALTER OR ADD TO MECH. NG O ; irn NOTICI7'I0 APPLICANT: II,aper nwking Iis C,,nicate of ISs 5.00emprion,You should becomo suhjoc(1.the\VorkoriCon......two APPLIANCE 5.00 HECKprovisions of te Labor Code, you muss b.rtlwilh eOm PIY winesuch provi+ions or Ili,permit shall be deemed nvokcJ. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONST ROCTION LENDING,AGEN'C'Y AIR HANDLING UNITIOVER IO,000C.EM,) 6.00 C FEEI hereby "Dinn Iha( there is a unstnlction lending agency IorEXHAUST HOOD(WITH DUCT) 5.00the• peD4rmmlce of te work on which this PeiiisrucJ(Sec. FILM3097,,'NonC.L HEATING UNIT(TO 100,000 B.T.U.) 8.00Lender's NumeLenderl.Wdre'ss HEATING UNIT(OVER 100,000 B.T.U.)9.50 IC
I certify flat l have read this applieatlonaid au (h
to than o above VENTILATION FAN (SINGLE) 4.00
information is aRrocl. I agree l4 comply with:d1 city and cutolly
ordinances and "alllaws relating In building colun'crion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
•� hereby amburiee reprewnlmi+es of this ciq' to enter upon the
•nrioned property for inspection Pugmus, BOILER-COMP IOwr 1Do,000 BTU)SEE FEE SCH. MECHANICAL
Oil ak e4 m rove, indelnnilY and keep IWrinlcsx 0a Cit,nt misc.- REFER TO ORD.
"Perlin. a•ailu( liuhilities,fu'Ipmcnts. Culls and eapcnscs wlicllCONST.TAX
1n
nay in un 'u)' accrue '4tc.tit said Cir,' in c.nscq"on,,o1'He PERMIT ISSUANCE 10.00
rat m LAL2✓�-� �J (j1J. LIC.NO. MECH.
`•�� 1. L L• [J[� MECH.CONT. TOTAL TOTAL
Sign' me.i APPlicam/Cunuucler Dan• I I .(�/\
OFFICE COPY IU