14788 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER -
BUILDING APPLICATION & PERMIT �.�
ADDRESS D S, PdCw zS G/L BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
88
OWNER'$ tie r A G S 7 PLAN CHECK VALIDATION
NAME !7 4 `� QTY. ELECTRIC PERMIT FEE
/N 'T' PHOrvE
�S
CONTRACTORS
NAME OUTLETS-SWITCHES.RECEP 10.00/1.00
NAME z�
vT1L4j PC,; M6 uc.Nn, C -_3b LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
n'S
ADDRESS PPLIANCES-RESIDENTIAL 4.00
A () c
j' Ll ,i,,[-1 r PHONE �.r�� / /J, / PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C.NO.
OR
ENGINEER
uc.rvo. SIGNS TRANS. 3.00
ARCH,0.ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20,00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS a
SERVICE CHANGE 20.00
o o LICFNSED CONI'RAC'1'OHS DP.CLARA CION
a u u I hereby antro Iha1 I ant licensed under Pnni,i....et Chaplct. \ I �I SSUANCE DATE
H rt H (,ammencing with Section 70001.1 Division 3 ul the business end BLDG. ELECT. PLG. MECH.
I- w z I',nf.ssions Code,and my license Is in lull 1.111 end etfem. •1
2 o w- License Class Lie.Number C III.i,; rt a ❑
B z r w Dme Cmuncmr_- BUILDING PERMIT
3 7 S-
S, a a OWNER-BUILDER DECLARATION
F. 0> " MISC.- REFER TO ORD INFORMATION
w g a w I hereby Idtim .hal I not exempt front ilio fanta.l.,',Licena` VALUATION $/FT.
H LL o a
Code:Any city Or county whirhrnptiresa PCHIIil I.1.n,Intn,alhr,
2 at¢ 0 improve,demolish.or repair any structure prim 10 its issuance,also ELEC.CONTO. LIC.NO. ELEC.
Law for the following reason.(Sec.7031.5.11u,mitVand Po.lc,smie, PERMIT ISSUANCE 10.00
- O IS uc,iikes the x,pbcunl or such permit I,,til,a signed stmt cut That TOTAL PERMIT TO
n w m u. he is Iicensnl purwtunt to The pietist om..l'the Cnnlr:Ixtor's Llmnx
ri. Law(Chapmr 9(cummmticing with Section 70001.f Divi,i.n 3 of the
Business and Professions Code)or Blot be is e,aupt terellanyanit QTY. PLUMBING PERMIT FEE -
IS r o .he basis for the alleged caCmpti in.An,violmiun of Section 7031.5 STORIES TYPE CONSTR.
a
im In,any applicant for a pcHHH subjects the applicant toucivll Penally
.fuel more shun five hundred 2ALTER-DRAIN& VENT-WATER IEA.) 5.00 !.r'
O I,a,owner of the u.r,Hy,or nay eripIOyc,,with wages a+ ggCK FLOW PROTECT. DEVICE 4.00 Oce.GROUP RES.UNITS
their sole Cum Perumiun,will Ju the wails,and 1h.,..unit,,I,nal
Herded or uttered to, sale (See. 7044, Business and 1'r.&ns•unDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's Lic.m.Law one,mm ug!),m a I owner al
Property who builds or lou,ruve,Ih,rean,and whO lit,,u,h work F IXTURES- PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through bis own employ....prov,dld that such h,prove-
• menu are nut intended..eliiied liar sale.ll,however,tht building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6,00
or inmmm
tprecis sold wittin one year.f contplcliun, the owner- GAS.EA.SYSTEM-OVER 4 IEA.. 2.00 BUILDING USE
builder will have the LurJa,of proving tlly he JIJ not build uriln-
brutefeTpuq,oxof A,,L INDUSTRIAL WASTE INTER. 30.00 RES IrvD CON FB Our.,
❑ I,as owner of the Property,ant eudusively contraeling with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct Ili, project.See 7044, If ones, LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and FIVE..an,Code:The C.nt,,cmrl Li east,Law d.,,not xppfy
to an owner.t property wllo builds or improves m,rLam.:oul who LAWN SPR IN KLERS-OVER 5IEA.) 1,00
IIcontracts loruu projects withu amtoa.nsl liaroeA Punhnl°t I„
He Lx,ioWLuw. SEWER-SANITARY-STORM EA.2001t/10.00
TRACT NO. PARCEL NO
O tart rvrmpl under Sea ,E..\I'.C.ha ih" WATER HEATER W/VENT 6.00
newer
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
11'ORKIi RS'C'OMPENSA1 ION DECI.ARATION WATER TREATING EQUIP. 5.00
I hereby altar, Ilia. I have a emili,at,Of consent to sell-rout,,' ZONING ENG.SITE NO.
OF a certificate of Workers'
Compensation Insurance,ur .ertilieJ
cu PY thereat IS -000,Leb.C'.).
Policy No. Company
0 ❑ C,rille , yi,hereby lunhn>,a FIRE SPRINK ENERGY T 24
Z Z ❑ Cenili J py i+ IileJcity in>p„Tion division.
__� MISC.- REFER TO ORD.
O
Applicant- �_ Y ❑ n❑ Y ❑ N❑
F - C B'�
CP:H'I'119CA' OP E..\I:.'sllsllON IJIdRI WORKERS' PERMIT ISSUANCE 10.00 ( FLooD ZONE A.L.u,c.
LCL 0 U COMPENSATION INSOHAN(.1 PLG CONTR. LIC.NO. PLG. �� -' Y❑ N❑ V ❑ NE]Z (This ,croon need 11111 be compin.J if the permit is or enc TOTAL
hLHWr,d dull...IS 100)or less.)
U O 1 certify Ilial in the pniunn:Inee of the work for which Ills per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U .nit is i"oed.I +hall nm Cntplay alp' Peron in any'Branner sit m
m
become subject to the N'ork,F, C.mm,m,A.0 Lax,of CAI...He.
i Ume Ap,Ii,an. ALTER OR ADD TO MECH. 5.00 ;EE
ING
} w N'OI'ICE'1'0 AP13LICAN'I: If,alter making this Certiticie of L's-
F Z ell,ptian,you Shedd become,ubject to the Workers'C.nlpeosall.n APPLIANCE 5.00 CHECK
,,, sisi.n, W the Leb.r Code, you mast I..Ilovolt lmaply with
U Inch provisim,Or This pmmil,hull he deemed revoked. AIR HANDLING UNIT BTO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 C FEE
I hereby allinn Owl .here is a nmstra,Iiae cold Ig agony Iia EXHAUST HOOD (WITH DUCT) 5.00
the parionmann• .f the wu,k lel whish this permit is Issued(Sec FILM
3097,Cit.C.1. HEATING UNIT BTO 100,000 B.T.U.) 8.00
Lenders AddA HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender i dJJrea
I eer iiy that I huvr...it Ilia upplic, i.nund'toric Ihw IIIc ubo.. VENTILATION FAN (SINGLE) 4.00 _
inion iefimi is cFu c,t. I a,r,,m comply with all cirynd county PLUMBING � s
urJinaners and solo laws relatiu, ,, building emulruction. and BOILER-COMPIO H.P.or 100,000 B.T.U.) 6.00
Nb
heby aolhnrin• ¢pr...el,aw,, .t t,,, dr,' to enter upon Ili. BOILER-COMP IOVer 100,000RTU1 SEE FEESCR. MECHANICAL
a hove n L, n•J prup.'rt S'for ins Pelton Phu Pnxs.
(We) .-to 1. late, ind"no"I wuI keep hanule,s the City of MISC.- REFER TO ORD.
upertal aybin,l liabililie,.Culp mol,. ..III ;uW nPs'Ine,whidh PERMIT ISSUANCE 10.00 CONST.TAX
nmy' y' xay' acctue ,ai0 C 11' iu .amn,R TIOCI of the
TIM, I Ilhia pcnnit. MLCH.CONI. LIC.NO. MECH.
_��J TOTAL TOTAL
igna.urcu Pliu,tlCuntrector UaI 2e- '
OFFICE COPY