14790 (5) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-- USE BALL POINT PEN ONLY
F
NG PROJECT-IDENTIFICATION PERMIT NUMBER APPLICATION &PERMIT - nO
IBUILDING—ELECTRICAL—PLUMBING-MECHANICAL T •Q.ZO - I PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORS - e
NOMEo �QOUTLETS,SWITCHES'-RECEP 10.00/1.00 _
ergo 1 �OAd LID No C— LIGHTING FIXTURES 10.00/1.00
C.NT CTOR's APPLIANCES-'RESIDENTIAL 4.00 1
aopOREss., q � •��( ,
x p L�elxJ 2eC LF PRONE /J,// • PANELS 10.00 ` DATE OF APPLICATION .
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P. :NO.
OR
ENGINEER - ,
ucND. - SIGNS TRANS. - 300
ARCH,OR ENG - - r BOO PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT - til
21P 'EMP.METER OWPOLE INS. 2000 - ' 'i
APPLICNT'S MOTORS'♦ _ SEE FEE SCH:
ADDS F 9 SID
' SERVICE CHANGE � � 20.00 -
• o o LICENSI!D CON'IRACTORS DECI.ARATION '
. a U 1 hereby affirm that 1 am licensed under provisions of Chapmr 9 •r '- 7 1RISSUANCE DATE
N a N. . (econacncing with Section 7000)of Division 3'of the Business and - BLD - CECT. PLG/ MECH.
D z Professions Code,and my license is in full force and effect. ,., w. _
Z 0 w o Lcense Class - I.a.Number r �- '
H w Date3-2 CoNmctor___C •-3� �Ity,o
a u f ' - )' BUILDING PERMIT -
n O a r OWNGIt-BUILDI R DECLARATION - - , INFORMATION
'x 3 C.y, I,hereby affirm that I ant ex rcpt from the Contractor's License` MISC.- , REFER TO ORD' VALUATION S/FL
u o ¢ Law for following (Sec.7031 S,tlusiness and l'rolessom, PERMIT ISSUANCE .10.00
Code':Any city or county which requires a permit to construct.alter,
-- h
a2¢ O Improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTR. 'LIC.NO. ELEC.
requires the applicant for such permit to fide a signed statement that TOTAL w"$ PERMIT TO he is lice used printout Wthe provisions of the Contractor's License _ -
Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe • t
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT _ FEE
¢ r$ the basis furthe alleged exemption.Any violation of Sect inn 7031.5 • , ' I STORIES . TYPE CONSTR.
n , by any applicant for a permit subjects the applicant for civil penalty
of not n '.. gLT,ER-DRAIN'&VENT-WATER (EA.) 5.00
mm than five hundred dollars(SS00).1 - - _{
❑ 1 as owner of me property,or my emj .y 'with wag as BACK FLOW PROTECT. DEVICE' "-„4.00 OCC.GROUP RES,UNITS
M'-
Ili it sole compensation,will do the work,and thestructure not
Intended or offered for sato (Sec 7044 Business rind Professions DRAINS-FLOOR;,ROOF,AREA,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 work FIXTURES-'PER•TRAP 5.00 SG.FT.FLooRAREA TOTAL ACREAGE
himself or through his own employees,provided That such improve-' •
meats are not intended or offacred for sale.If,however,The building GAS-EA.SYSTEM-11 NC.4 OUTL ETS 6.00
or improvmnent is sold within one year of completion,the owner- GAS-EA.SYSTEM=OVER 4 (EA.) 2.00
builder will have,the burden of proving that he did not build or int- - . , BUILDING USE
prove for purpose of sale.). - RES IND ,.CON' PBS Other
❑. I,as owner of the property;ain exclusively contracting with' INDUSTRIAL WASTE INTER. .30.00 ❑, ❑ El , ❑
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS'sl INC 5 V_ .B. 6.00 _ ASSI=.SSORS PARCEL NO.-
and Professions Code:I'hu Contractor's License Law docs not apply - _ -
to an owner of properly whit builds or improves thereon,and who. LAWN SPRINKLERS-OVER 5(EA.) 1.00
contract's for sect T projects with a contractors)licensed pursuant to, SEWER-SANITARY-STORM EA,200ft/10.00
the Contractors License Law. _ •TRACT NO, PARCEL NO,
❑ 1-am exempt under Sec. ,B.&P.C.lilt this WATER HEATER W/VENT 6.00
faason
Owner Date WATER SYSTEM 5.00 - ACC.DATE - ACG.FILE NO.
wo RKERS'COMPENSAnoN DECLARA'HON - WATER TREATING EQUIP. :5.00
I Imi,by affirm that 1 have a certificate of consent In self-itnure,
or a certificate of Workers'Compensation Insurance,or a cenIfind �,IZONING ENG,SITE NO,
co Try thereof(Sec.3800,I,ab.(7). -
IolicYNo._ --Co np:my _-_ -"
U' ❑ CertiIi d t Y is hereby f ni cd. - -
'FIRE).PRINK. ENERGY T-24
z'Z t ❑ Ceiti" copy H Iglu syjl ;the city inspect ion divas on.
O , Apphwnt • MISC.- REFER TO ORD. +ey.O N� No
,Y �
~ rn PERMIT ISSUANCE 10.00 �L3� -
cc IiR PIC , i01;HK GMPTIO - WORKERS' _ FLOOD ZONE A,L.U.C.
L MPENSAI'ION I SURANCE - PLG.CONTR. LIC.NO. PLG. 'C' El .-El
O Y ❑ 11CL O (This section need not be completed if the permit is far rine TOTAL ✓ Y N N
Z hundred dollms($100)or less.)
O' 1 certify that in the perfarmance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL E- mit is issued,I shall not employ any persona.any mann,,so as to `
U W - become subject to the Workeri Compensation Laws of California.
Q. Dare Applicant ALTER OR ADD TO MECH. 5.00 . BUILDING
} to NOTICE TO APPLICANT: If,after making this Ceniticale of Ex- _
- F ? . cmption,you should hacione snow m the Worker,'Competleation APPLIANCE 5.00 PLAN CHECK
Ira m n of the Labor Codc, you amst bolhwilh comply with FEE
Uf
such promrmas•an this Fern(shell be deemed revoked AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 ".2
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 600 SEISMIC FEE;
I hereby,affirm that there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 5,00
The performance of The work for which this permit is issued(Sec. MICROFILM, -
3097,Civ,C.f HEATING UNIT(TO 100,000 B.T.U.) 8.00
' • Lenders Name "- HEATING UNIT(OVER 100,000 B.T.U.19.50 T
Lender's Address ELECTRIC` -
Icertifythatllo 'ed the application and it that the above VENTILATION FAN,(SINGLE) 4.00
Information is correct. 1 agree to comply with all city and county - .PLUMBING Ir
hn,ti n, and stale law., relating to budding construction and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
- h r by.„eulhove al r•sintatrvu of [lin city to "it. upliu The , BOILER-COMP (Over 10,000 BTU)SEE FE SCH.E !
above-mentioned property lot inspection purposes. _ MECHANICAL
ree to save, in unify and keep harmless the City of MISC.- REFER TO ORD.against liubili ' s,judgments, costs and expenses which CONST.TAX'Caperle,i
y waypee a Inst said City in consequence of thePERMIT'ISSUANCE : 10.00 this petal .'” MECH.CONT.. LIC.NO. MECH.
3 _ orAI TOTAL tis
♦ Tg azure Ap cant/Contra D' a .�
OFFICE COPY, l
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