14431 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMITNUMBER -
BUILDING APPLICATION & PERMIT 14 431
ADDRESS BUILDING - ELECTRICAL-PLUMBING -MECHANICAL _
7S-S2xdag zkvi)
OM ER'S PLAN CHECK VALIDATION
NAMLr OTY. ELECTRIC PERMIT FEE
CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1,00 (�=
NAME
Y;tz I a4p i5irc r LIC.No. ar
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4.00
O -JOILPPHONE PANELS 10.00 - DATE OF APPLICATION
RCRITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
O
OR
ENGIN EEO
LIc.Nod - SIGNS TRANS. 3.00
AR. ENG. 500 PERMIT VALIDATION
ADDRESS
ss SPECIAL CIRCUIT .
TIP ITEMP. METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w o o LICIT NSED CON7'RAG1'OR$DECLARATION
¢ v u I hereby at I Ihal I an, licensed colder pmri,ion,o1'Chapnr 9 1 ISSUANCE DATE
P- a w Connnentang wish Section 70001 of Division 3 of tire business and BLDG. ELECT. I PLG. MECH.
Nz ProfessionsCOd"Lad my license a in lull los:)',I IA.1'f}.yt r ❑ ❑
z o -
License Class- ./.0Lic.Number y_YZ].Ef_- ❑
o r° Uun•L]119ff _ConOaclorR�CMO_�G6.0-T. \.�•- - It (}
a x f 77__________ rI f`•t`OC'0 BUILDING PERMIT
¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION
Ito tx " 1'•'; REFER TO ORD
3 4 H I hereby ullirnl that I ant exempt front the Contractors Licems• MI$C.- VALUATION SIFT.
Fuoa Law for the following rclnon.ISec.7031.5,Uu,incs,and Professions PERMIT ISSUANCE 10.001/0-
0 Code:Any city ur county which requires z Penni,10 construct,aitvr,
¢ 2 ¢O inmrgvc,denloiah,or repair anY',Irt¢ un,prior m
IiiHi ua,a6
uagu ELEC.CONTR. LIC.NO. ELEC. /
G n requires the applicant for such pennit IO file a signed statenwN Ilwf TOTAL PERMIT TO
X o9 he is licensed pursuant to the provisions of the Conlnmmr's License
F 2 i Law(Chapter9(conmtenc ink w i th Sed inn 700010 f 1)1,mou 3 of f hr �T
¢ Ilusincas and Professons Codel or Ihw he is ex,nnpl Iherei«mh and OTY. PLUMBING PERMIT FEE
¢ r $ the buss for the allcgrd exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w, by any app,(cant for a permit subjects the applicant oa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more frau If,,hood«d dollars 13500).):
❑ 1,as owner of it,,property,or nhy employees with wakes as BACK FLOW PROTECT. DEVICE 4.00 oCC.,-Roup RES.UNITS
their wale compensation,will do the work,and the structure is nor
intended or offend for solo (Sue. 7044, Ilusinns and I'nAc,,iuns DRAINS-FLOOR, ROOF,AREA,COND. 5.00
Code:'file Coutmemr i License Law dues nor apply w an owner of
property who builds or improves thereon,and who docs umh work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own Hrploya,, ,nod,d,hal such improv,- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
I are 0. intended or offered for sale.It.however,Iry building
`_;.• or improvemm
ent is sold within one year of confliction,tire owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have lite burden of pros io,that lie did nut build ur ins RES IND CON PB Doer
prove lot purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ El ❑ ED 13❑ 1,as owner of the property'.toll exclusivOy contracting with
licensed contrucmrs Io canatrun the Inolae(Sec. 7044,hush... LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSES50HS PARCEL NO.
and Professions Code:The Contract.,',License Law dues nnl apply
to an owner of property who build,or improves thereon.and who LAWN SPRINKLERS-OVER 5IEA.( 1.00
cmRracls for slid,projects with a amlmcmNs)licensed pw',u'unt I.
she Contractor's Late nse•Law. SEWER-SANITARY-STORMEA,200ft/10.00 TRACTNO. PARCELNO.
❑ loco exengn under Sec. ,h„4P.G.lorlhl, WATER HEATER W/VENT 6.00
reason
Owner flat, WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKFItS'COMPENSA'IION DI..(LARA'I ION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate III curoum to se 11-moure,
or a ceniGcale of W'ork,,,Qmprcnm,ioa Insurance,or a c,Hiii,d ZONING ENG.SITE NO.
Copy X lhurro 3800,1ah.C.1.
0 N
cfic 1'0Nntfin, ( brnne"nY-E�S
Cs $y flit}}}uuyssred. FIRE',PRINK ENERGY T 24
Z z A❑ ant_d cop is lihry inspeol ion di.inion. MISC.- REFER TO ORD. v N Y N
� - COR'fIPICAIIi OII IiXISAI PTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.u.C.
W > COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG.
IL O (This trelion need not be cuntpleed it' the penult is cur One TOTAL Y❑ N❑ Y ❑ N❑
0 2 hundred dollars IS 1001 or Ivss.l
U 0 I certify th,d in the perl'oovancc o1 the walk for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- (nit is issued,I shall nm eni,loy any Person in any nrsnnch so as u+
U become subject to the Workers Cmnpcnsutiun Law,of California.
OL Umc-Applicant- ALTER OR ADD TO MECH. 5.00 BUILDING
>_ DO NOTICE 1'0 APPLICANT: If,alter(nuking Iris Cvtrdw,c or Es-
s z empNun,you should becmne subject 10 the WOrke,,Cumpcm:Itiull APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you Inco, forthwith comply will, FEE
U such pmv6lons or fills pennit shall be dn
cned Ixvoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSfRUC'I10N LENDING AGENCY AIR HANDLING UNIT(OVER IO,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there i, a cmutruetiun lending agency I'.. EXHAUST HOOD (WITH DUCT) 5.00
tire 3097ICw Cwnce of the work for which this permit is issued(Sec.. HEATING UNIT ITO 100,000 B.T.U.) 8.00 MICROFILM
,
Lender's Name
Lender',Add, HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ess
I wnHa the I bmc nI a this n comply and slate that d xbuvc VENTILATION FAN (SINGLE) 4.00
inlorllmfiun is cornet. I agree ni g to b with all city and county PLUMBING
• ordinances and sfwe lows refining m building construction. and BOILER-COMP(3 H.P.or 100,0006.T.U.) 6.00
hereby aulh.,W representmives Of this city to enter upon the BOILER-COMP(Ove,100,00081-UISEE FEESCH. MECHANICAL
above-Inentioned property for inspection Purposes.
(We) agree In still. indemnify anti keep lunnlcs tit, ("I, or MISC.- REFER TO ORD.
opirfinu against liubilitivs•jodkn¢os. 1.111 and cxpnues which PERMIT ISSUANCE 10.00 CONST.TAX
4211I.S.ul'.'o,
ay ia, way aecro- aµaina mid City in conxvluence of the
of Ibis peon- MECH.CON r. LIG NO. MECH.
/07 TOTAL TOTAL
APphcanDCmumnur �R e
OFFICE COPY