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1243 (2) PERMIT NUMBER , . APPLICANT , FILL IN i STREET ADDRESS OF PROJECT: •UIr.�OL/ O'f'• �Lf•�. Plans Received By........... .................. .........Datel/_ .. .__ Legal Description: Tract. . ........... ...... Block............ Lot...................... REO.: Plans.... Survey.... Calcs: Struc Energy.... Elegt. ech... Description of Work: .f�iEMDQ/.E. :........._ .................. b Plans Checked By..........f.�.(�...... �,/ Date . �'. . .... let Struct. Improvement on Parcel: Yes.... No.... Area of Bldg........../..J. Application Approved By................. /L Date .... _�S'.-.ZA) Separate Structure........... or Addition/Alt ation to Exist. Bld. ....... Validated B �..... .r... By ................................................ ....Date ............ No. of Stories...../......... Use of Building �iLf(Le....r.....S�Gt.f'a....... Compensation Certificate Verified By Date ........... Valuation.�ojj Project: $.. ./ (....)_...................................... .... .....:,. Mli-.l It a , , . . , $ �. �b ...... Owner: MW .7?...i'7_. A/_...................... Phone.:L7AS ' r p 0-f1 Contractor: __ .. ... . ....... City Bus.Lic. e..__...__................... Permit Fee (plus penaltyIf a licable $... .....r..... Address: ...._... ......................... Phone:.................... Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... Contractor - Electricalecirlcal: ................................. _.......... Energy Plan Check Fee (Dep. of $........ Rct. #........ ............... ....... City Business License 4.................... Phone:.................... Strong Motion Fee .......... .................... ..... ...__............$...........,.3a_ Plumbing: usi....................................................... _................... Plumbing Permit Fee ................................................$....................... City Business License x.................... Phone:ne:.................... Electrical Permit Fee ...................................... ....._.......$..................._-- Heating and Cooling .................................................................. Mach. Htg./Coolg. Permit $ ..............................$...................... City Business License #.................... Phone:.................... Construction Tax.............................................$................ .... ... Architect/Designer: .................................................. Phone:.................... Sewer Conn. Fee .............. Water Conn, Fee ..............$....................... Engineer: Phone:................. Landscape Fee .................... Street Tree Fee ............$........ ..r Lender: ....................................................................................Q....P..nown Misc. Fee ........................................................................$......(.�.......... 1. "1 certify that In the performance of the work for which this permit Is • , , ; $!G i s-V Issued I shall not employ any person In any manner so as to become subject to the workmen's compensation laws of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER ...___....................c..___. ........................ DATE ..............._........... ZONING • ...._...... I certify that as the applicant I am licensed under the provisions of the Contractors License Law and further that my License No. ............................ Environmental Status: Exempt ........ . Other._................................... in Classification ................... Ia In full force and effect: or .n ............ DBSIgO R9VIBW Approval: Bldg. ............ Site Sign ��������-- I certify that I em exempt from the "Licensed Req.'•ad" provisions of the """ """"""' Contractors License Lew. (State basis of exemption., Use Zone ... P.D. Conditions ..........fki:....................._..................... 1 hereby acknowledge that I have read this application and state that the above Is Coed. Use Permit x...... Variance e._... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and State Laws regulating ApprovedBy........................................................... Date ........................... building. I (we) agree to save, indemnify and keep harm tess a City of Cupart lno •• • against liabilities, judgments, costs and expena which may in any way occurs against said in cones f the nting of this er it. ❑Cr08Chment Permit........................ Greet of EaSemenL....................._ SIGNATURE OF Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRALTO ..... ..x. ...... fAOATE ._4.�...... Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly valid ad I• form nstllub• a Bulldi P nil This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null d void should work not be cemmi-ri vi Plans Checked By........ Date........ Approved By........ Date.................... 120 day, from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATIONFOR ELECTRICAL PERMIT PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ PERMIT INSTALLATION NO. EACHI FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ....................................$4.00 - - TOTALNUMBER(lessthan1000watts) ... ............. ... $ .50 -........... Each additional outlet ............................................ 1.00. ............. Range........ Cooking Unit........ Oven........... .... ........ 2.00 . .............. Water System (Installation, Alt. or Repair) ................ 4.00.............. Dryer.... Garb. Disp..... Dishwasher.... _...... ...__..... 2.00 . _............ Water Closet.... Water Heater.... Ld. Tray.................... 4.00 ............. SERVICE OR TEMPORARY POWER to .. 2.00 ............... Lavatory.... Shower[Pan.... Bathtub.... Sink.................. 3.00,............. 100 amp/$5.00, 200/$7.00, 500/$9.00 Wash. Mach..... Dishwasher.... Garb. Disp..... .............. 3.00.............. 800/$20.00. 1200/$40.00 ..................... .............. ................ ............... Sewer .............^/ ..........`.L+:,: ... 8.00.. ............. MOTORS,Generators,Welders, Heaters, Lawn Sprinklq$P;00 Ea. add Sys. $2.00.................................... per HP—KW—KVA to 1/$2.00, 5/$3.50, Vacuum Breakers ....._'A.J lr^ ... ............ 4.50 .. 20/$6.50, 50/$10.00, 100/$12.00, Slop Sink_...../Iflcor Sink....66Floor Drain ................ 4.00 ............. 500/$15.00 ...........__._.................................__....._........... . .........._... Urinal.... Intercepto4.. Water Softens r.... ..........{II............ 4.00 ........__. Signs with I XFMR ..........._................._....... ...._._....... 2.00 ................ Plumbing Piping withodi. futures ......................I............ 4.00 ............. Each additional XFMR/Time Clock ................. ... .50 .. .............. Misc. ..................................... ................................................................... Annual Electrical Maintenance ................ 25.00 .. .............. Permit Fee ..........................................$ 6.00 Other (see Ordinance Current) _................ .............. .._........................... TOTAL PLUMBING PERMIT FEE'(plus penalty ....._._.....................__........_......._........._._..... ..__.............._........ ............ APPLICATION • • e• .. . ....... Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION 1..3.0017 . EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 100M ........................ . $ 6.00 ... ......... • • •• , over 100M .................... . 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP................. ... 6.00 ...............Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP................ ... 9.50,...............Plumbing Ground Work ......................... .... ............................................. to 30 ton/HP.............. . 12.00 ...............ough Electrical ..................................... .J.. . so .7 Yin. to 50 ton/HP................ ... 17.00 ...............ems -.pllmhiAg.a^A•tleelk+9 ............Cr ... ..........C11-19nw. Space Heater........ Wall Heater .......................... .....8.00 ...............sulation / Energy............................... .................................................... Flues - other than above .................................... .. ...3.00 ............... GasTest .................................................................................................... Vent Fan: Kitchen........ Bath ....................................... ...3.00 ............... Temporary Power Gas / Elect............................................................... Commercial Range Hood 6.00 ............... .................................. ......... ... Final - Electrical ........................................................................................ Misc. ........................................................................................................... Final - Building/Mechanical .................................................................. Permit Fee ........................................................................ $ 6.00 Final - Design Review / Landscaping ...... .. .... ........ . ............................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $ Final — Public Works...........................................................