9437 (2) r�A
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LD ING PROJECT I DENTIF I CATION PERMIT NUMBER
PDILDi NO Aa, fir v ,f<pTe APPLICATION & PERMIT 943
ADDREss
rJ 60 �cN/ J.(+/ L4 ryl/¢ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATION
NAVE ,y \ CITY. ELECTRIC PERMIT FEE
• G~ �/ C1/'P� PRUNE `
NAMERAcrors OUTLETS-SWITCHES-RECEP 10.0011.00
prldes Go/- 114/,1 f LIC.N092276`7 LIGHTING FIXTURES 10.00/1.00
""TRAcrDWs PPLIANCES-RESIDENTIAL 4.00
ADDRESS A//s
/O�oN/*Nr /•�-✓� PRONE Xel PANELS 10.00
DATE APPLICATION
AARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECKK FEE P.C.No.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
AARC
DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT!VALIDATION
ZIP EMP.METER OR POLE INS. 20.00.1+&Qm"C ..
ANrs
ADDRESS MOTORS SEE FEE SCH.
(((��',��,
SERVICEPOLE GE 20.00 �,v L✓v ( ' '`'rM,vp
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 17&.t"& I Avij Ri•
a v 1 hereby affirm that I an licensed under provisions of Chapter l) tI-'L ISSUANCE DATE
w z w (commencing with Section 7000)of Division 3 of the Business and
Q% BLDG. ELECT. PLG. MECH.
r �z Professions Codc and rey license is in full force an of ecu. ❑ ❑ ❑ ❑
Z o y - Licems Class- / /�C / Lic Number /
0 z r o Date Comnctor'(
¢ m f BUILDING PERMIT
a ¢ re u OWNER-BUILDER DECLARATION INFORMATION
uAxi 3 LL I- 1 hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD VALUATION S/FT.
F LL o j Law for the following reason.!Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
�� Code:Any city Dr County which requires a permit to construct,alter,
¢ ¢ a 2O improve,demolish,or repair any structure,prior to its is;coke,also ELEC.CONTR. LIC.NO. ELEC.
re requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO
w he is licensed pursuant m the provisions of the Conira(tors License
" >i Law(Chapter9(commencing with Section 7000)of Division3of the MU 1/e SriQVC.7U.FL
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
s i o
¢ r o the bans for the alleged exemption.Any violation of Scmlon 7031.5 STORIES TYPE CONSTR.
dam _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5,00
of not more than five hundred doll...(S500f):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and 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 F IXTUR ES-PER TRAP 5.00 SO.FT._FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that suchins pmvo-
meets are not intended or offered for sale.If,lmwever,te
hbuilding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING 115E
builder will have the burden of proving that he did not build or ins . RES IND CON PB Omer
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the property,ant exclusively contracting with El ❑ ❑ ❑
licensed contractors to construct the pr()cct(Sec. 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:-Phe Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.( 1.00
contracts for such projects with a emitmctor s)licensed pursuant to
the Contractor's license Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O lam exempt under Sec.-,B&11.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO,
' WORKERS'COMPENSATION DECLARA'T'ION WATER TREATING EQUIP. 5.00
I hereby affirm that I have.certffie.Ie of Conwn t to Sclfminsuro. ZONING
or a certificate of Workers'Compensation Insurance,or a cerlitied ENG.SITE NO.
Copy Ihc..ol'(Suc.3800,L.b,C). f.tA'JI v
Policy No. Company
O ❑ Cerifiede fylsltereby�-nishal. FIRESPRINK ENERGY T-24
z O ❑ Ccrtificd op s`lJh. `it�Ahcnspcction division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant v N V N
cc y :R1'I FICA'1'1!