8325 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING - �_ APPLICATION & PERMIT
AD ��
oR -� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 5 �
39L_ 3 �r
OWlven's P PLAN CHECK VALIDATION
"nmE l�-`� C TY. ELECTRIC PERMIT FEE
e7lDNE J
NTRPcaORs
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
'44Q Ic,NO LIGHTING FIXTURES 10.00/1.00
CONTRACTs PPLIANCES-RESIDENTIAL 4.00
PDD 55ff
PRONE0q 7 PC
PANELS 10.00 GATE OF APPLICATION
PR RI 1 EC PANELS (OVER 200 AMP) 20,QQ PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00 '
ARCH.
oo Ess ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT E� MOTORS SEE FEE SCH.
ADDRESS I
SERVICE CHANGE 20.00
0 0 o LICENSED CONI RACTORS DECLARATION TEMP.POLE 30.00
a E.
u U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y A w Icontmencing with Section 7000)of Division 3 of the business and BLDG. ELECT. pLG. MECH.
F w z Nol'essions Cod ny license is in full for 1c t 1 c
z O m - License lass n �Con Number ..L2c�l �t j
Q H w Date Cont ruclor_gL i�
I y E /7� BUILDING PERMIT
a w OWNER-BUILDER DECLARATION INFORMATION
wg LL 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION
F LL o j Law for the following reason.(Sec 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 J
Code:Any city or county which requires a permit to construct,alter, J
a, ¢ p improve,demolish,or repair any structure,priorto its issuance,also ELEC.CONTE. LIC.NO. ELEC. J v 1
- 0 M requires(be applicant fur such permit to file a signed statement that TOTAL PERMIT TO '.
o. w m u- he is licensed pursuant to the provisions of the Contractor's License f t
rzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe J
Ei 4 Business and I'rol'ersions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE ' . r
cthe basis for the alleged exemption.Any violation of Section 7031.5 STORIE50' ,TYPE CONSTR.
by La 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 dollars'(8500))'
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 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
properly who builds of improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
_ meats are not intended or offered for sale.if,however.the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
. or improvement is sold within one year of completion. - . .) 2.00 the owner- GAS EASYSTEM-OVER 4 IEA
builder will have the harden of proving that he did not build or int- BUILDING USE
'Love for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer.
C1 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044.Busines LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for Such projects with a conlractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lamcxcmptundcr Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
mason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKF RS'COM PENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofemment to wlt unsure. ZONING
or a certificate of Workers'Compensation Insurance,Or t certifi,d ENG.SITE NO.
co,thea /B.CJ.
I'olicY Nr��� !"Y /J llh_1�
O ❑ CCY ied c ppy�is hereby furni� FIRE SPRINK ENERGY T-24
Z Z ❑ Ccrrfil is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant A/ Y❑ N❑ Y ❑ IN
L2 C Ii R1'll'I CAT E O I'EX I PTI ON PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL v❑ NE] . Y E) N❑
Z hundred dollars($I O07 or less)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued, I shall not employ any person in any manner so as to
O hcmmC subject to the Workers'Compensation Laws of California.
O W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NOTIC17 TO APPLICANT: If,after making this Certificate of Ex
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"GEM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
e Tcriorma ce of tire MICROFILM
e work for which this permit is issued(Sec. HEATING UNIT (TO 100,000 B.T.U.) 8.00
3
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
_ ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCR. MECHANICAL
above-mentioned property for inspection purposes.
(W• agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cape i o against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in
wee of theofthis pe mi 1. MECH.CONT. LIC.NO. MECH.TOTALTOTALSib ppbcmt/Contractor
INSPECTOR COPY
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