7127 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDINGPROJECT IDENTIFICATION A PERMIT NUMBER
ImLOING ' � '1L APPLICATION & PERMIT 7127
ADDRESS �&6o Ay 0.4 � 4o
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
n
OWNER'S
If PLAN CHECK VALIDATION
NAME PHONE CITY. ELECTRIC PERMIT FEE
.
CONTRACTORS
NAMEUTLETS-SWITCHES-RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
e-DNTRACTO S .� PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONEY' �e^ PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.SS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 15.00
APPLICANT MOTORS SEE FEE SCH. '
SERVICE CHANGE 10.00
o a o LICtiN$Ii l)CON'T'RACTORS DECLARATION
SE U U I hereby af0"n that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
yaw )commencing with Section 7000)of Division 3 of the Business and BLDG. E T. PLG. MECH.
F y z Professions Code,and my license ism full force and effect. ❑ ❑ El
i m W License Class Lie,Number
Date Contractor
y J Bill DING PERMIT
c ¢in 4 OWNER-BUILDER DECLARATION INFORMATION
K
3 a N I hereby aftiDo Ihat I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o j Law for the I'ullowing mason.(Sec.703 I.S.Business and Professions PERMIT ISSUANCE VATION SIFT.
_ 6.00 /
Code:Any city or coney which requires permit to construe alter,
rt ¢ Q 0 improve,demolish,or repair any structure,prior to its issumIC ,also ELEC.CONTR. LIC.NIT ELEC. /)
IS requires(tic applicant for such permit t0 file a signed statement that TOTA / PERMIT TO
e. w m he is licensed pursuant to the provisions of the Contractor's License
�zQ
Law Charter 9(Commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
R F Oo the basis for the ullcgcd exemption.Any violation of Section 7031.5 STORIES TYPE CON TR.
by any applicant fora permit subjects the applicant tea civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not Clore than five hundred dollars(S5001.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
Inlcn h,d or offered for s;fle(Sec. 7044, Business and vrol'cssion* DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'The CmHractor's License Law does not apply to an ownerol
property who builds or improve%thereon,and who does such work FIXTURES-PER TRAP 4.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such""Prove-
menu are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM.OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or int- wD CON PB Omer
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am exclusively contracting with ❑ El 1:1 1:1licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'The Contractor's License Law does not apply
r to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts Ibr such projects with a coutraciorls)licensed pursuant to
the Contractor's License Caw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE ENO.
WORK ISRS'CdtdPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby ul firm Out I have a conilicate of consent to sell-insure'
,it a certificate oZONINGf Workers'Compensation Insurance,or a certified ENG.SITE NO,
sD thereof(Scc.3800,Lub.C.).
Pol 'y Nn. CompwtY .
Cu 1'ied opy is he mby ' "'shed. \ FIRE SPRINK ENERGY TT4
Z Z 1 �,rifted 'opy 's tiled wit the city in,Rection division.
O ApplI n MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑
w _ Ci 'ICn'1'lic It.A; PITON PROM WORKBRS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.uc.
LU 7 N Co vt 1)iNS 10N INS111L1NCB PLG.CONTR. LIC,NO, PLG. V❑ N❑ V❑ N❑
d O (Thi. 'd irin mM not he completed if the permit is (or one TOTAL
Z) Z hundred dollors(S 100)or less.)
U O 1 certify that in the Porhxnlance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ ally person in any manner so its to
U become subject to the Workers Compensalion Laws of California.
ED Dale Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
J - m NONCE 'I'0 APPLICANT': If.after making this Certificate of Ex-
F Z enprtion,you should become subject to the Workers'Compensation APPLIANCE 4.00 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 10p00C.F.NL) 3.00
CONST'BUTTION LENDING AGENCY AIR HANDLING UNIT(OVER I0=C.EM.) 5.00 SEISMIC FEE
I hereby infirm (hal (hone is a Construction)coding agency for EXHAUST HOOD (WITH DUCT) 2.00
1 the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.G). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's AddreHEATINGUNIT(DVER10Q000B.T.U.)7.50 ELECTRIC
ss
I certify the l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
inforination is correct. 1 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.) 4.00 1
hereby authorize representatives of this City to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
uhuve-mentioned property Ibr inspection purpows.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cope ino uguinst lino'lies,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
nr�it oily way u' ru against said City in consequence of the
antis ,ofthispe" it. MECH.CONT. LIC NO.,^ MECH.
z2 TOTAL TOTAL
S'
To of lir Contractor Date '
INSPECTOR COPY