7126 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT7126
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ADORES; UILDING -ELECTRICAL-PLUMBING-MECHANICAL
DINNER PLAN CHECK VALIDATION
NAME QTY.
NAME ELECTRIC PERMIT FEE
PHONE'S• caoRs - OUTLETS-SWITCHES-RECEP 5.00/1.00
, NAME
LIC,ND LIGHTING FIXTURES 5.00/1.00
CON THAI TOR'E ' L/�A APPLIANCES-RESIDENTIAL 4.00
AOO 1E
/ FHON Q" PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.N0,
OR
ENGINEER
LIC,No. SIGNS TRANS. 3.00
ARCHE RENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
ADDRESS /
ADRESSr$ MOTORS SEE FEE SCH. 1
SERVICE CHANGE 10.00 0 a
woo LICENSED CONTRACTORS DECLARATION
a o U I hereby ul'fircn that I con licensed under provisions of Chapter 9 ISSUANCE DATE
BLDG. E
w (C(Imll.Cllelllg with Secfon 7000)of Divlxlon 3 of 111,Business and LEC PLG. MECH.
�z Prof sessions Codc,and my license is in full Ione and effect.
Z 0 m - License Class Lia NO n.her
H w Dale Contractor
a BUILDING PERMIT
Ixw a OWNER-BUILDER DECLARATION INFORMATION
w 3 A 1 hereby at irm that 1 am exempt front the Contractors License
se MISC.- REFER TO OR
�+u VALUATION $/FT.
F I. Oa Law lit the following reason,(Sec.7031.5.Businessand Yrofcssions PERMIT ISSUANCE 6.00
Cade:Any city or county which requires a permit to construct,alter,
aimprove,demolish,or repair any structure,prior to its issuance,at, ELEC.CONTE. LIG NO. ELEC.
ra
O LL relllllfl'S ills applicant for Sn[II permit t0 file a signed S(aLL'nIL'Ot(11dt TOTAL ERMIT TO
whe is licensed pursuant to the provisions of the Contractor's License
F Z I law(Chapter 9(commencing with Section 7000)of l)ivision 3 of the
- 4 tRosiness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
r oo he basis for the alleged exemption.Any violation ofSeclion 7031.5 STOME5 TYPE CONST .
to T by any upplicm.tI..;I permit subjects the uppiwant to a civil penaltyALTER-DRAIN& VENT-WATER (EA.) 4.00
of nod more than five hundred dollar.,($5001):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES,UNITS
dh,ii-sol,compensation,will do Ota work,and Ilia structure is not
intended or off rutP for salt (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code'I lie Contractor's License Low does not apply to an ownerof
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOORAREA TOTALACREAGE
. himself nr through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If,however,the budding GAS-EA.SYSTEM-1 INC-40UTLETS 4.00
Of int Provenxn( is split within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING uSE
builder will have the burden of p,ovmg that he did not build or im- RE IND CON PB Omer
provC for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
0 I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00SSESSORS PARCEL NO.
and P")fessions Code:'I he Cont me t or,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 contraclons)licensed pursuant to
Ole Contractor's license Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
0 I am excerpt undcr Scc. ,B.&PLC.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK F RS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 4.00
I hereby a10nn thnt I have a ceHirwate ,I Consent it,self-inxu m-' ZONING
or u tens(Icate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(See.3800,Lab.C.).
Policy No. Company
Cer11 c copy rsloa,4yfur fished. FIRE SPRINK ENERGY T-24
z Cert he 01'eJ w I the cit speCtion division. MISC- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
CC CB FICA PE 'Ire.MPTION PROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C.
COM 14 ON INSURANCE PLG CONTE. LIC.NO. PLG.
EL O IT III, 44clion need not be completed if the permit is I'N,on, TOTAL Y❑ N❑ Y❑ NO
It undyed dollars IS 100)or less)
`-U O 1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F Nor is issued,I shall not employ any person in any manner So as to
U becunw subject(o the Workers'Cantpensalion Laws of California.
�,ED Date ! Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
'} to NOI'I(:It TO AITLICANI'1` If,after making this Certificate of lix-
Z ccn,tion,you should become subject to We workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must Wrthwith comply with FEE
S. L) such provision or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH-DUCT) 2.00
the performance of the work for which this permit is issued(Sec HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
i Lenders Address
I certit, that I have read this appliewion and Stade that the above V ENTI LATION FAN (SINGLE) 3.00
r
telis correct. I agree to comply with all City and county PLUMBING
ordinances and slate laws relating to building conslnletion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
`.- hereby amhoriae representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mmrlioned property for inspection purposes.
(We) agree m save, indemnify and keep harndesv the City of MISC.- REFER TO ORD.
Cup,rdino against Ilabili'•,,it lances. coats and cxPenscs which PERMIT ISSUANCE 3.00 CONST.TAX
HIS y it try way act, , coin[ said City in consequence of the
grting f this peru, Is CH.CONT. LIC.NO. MECH.
X42 TOTAL TOTAL r
Sig reo App can ImCtor Date
INSPECTOR COPY