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8213 (3) APPLICANT TO FILL IN INFORMATION WITHIN,RED LINES - USE BALL POINT PEN ONLY BUI LOI NG PROJECT I DENTI FICAT,ION PERMIT NUMBER} ( ' y BUILDING r © APPLICATION & PERMIT 81 ADDRESS = G BUILDING -ELECTRICAL-PLUMBING MECHANICAL 2 \� OwNEip 700 A Off AA 12A PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE NAME"ncroes UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No. IGHTING FIXTURES ADORE SE 10.00/1.00 ADORESE oR's APPLIANCES-RESIDENTIAL 4.00 PHONE _PANELS 10.00 DATE OF APPLICATION v ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE. P.C.No. O OR ENGINEER LIC No. 2 SIGNS TRANS. 3.00 ARCH,OR ENG. ISPECIAL CIRCUIT 5.00 PERMIT VALIDATION Av ,\ AooREss �J•/. CA, zIP EMP.METER OR POLE INS. 20.00 APPLICANT Is ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 o o LICENSE[)CONTRACTORS DECLARATION TEMP.POLE 30.00 ao v I hereby affirm that I am licensed alder Provisions of Chapter 9 z w ISSUANCE DATE m (commencing with Section 7000)of Division 3 of the Business and ¢ a BLDG. ELECT. PLG. MECH. r N i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ O m - License Clan •Lic.Number Q Nz w Date Contractor - J. ¢ re f BUILDING PERMIT M o n ° OWNER-BUILDER DECLARATION INFORMATION wg LL H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT. FUOJ Law for the following reason.(Sec.7031.5.RuRLr,,and Professions PERMIT ISSUANCE 10.00 ,�� Code Any city.,county which reyuiresapermit to construct almq �..�r�\ Q , ¢ Improve,demolish,or repair any Structure,prior to its issuance,also ELEC,CONTR. LIC.NO. ELEC. LL requires the applicant lir,such permit to file a signed statement that TOTAL PERMIT TO i: In se requires is licensed pursuant to the provisions of lira Contractor's License Hzi Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE ¢ c the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n3� by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 at not more than than five hundred dollars(S500).1: ❑ I,as owner of the property,ocmy employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code'.'Che Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees.provided that such insprove- oments rimprovnot emenntendcdor wo((eronefor yearl o If,however.the the owner- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 .r improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he Aid not build or ins- BUILDING USE place for purpose of Sale-). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omxr Las owner of the property,am exclusively contracting with ❑ 1:1- ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contmctor's License Law dues not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for Hula projects with a contmetorls)licensed Pursuant to IIlc Contractgr's License Law ) SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. ❑ tum Exempt nd ,B.&BC.for this WATER HEATER W/VENT 6.00 rcaoJ / Owren / Uaie - WATER SYSTEM 5.00 / ACC.DATE ACC.FILE N0. 'ORR Is S'CONIPENS N'DFCLARATION WATER TREATING EQUIP. 5.00 Ihereby uffiI. (hull critical,of r, 11 to se vc or o eeriificate of Workers'. mpensalion Insu runce, N a c"(ificd ZONING ENG.SITE NO. ,ropy thereof(Sec.3800,Lab.C.f Policy No. Company O \ ❑ Certified copy is hereby umished. FIRE sPRINK ENERGY T 24 Z Z ❑ Certified copy is tiled wish tin city inspection division. O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ ~ Sea PERMIT ISSUANCE 10.00 � CERTIFICATE OF EXEMPTION PROh1 WORKERS' FLOOD ZONE 1 A.L.UL. W CO � COMPIiNSAT10N INSURANCE PLG.CONTR. LIC.NO. PLG. Z( This Section need not be completed if the permit is for one TOTAL Y❑ IN[:J Y [:] N❑ hundred dollar,IS 100)or less) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY ll I- mit is issued,I shall not employromarinerso any Pen in any as to- IJ become subject to the Workers'Compensation Laws of California. .. n Date Applicant� ALTER OR ADD TO MECH. 5.00 BUILDING aft [��S.�U�.•m NOTICE TO APPLICANT: If, lie,making this Certificate of fx- H Z emption,you should become subject to the Workers'Gompensmion APPLIANCE 5.00 PLAN CHECK provisions of tire Labor Code. you trust forthwith comply with FEE Ute, such provisions or this permit shall be dreard revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 1 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE . 07 I heavily affirm ilia( there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 file performance of Ne work for which ihis permit is issued(Se. �1 s'H EATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.CJ. Lender's Name Lender's AddreHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ss I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information n correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction.itynco and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city t. timer upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL abovomentioned Property.for inspection purposes. (We) agree to save,cindemnify and keep hunniess the City of MISC.- REFER TO ORD. CopeJ1i o a instAiabilities,judgments,costs and expenses which CONST.TAX ma in anyaw:I_ascrue against said City in consequence of the PERMIT ISSUANCE 10.00 brantinSoLti alio MECH.CONT. LIC.NO. MECH. TOTAL TOTAL igna(u of A " a /Cant cto Dae 7A S`b S INSPECTOR COPY , I