C8337 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
ADDRESS
BUILDING-ELECTRICAL=PLUMBING -MECHANICAL8337
,OWNER'S PLAN CHECK VALIDATION
/ "AME ' Gr OTY, ELECTRIC PERMIT FEE
vNouE Y
CC NTERACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAM
NOf Yh �n L
LIC.No. n4 LIGHTING FIXTURES 10.00/1.00
- APPLIANCES-RESIDENTIAL 4.00
WOR
/ ADDRESS OURE55
L RO.E PANELS . 10.00 DATE OF APPLICATION
OgcuO[cT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
' LIC.NO. SIGNS TRANS. 3.00
no R'ESS Ervc' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
Avvucnrvrs
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
Hoo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00
< U u 1 hereby of firm llut I am licensed under provisions of Chapter 9 ISSUANCE DATE
Ni (commencing with Section 7000)of Division 3 of the Business and
¢ BLDG. ELECT. PLG. MECH.
Hw i 1'rolisslons Codv,an my lie•n: is in full fume and effect. ❑ ❑ El Z O w- 4.icunw Class ¢,Number _
9 F a/ Date Contractor
H _
¢ y BUILDING PERMIT
¢ a 4¢ OWNER-BUILDER DECLARATION A
a, o INFORMATION
E
;LL w I hereby collo that I one exempt from the inessaelalS License MISC.- REFER TO ORD
LL o ¢ Law for the following reason,(Sec.703 1.5,Businessand Ln v,um, PERMIT ISSUANCE 10.00 VALUATION $/FT.
L• - -' Code_Any city orcounty whichrequiresepennit toconstruet,alter,
aa Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC NQ ELEC, /G�-�
y c u requires the applicant for such permit to file a signed statement oat TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License
i
Law(Chapter 9(commencing with Section 7000)o(Divisiun 3 of ther
iA Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 4-'D �L V �VLG2
¢ H o the basis for the alleged exemption,Any violation of Section 7031.5 STORIES TYPE CONSTR,
dan
am _ by y applicant for a permit subjects the applicant ton civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
.final more than five hundred dollars(5500).1:.
❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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 Prol'es,mm, DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
tomb,are not intended or offered for sale.If,however,thebuilding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the harden of proving that be did not huild urn int- BUILDING USE
prove for purpose ofsale.). i
INDUSTRIAL WASTE INTER. 3000 RES IND CON PB De,
❑ 1,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. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or inmproves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(O licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0,
WORKERS'COM PENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby a(firin that I have a certificate of consent to sel&insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance.or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
U ❑ Certified copy ie hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y❑ N❑ Y ❑ N❑
F- w PERMIT ISSUANCE 10.00
� f.ER1'IFIGOMPENFAX IOTINS FROMWORKERS'ERS' FLOOD ZONE A.L.U.C.
W � COM11Pf;NSA1'ION INSURANCI[ PLG.CONTR. LIC.NO. PLG,
CL 0 1'1ot'his section need nbe completed if the permit a lot one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars($100)or less.)
U O I cerci y tlmt in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL F mit is is d.I hall not employ any person in•:uny manner so as to
ED become ubje he or e"
rcpensatio w o(Calilornia.
y� Dam Applicant c ALTER OR ADD TO MECH. 5.00 BUILDING 7 J Z!
} to NO'41 'I AlPLICAN'f: If,alter making this Certs NCam of Ex- -
F ? 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=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a c...Duction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perforrnance of the work for which this permit is issued(Sec. MICROFILM
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders AddreHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ss
I certify that I have read this application wad Stam 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-OCIMP(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 SCH. MECHANICAL
above-mentioned property for inspection purposes.
(Wg) ogee,to Save,//indemnify and keep Ienal yx the City of MISC.- REFER TO ORD.
it,N mo against 1ia611ties,) tlyents, costs and expenses which CONST.TAX
al In any way ace me ag, f st aid City in consequence of the PERMIT ISSUANCE 10.00
gra Ig of. 1LPct MECH.CONT. LIC.NO. MECH.
\ TOTAL TOTAL
Sign lu -o plicae ont actor Dat
INSPECTOR COPY
I