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C8484APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LD ING PROJECT I DENTIFICATI ON APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL8484 PERMIT NUMBER BUILDING ADDRESS ' i� OMES cH� ER'B Z� NAM / �ANTdHfl7 NAME PHONE ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ��� 2j •(� /Z 7 2 J p C r �CS� s //US DATE OF APPLICATION CONTR4CTOR3 - NAME 131-44 H CONS RV�'T/DNC tc,NO. O OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS �.p r� 3004' SGo Ti �n pHOONN•✓,I'�PANELS y PPLIANCES- RESIDENTIAL 4.00 10.00 CRIT T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. WEER uc. rv0. I SIGNS TRANS. 3.00 ARCH ADORES D 6JSS /'/O1N,4f�?G ST- SPECIALCIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZI �7//�i S'� APPucA S ADDRESS G/O JIv VQ{�lyrjr�.r.{7�, f{yt11.TOR MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 /rCl2llii) ('WACT % ATe r TEMP. POLE 30.00 I hereby affirm Thal I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. icense Class �.�I Lic. Number DateComraclor ISSU NCE DATE BLDG. ELECT. PLG. MECH. El 1:1 11 El .� . / - OWNI?R.BUILDER DEdl A*AR(BIOf 40AAST I hereby collo that reason. I am exempt from the Contractors License Professions Code: Any city or cnmlly which roquires a pcnnit to construct, alter, Code:Law Any cityl or coutywhch regiresa Burin reconstruct, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to filen signed statement that he is licensed pursuant to the provisions of the Contractor's License BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION ! V oU $/FL ELEC. GONTR, LIQ NO, ELEC. TOTAL PERMIT TO Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE T the basis for the alleged exemption. Any violation o(Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty not more than five hundred dollars ($500),): \/,A/of ALTER -DRAIN -WATER (EA.) 5.00 O 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sea 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of -s - FIXTURES -PER TRAP 5.00 GAS-EA.SVSTEM-11NC.40UTLETS 6.00 50. FT. FLOOR AREA 9� �O TOTAL ACREAGE properly who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve. ments a re not intended or offered for sale. If, however, the building or improvement is sold within one year o(compld ion. the owner- builder will have the burden of proving that he did not build or im. prove for purpose of sale.). 1 as owner of the property, am exclusively contracting with �C GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Omer El 11 1:1 El INDUSTRIALWASTEINTER. 30.00 S it contrudory to construct the project (Sce. 7044, Business and Professions Code: *1 lie Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(i) licensed pursuant to lite Contractor's License Law. LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. 3t. - l , SEWER -SANITARY -STORM EA. 200it/10.00 TRACT NO. PARCELXO. ❑ I an, exempt under Sec.-. B.&P,c. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sell -insure, o a certificate of Workers' Compensation Insurance, or a cenified ZONING ENG. SITE N0. copylhereof(Sec.3800,Leb.CJ. F/02E01AwaY PUN.I/ Policy No. Company g `�. ,III^ , RE SPRINK v ❑ N❑ ENERGY 24 Y ❑ N❑ ❑ Certified copy ishereby urmshe WP 90 D S / Certified copy is filed with the a1 inspection division. A h Carl MISC. - REFER TO ORD. CERTI FICA' 117 OF G XEMPf10N FROM WORKERS' PERMIT ISSUANCE 1 10.00 FLOODZONE A.L.U.C. COMPENSATION INSURANCE This section, need not be completed if the permit is for one Y ❑ N❑ Y ❑ N❑ PLG. CONTR. ❑c. NO. PLG. TOTAL hundred dollar, IS 100) or Icss.) I certify that in the performance of the work for which this per ,tit is issued, I shall not employ any person in any manner so as to OTY: MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 07 become subject to the Workeri Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 I NOTICE: TO APPLICANT: If, after making Ibis Certificate of Ex- APPLIANCE 5.00 PLAN CHECK FEE / emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you most forthwith comply with 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 10,000GEM.)6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 v I hereby affirm that (here is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30?7.Civ.C.l AN J, ,Lender's Names S£NrI TION qt. 311NK MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC L`ender's Address �55 ' I certify that I I ve read i iQapp Ic3tl nd tat t�G1ie above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county m ordinances and stale laws relating building construction, and PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 hereby authoriac representatives of this city to enter upon the ehove-mentioned property for inspection purposes. BOILER -COMP (Over 100,000 RTU) SEE FEE SCH. MECHANICAL (We) a e to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cuperlin ages' st iabilities, judgments, costs and expenses which may i any a accrue a st said Ty in consequence of the grand gof is it. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO, MECH. Signature of o re o e TOTAL TOTAL Tic 1 INSPECTOR COPY