7051 APPLICAN� TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT I DENTI FICATI ON SPERMIT NUMBER
BOILOINO 21030 HOHESTEAD 'r•D. APPLICATION U PERMIT 7051
AODEs
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
( NAME NICk PAPAGEORGI0U QTYELECTRIC PERMIT FEE
•, PHONE PAID
CONTRACTOR sPOLj(A IRE I"'I6C HANICA.L UTLETS
-SWITCHES-RECEP 5.00/1.00
NAME
EIC.No. C LIGHTING FIXTURES 5.00/1.00 MAY 2-- 1985
CONTRACTORS Io1O OLINDER CT, PPLIANCES-RESIDENTIAL 4.00
\ ADDRESS
8A1J NIONE PANELS 5.00 I1RfiThfQffiAN
ARCHITECT - SIGNS 6.00 PL K P.C.NO.
ON
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRESS ErvG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
! i /' TEMP.METER OR POLE INS. 15.00
r
APPLICANT SB �/` / 1�e! e 'Z MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
O o LICBNSHD CONTRACTORS DECLARATION
ii u I hereby affirm Ilial I ant licensed under provisions of Chapter 9 ISSUANCE DATE
G a w (commencing will,Section 7000)of Division 3 of the Business anJ BLDG. ELECT. PLG. MECH.
r N z Professions Code,anA my license is in(all farce and effect.
z o H - License Clan=1'Qg-4.3 ic.Number El ❑ 110 z H O' Date_ Contractor_
" - 'W'` - t� �OBUILDING PERMIT
Q y `c J
a a OWNI!R-BDILDF.R DECI-ARA'1'IONI"Ea GH . INFORMATION
MISC.- REFER TO ORD
X ;A r I hereby ultimo Ihul 1 ran cxenipl from Ibc Contractor's Licensee VALUATION
H LL o j Law for the billowingreaGin.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6-00
Code:Any city or county which requiresa permit toconstrud..Iter,
rtLa K Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
us
A w
- O e, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License 1'
rzi
Law(Chapter 9(conrmencing with Section 7000)of Division 3 oftheAA
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �V, r
EE 1- $ the basis for the alleged exemption.Any violation of Section 7031.5 STOHIES TYPE CONSTR.
by any applicant for a permit subjects the applicant o a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2-00 OCC.SHOUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:"fhe Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work N FJXTU FS�9 R TRAP 4.00 SG.FT FLOOR AREA ;TOTAL ACREAGE
. himself or through his own employees,provided that such improve-
mentsamnotintendedorofferedforsale.If,however,the building GAS-E`A.SVSTEM-11NC.40UTLETS 4.00
or improrxmc 1 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 inn- - RES IND N PB Omer
prove for pugnose of sale.). INDUST Ix L WASTE INTER. 20.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7144,Business LAWN SeRINKLERS-1 INC 5 V.B. 5.00 ASSESSo REEL NO. .
and Professions Code:The Contractor's License Law does not apply
lD an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlractons)licensed pursuant to
Dlc Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
O I am exempt under Sec. B&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.GATE ACC.PILE NO.
WORK FRS'COMPRNSAI'ION DIiCI-ARA'I'ION I� WATER TREATING EQUIP. 4-00
1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified
ENG.SITE N0.
copy thereof(See.3800,Iab.0 L
Policy No. Company
0 Is: ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
z 2 ;4Cerlified copy' is Filed with the city inspection division.
FOJ Applicant p�Ly� MISC.- REFER TO ORD. y❑ N[3y ❑ No
� N CI:R'1'lll'IICA'!I'I;01;IiXLMPTION ItltOM WORKI'RS• PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG.
d ❑ II"his section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑,
Z) Z hundmd dollars($100)R,Icx J
U O 1 certify that in the performance of(tie work for whiethis per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manne so as ho
U becomrk
e subject to the Woen'Comns
peation Laws of CiN-uia.
O ED Dare Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} m NO I'ICH*TO APPLICANT: If,after making this Certificate of 1?x-ln �v)
Z eruption,you should becnc subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK W
provisions of the Labor Code, you musl to Rlwilh Comply will FEE �.
U such provisions or this permit shall be deenwd revoked. AIR HANDLING UNIT(TO 10PMC.F.M.) 3.00
CONS'T'RUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 5.00 SEISMIC FEE
I hereby affirm mat there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the perform:ince of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CAHEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name/
Lender's AdHEATI NG UN IT(OV E R 100,000 B.T.U.)7.50 ELECTRIC
Address 01
Icer)ify that I,haveread this application and state that the above ,4 VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING S�
ordinances and stale laws relating to building construction, and BOILER-ODMP(3_H.P.or 100,000 B.T.U.) 400
hereby aulhorim representatives of this city to enter upon Ilse BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpous. -
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
may innnany way�nst accrueu against Said Citysts and ex in consequences ofhthe PERMIT ISSUANCE a 3.00 CONST.TAX
gra;ny thrt permit MECH.CONT. LIC.NO. MECH. -
v ll 1r POVAIR1- 2--3 8z�1 TOTAL73C1 TOTAL
Sngna�icant)Contractor DateDate CAL
FOROL YA IQP TIE C NAN I CA L INSPECTOR COPY - �7�OL YA IQE rI EC NAN I CA L INSPECTOR COPY