C9189 APPLICANT TO FILL IN-INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
7 BUILDING APPLICATION & PERMIT
ADDRESS45S A!
�„�, . 41BUILDiNG-ELECTRICAL-PLUMBING-MECHANICAL 9189
89
4 O R's - - - PLAN CHECK VAL IDATION
"A TY. ELECTRIC PERMIT FEE
PHONE 2i
CDNTRACTOR'S
NAME .�11 ^� qq OUTLETS-SWITCHES-RECEP 10.00/1.00 I
t L"Ag LIc.NDa_rs(� 7 LIGHTING FIXTURES 10.00/1.00 ,
ADDRe15 TDBa a.115 APPLIANCES-RESIDENTIAL 4.00
64h, II 1
OrvE 'T I PANELS 10.00 DATE OF APPLICATION N
A CHI ECT PLAN CHECK FEE P.C.N0.
PANELS (OVER 200 AMP) 20.00
DE NGIry EER ,�e pp 14^a v,
uc t1O. In SIGNS TRANS. 3.00 r
AEG
Ess ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION.
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS rG MOTORS n SEE FEE SCH.
N SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARA ION TEMP.POLE 30.00 71171d
G u U 1 hereby affirro that 1 am licensed under provisions of Chapicr 9 ISSUANCE DATE
v, u (commencing with Section 7000)of Division 3 of the Business and
G BLDG. ELECT. PLG. MECH.
i Professions Codc a my license is in full fort'and cffeL w.
z o m- License Class Lic.Number
O r I7atc Contractor e ,
a m -a BUILDING PERMIT
¢
in c O ER-BUILDER DECLARATION
o a O MISC.- REFER TO ORD INFORMATION
X 3 w 1 hereby allirm that I am exmnpr from the Contractor's License
LLOJ Law for the followingreason.(Ser,703 I r5,Business and Professions PERMIT ISSUANCE 10,Q0 � �.�, "'VALUATION $/FT. I
Code'Any city crcourty which ecruesupermllto onsrruct.alter,
¢ ¢ improve,d demolish,or repair any t structure,e p for tots Issuance,also ELEC.C TR. LIC.N0. ELEC. / Q
u �'� requires theapplicant for such permit to fl a signed statement that t 1' TOTAL U _ PERMIT'TO
lie is licensed pursuant ant to the provisions of the Conl ao s License -
Hza Law(Chapter 9( onm eingwith Seticn 7000)ofDekimr 3ofthe S�.t��je'7/Y r'V G-- G��
s D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I- o the basis for the alleged exemption.Any violation of Sect 7031.$ 1 STORIES TYPE CONSTR.
damALTER -WATER IEA) 500
_ by any applicant fora permit subjects the applicant toacivilpenalty - . .
Ll nut Timethan fivehundred dollars(3500t) �ti1 %G
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and lire sl nmlure is not
intended or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees, le,if,however,that such inrprove-
' .memsarcnhr ugh [its or employeesnle.if.ed that such
building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or mi- RES INDCON PB Other
,.
prove for purpose outside.). INDUSTRIAL WASTE INTER. 30.00 El EY
CO � .
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
end Professions Code.'Fire Contractor's License Law docs not apply '
to an owner out property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sir,-,BAP.C.for this WATERHEATER W/VENT 6.00
reason ( J
Owner Date WATER SYSTEM 5.00 i.ACC.DATE ACO.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that 1 have a certificate of consent to elf exam, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Imsuancc,or a certified
.tJ copy lhereof(Sec.3800,LabG.L fIL , QL
Policy No. Company
❑ Cer 1;ed 'op is hereby famished. FIRE SPRINK ENERGY T 24
FZ It 'Ccrlifiv, <o is Odd w'tl1 l c til 'n(p" r ti -sions
p7� Ap But MISC.- REFER TO ORD. Y � N� 'Y ❑ N�
CC h CERTIF CATS 01'1 XEMPTON FROM WORKERS' PERMIT ISSUANCE 10.00 G*� FLOOD ZONE A.L.U.C.
ED > CI
COMPENSATION NSURANCE PLG.CO R LIC.NO. PLG. q
M 0 Flhis section need nor he completed if the permit is for one A TOTAL CK YE] NE] YE] N�
Z) Z hundred dollars IS 100)or less.)
U O 1 certify that in tie performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shalbnot employ any person in any manner So as to
w become subject to the Workers'Compensation Laws of California. BUILDING
Da[c A licanr JIV
Q. vp ALTER O ADD TO MECH. 5.00
} rn NOTICE TO APPLICAN'C. If,after making this Certificate of Ex- _
Z_ cnrption,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 10000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE till
I hereby affirm that there is a construction landing agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the wok for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). ' I� HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name {V HEATI NG UN IT 100,000 B.T.U.)9.50 oC1
Lender's Address ELECTRIC
I terrify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and stat, laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 "'-
hereby authorize ieprawatatives of this city to enter upon lire BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ahoviceentioned property for inspection purposes.
(We) agree to save, indemnify and keep beradess the City of MISC.- REFER TO ORD. -
CLie a against liabilities,judgments, costs and c."rows which W CONST.TAX
may n my way acerae against said City in consequence 4Qf the PERMIT ISSUANCE 10.00
Ron n of this peermtJ[�. ( MECH.CONT. LIC.N0. MECH.
A/veA--A H. 10L TOTAL lr-laE~,I(rfrd��- TOTAL TOTAL of 0 .2 �.
Sig temo'Applicant/Contractor Date
INSPECTOR COPY
I