6185 �'.
APPLICANT TO FILL IN INFORMATION WITHIN RJED1LINES - USE BALL POINT PEN ONLY
BUI LD1 NG PRdJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
6185
AOI 10200 Imperial Ave BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S , . PLAN CHECK VALIDATION
NAftIM PAINTING 408-996-3897 OTY. +ELECTRIC PERMIT FEE
PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 5.00/1.00
IOLLS FIRE PROTECTION
42240
e•e LIC,No LIGHTING FIXTURES 5.00/1.00
ADDRESS rums APPLIANCES-RESIDENTIAL 4.00
42430 .Ulac Qin #'3 PHONE 490-284 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6,08 PLAN CHECK FEE P.C.NO,
OR
ENGINEER \`
nuc.No. SIGNS TRANS. 3.00
non Ess ENG. SPECIALCIRCUIT 5.00 - PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 /
ASDDRES MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00 TFY
ro o LICENSED CONTRACTORS DECLARA'T'ION r
a u I hereby afrrm that I am licensed under provisions of Chapter 9 ISSU/ ATE
ie a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F y z I"Wessions C L rY license is in full`= ,rf yf, ❑ ❑ ❑ ❑
z o m - License Gv� .f-Lic.NO bit 4 7
2 ce I 9 Contractor
r BUILDING PERMIT
5w¢. OWNIi R-BUILDER DECLARA'TON
U INFORMATION
wore MISC. REFER TO ORD
g; w w I hereby collo that I am exempt from the mess Contractor',pts license VAwATION $/FT.
,;o ¢ Law ITTthecitylowingreason.(Sec. uires a,barit esandProfusions PERMIT ISSUANCE 6.00
20 RnmoCodeseny city or coo ntywhiny structure permit rots issuance,
also
Q ¢ Q p, improve,henmlish,of repair any structure,prior its iatement also ELEC.CONTR. LIC.NO. ELEC.in
K O R' he Wrec nedp ursua t t t such revisit In of
J signed ot ctor'se License Blas. TOTAL ERMIT TO
u w m yl he is licensed pursuant to the Provisions of the )ofDivmr's ut 3the
Zr Law(Chand Procosion,Code)lh Section is exempt therefom the
¢ the
btss for
he alleged
ernpl or that lie i is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F$ the basis for the alleged exemption.Any violation of Section eL$ S
. i9k 1:
by any arplicam fora permit applicantsthe applicaroacivil panmlty ALTER-DRAIN&VENT-WATER (EA.) 4.00
II ofootmore than five hundred dollars(S500f):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
,I i their sole campeewtion,will Jo the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
p, Code:'rye Contractor's License Law does Trot apply to an owner of
,r loomerty who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself'or through his own employees.provided that such improve .
metas are not intended or offered for sale.If,however.the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
r improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the brume,of proving thin he did not build or ins
t prove fVr purpose of sale.). INDUSTRIAL WASTE INTERRES IND CON PB Omer
N ❑ 1,as owner,of the property,um excILISIV ly contracting with . 20.00 ❑ p ❑ ❑ ❑
I( licensed contractors to constructthe project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO,
r and Professions Code:'rhe Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contmclor(s)licensed pormaRl to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
P, I ant exempt un der Sec. .B.&P.C.for this WATER HEATER W/VENT 4.00
reason
!' 1 Owner Dale WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
I r
/, WORKERS'COVPHNSA'1'ION Dh(n,ARATION WATER TREATING EQUIP. 4.00
I hereby alfrm that 1 have a ctrliBcaW of consent to wli-mwtm.� ZONING u or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
111
copy werenl1seR_Cmnpmny Diyereidied Ri
I'a0 est _Company
I ❑ Certified copy isherebyIlled furnished.the FIRE SPRINK ENERGY T24
z Z ❑ Cetlil ieJ copy is tiled wish the city inspection division.
MISC.- REFER TO ORD.
0 Apph'a\tL Y❑ N❑ Y ❑ N❑
I N CP-R'1IPICA'f r:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
Lu CO.MI'FN'SA'IION INSURANCE PLG.CONTR. LIC.NO. PLG,
CL CI I'fho seschi n ,ted nor lie complete(1 if the permit is for one TOTAL Y[:JN❑ Y ❑ N❑
:3 Z hundred dollars IS 100)or lcss.l
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
rt IL N mit is issued,1 shall not employ any Person in any manner so as to
U U become subject to the Workers'Compensation Laws of California.
0.. Dam Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you sl o id bee ome subject ro the Workeri Comperm tRm APPLIANCE 4.00 PLAN CHECK
Provisions of the Labor Cute, you must forthwith comply with FEE
U such Provisions Or this Permit shall be deemed revokWL AIR HANDLING UNIT(TO 10MC.F.M.) 3.00
( CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10C.F.IA) 5.00 SEISMIC FEE
I hereby affirm Thal Ihme is construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of[lie work for which this permi)is issued(See MICROFILM
3097,Civ.C.h HEATING UNIT(TO 100,000 B.T.U.1 4.00
Lenders Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lcnder s Address ELECTRIC
I ceililydthal l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
• i il'ormulimi is correct.1 agree to comply with all city and county PLUMBING
Ordinances and state laws relating to building comstmdion. and BOILER-COIx�(3 H.Ror100,000B.T.U.) 4.00
hL•tebysaWymi, represenfalives of this city to enter upon the BOILER-COMP (Over 100,00GBTUI SEE FEESCH. MECHANICAL
above-meNiyned property for inspeC6un purposes.
(We)\agar: to save, indemnify and keep hmmlLss the City of MISC.- REFER TO ORD.
1 Cuperhms'agamSt liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
( may in 20yAlvay accrue against said City in conserucnce,of the
t granting of Ibis'Ipermit. MECH.CONT. UQ NO. MECH.
1' `' I _ 1 4.4 TOTAL TOTAL 49
Signature of Applicant/Contactor Date 153
`
t INSPECTOR COPY