8599 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
�. awDflLOING APPLICATION & PERMIT
q° E55 ^ _ 8599
LTZ SCO � BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
OWNER'$ �f _ PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
�-
CONTRACTORS
Nq E ,'L OUTLETS-SWITCHES-RECEP 10.00/1.00
A"/J -Y^ �fL IC.NO.`i6311'j LIGHTING FIXTURES 10.00/1.00
AODRESS�6Q �"" PPLIANCES-RESIDENTIAL 4.00
CIcUDAIS'
/J_JoS G g kl PHONE asa- 43 PANELS 10.00 DATE OF APPLICATION
Ogc°rncCT PANELS (OVER 200 AMP) 20,0Q PLAN CHECK FEE P.C.NO.
ENGINEER
Lica No: SIGNS TRANS. - 3.00
ADD ESS ee¢ SPECIALCIRCUIT '5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
APPLI EMOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 S
D
, 00 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 Q S�
a mo u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F. H i Professions Codr an mY license is in full for unci effect.g ❑ ❑ ❑
OP
0 w o .Lice lass ® .Lie Number
Date Contractor
� � M < TNG.
rc w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
a,0 d U. INFORMATION
xr g H I hereby affirm that I am exempi from the Contractor's License MISC.- REFER TO ORD
VALUATION $/FT.
FLL0 A: Law for the following reason.(Sec.703L5,dusinessanJ Professions PERMIT ISSUANCE _ 10.00
w0 Code:Any city or county whichrequiresapermittoconstruct,alter,
< improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O ¢ requires the applicant for such permil to Ole a signed statement that
a. he PERMIT TO
R
m he is licensed pursuant to the provisions of the Contractor's License D
Hii