C8157 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER \
BUILDING APPLICATION & PERMIT /^
AOORESS
. .� ^n BUILDING - ELECTRICAL=PLUMBING-MECHANICAL /Vi_ 8157
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ME �� �+'"�pa�.(�i.(-1'L�1Z /IL,7C TY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
M d1W&O
AERACTOR SOUTLETS-SWITCHES-RECEP 10.00/1.00
C.ND. LIGHTING FIXTURES 10.00/1.00
G A R' PPLIANCES-RESIDENTIAL 4.00
DDREss
V4, t`AMJAh4L PH N PANELS 10.00 DATE OF APPLICATION
A C F
PLAN CHECK EE P.C.NO.
/ ORENGINEER CjL GPI/T-C^G � PANELS (OVER 200 AMP) - -==-20.00
uc.NO SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT, 5.00
V9J Y7TOV /LLO C zIP EMP.METER OR POLE INS. 20.00
ADDRESSS
PucSMOTORS SEE FEE SCH.
J
•'' SERVICE CHANGE 20.00
o ) �y� LICENSED CONTRACTORS DECLARATION' TEMP.POLE 30.00 1/,(S�
G U ^ 1 hereby affirm Ihut I con licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
BLDG. ELECT. PLG. MECH.
F D z Professions Cold ad my license is in full fur cffec
1 L
Z 0 m a License Class- l Lia Number
r Date VVV ��' .�Cnntreclor y
a r �• BUILDING PERMIT
¢ ¢ a OW 1> -BUILI UEC 1K 'PION
o a u INFORMATION
X 3 LL H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LLOj Law for the following reason(Sec.703 L5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
f Code'.Any city or county which Rvluiresa permit to construct, 96U OOG
¢ ¢ ¢'0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. .7U o
Be requires the applicant for such permit to file a signed statement that TOTAL LL
PERMIT TO
A.
w m,A he is licensed pursuant to the provisions of the Contractor's License
> Low(Chapwr9(commencing with Section 7000)of Div inion 3 of the
i o Business and Professions Code)or that l,c Is exempt therefrom unit OTV. PLUMBING PERMIT FEE /'V 7C�rJ cMUdG
¢ H o the basis for the alleged exemption.Any violation ofSeclion 7031.5 STORIES TYPE CONSTR,
a. !2 by any applicant for a permit subjects the applicant to a civil penally gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).): -
❑ 1,as owner of the property,or my employees with wages us BACK F LOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's 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 or through his own offered
for sale,provided that such impnwo-
merits rnself a througot his or oemplo ees,pro If.however,that such
he buildniloo e- GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS-EASYSTEM': 4 IEA.1 2.00
builder will have the burden of proving that he did.not build or ice .- BUILDING USE
prove for purpose of sale), RES IND CON PO Other
❑' I,as owner of theparty,ro um exclusively contracting with INDUSTRIA L.WASTE INTER. 30.00 ❑ ❑ ❑ 0 O
p
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The 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 will,a cortractorts)becnsed pursuant to
th�mtractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
Ed l am exempt under See.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. j
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure•. .ZONING ENG.SITE NO.
or u certificate of Workers'Compensation Insurance,or a certified
Pcopy I
hereof
re -lSec.3fl 00Lab.0
No. �j��L„•_�/� An
Policy C0,L b
0 ❑ Certified copy is h mb furnished.
❑ Certill• is�il• i 1 Iq t ns tion division. FIRESPRINK ENERGY T-24
Z' Z 7 1rA #n� MISC.- REFER TO ORD. � � E] E]
O Applicant �/ V N V N
CC rn -7TIO PERMIT ISSUANCE 10.00
Tr'- CIiRT1I'ICATEONSAEIOTINS PROMWORKERS' FLOOD ZONE A.L.UA.
ILS Cvil not'SA'I'oro INSURANCE PLG.CONTR. LIC.NO. PLG. Y� N� Y � N�
CL O (This sellarn need not be compleleA if the pennil is for one TOTAL
:D Z hundred dollars 141001 or less.)
U O 1 certify that in me performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of California.
LU DateApplicant peBUILDING �� Uv
/ F m NOTICE FO APPLICANT: If,after making this Cerlificam of lax- ALTER OR ADD TO MECH. 5.00
Z emption,you should become subject to the Workers'Comnsation APPLIANCE 5.00 PLAN CHECK
A, provisions of the Labor Code, you must forthwith comply with
^UI such Provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE d G10
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). �_ JL HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that 1 have read this application and state that the above.' VENTILATION FAN (SINGLE) 4.00
information n estate . I agree to comply with all city and county" PLUMBING
i n oolitas and scum lows relation to building construction nand BOILER- MP13 H.P.Or 100,000 B.T.U.1 6.00
above-reby authorize representatives rs' of this city m enter upon the BOILER-COMP(Over 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned p party for inspection purposes.
(We) agree to c, in'demmify and keep hmmless the City of MISC.- REFER TO ORD. 'y�
Cuperlinu again abilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
By
qp
accrue Bound said City in consequence of the -
Yunit. �/ ' CH.CONT. LIC.NO. MECH.
TOTAL TOTAL /�5 o
ig a p cant/Contractor Uutc r
INSPECTOR COPY
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