9119 �PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 9119
ADDRESS
X T i BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATION
NAME
�,L/J QTY. ELECTRIC PERMIT FEE ��
x WF 2 RUNE _
CONTRACT Rs-� UTLETS-SWITCHES-RECEP 10.00/1.00
NA%E_% �\ PC 7-771' /
J-- JUC.NO. LIGHTING FIXTURES 10.00/1.00
POORCSS RTs
POOR CSS
'- APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER r
T C.No. SIGNS TRANS. 3.00
ADDRESS ENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 n
APPLICANT
ADDRESS MOTORS SEE FEE SCH. /l
SERVICE CHANGE 20.00 r^
o¢ z /
Foo LICENSED CON'I'RACI'ORS DECLARATION TEMP.POLE 3(Fs �/1
G v U I hereby affirm that I am licensed under provisions of Chapter 9 ' ISSUANCE DATE
y O1 (commencing with Section 7000)of Division 3 of the Business and
a a BLDG. ELECT. PLG. MECH.
H N 2 Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑
z o o - License Class Lic.Number
o m - Date Cmd"c nr
a x E BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
¢ u, u - INFORMATION
X ;LL n -Thereby affirm that I am exempt from Om Contractor's License MISC.- REFER TO ORD
LL_ oa Law for the following reason,(Sec.7031.5,Basinessand Professions PERMIT ISSUANCE 10.00 VALUATION g/FT.
Coder Any Cityorcounty which requires a permit to construct,alter,
rt ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
a
O¢ requires the applicant for Such permit to file a signed sLtle reut that TOTAL PERMIT TO
X
m he is licensed pursuant m the pmvisians of the Contractor's License
HiQ Law(Chapter q(emmmencing with Section 7000)ofl)i,i,inB 3 of the �i0
4 o Business and Professions Code)or that he is exempt therefrom anJ QTY. PLUMBING PERMIT FEE "v
¢ H o the basis for IIIc alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; `O by any applicant for a permit subjects the applicant to a civil penalty' ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(S500L):
❑ 1,as owner of lite property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do th
e work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions w DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code. The Contractor's License Law does not apply to an owner of
property who builds or improves McIver,and who does such work F IXTUR ES-PER TRAP 5.00
himself or through his own employees,provided that such Impoose J SD.FT.FLUOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement Is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ y
licensed contractors to construct Ill' pro"ct(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code
:'Fine
Card acm's License Luw Rocs not apply
to4c'
of property wit olds 1r improves thereon.cold who LAWN SPR INKLERS-OVER 5 IEA.) 1.00
csuch projects ith con rucliaoo licensed pursuant m SEWER-SANITARY-STORM EA.20017/10.00
thtr License La TRACT NO. PARCEL N0.
empt under Se ,B.&P.C.Ior thisWgTER HEATER W/VENT 6.00
\' reRO Date% WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
q'ERS' 'NSA' IO DECLARATION WATER TREATING EQUIP:' 5.00
I hereby Aave a cerlific Ic of consent to s'elGinsurc, ZONING
or a certificatCompensali n Insurance,or a certified ENG.SITE NO.
copy thereofab.C.L
Policy No. Company - -
0 ❑ Certified ropy is hereby furnished. FIRE SPRINK ENERGY T 24
z Z0 Certified copy is filed with the city inspection division.
MISC.- REFER TO ORD.
O Applicant Y❑ IN Y ❑ N❑
CC LQ c.
LU CF.H'I'I FICI P F-XEMIINS FROM WORKERS PERMIT ISSUANCE 10.00 FLOOD ZONE A,L.0
W > CCOOMPP ENSATIONN INSURANCE PLG.CONTR. LIC.NO, PLG.
0. Z IThis section need not be completed if the permit is lot one TOTAL \ YE] N Y ❑ N❑r
hundred dollars IS 100)or les.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1- mil IS issued,I Shall not employ any person in any manner so as to
U
U become subject to the'Workeri Compensation Laws of California. ' I
ELI Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 1M. 5v
} to NOTICE '1 O AI'PLICAN'I': If;alter making this Certificate nl lix-
H ? mnphon,you should become subjectto the Worker,Conlpensution APPLIANCE 5.00 PLAN CHECK
provisions of Ole Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F,M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE
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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
LeHdcr a Address ELECTRIC
I certify 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 state laws relating to building construction, and BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter Upon the BOILER-COMP.(Over 100.000 BTU)SEE FEE SCH. MECHANICAL,
cane y mentioned property for i specbou pas rpous. _ _
( '1) agree to -ndemn fy and keep harmless the City of MISC.') REFER TO ORD.
Cu r no againstbi' ies,ju •mems, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
For, any wary cone agai said Cily in conscyucnce of the
gra of tbix porn MECH.CONT. `1 LIC.NO. MECH.
/
_ TOTAL TOTAL
of Alicant/, Date
INSPECTOR COPY