C8162 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADOREss /�
0 '400 vNAR1gw� 1 4V_ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL l7 JS
OWNER'$ PLAN CHECK VALIDATION
NAME SQTY. ELECTRIC PERMIT FEE
Y VA CokAP4 U'(PRONe
NOMEPncTOR's UTLETS-SWITCHES-RECEP 10.00/1.00
u qv..4 > - T TIeLIC.No. 3,5 C, _LIGHTING FIXTURES 10.00/1.00
ADDRESS TORR CAixllr'S3kr-L CA, 9$00$ PPLIANCES-RESIDENTIAL 4.00 .�
. CANkP vr PHONE f PANELS 10.00 DATE OF APPLICATION
• ARCHITECT M ` PLAN CHECK FEE P.C.NO.
?l
ENGINEER
Car s2T ISS A ASS PANELS (OVER 200 AMP) 20.00
uc.NO.f,4 SIGNS TRANS. 3.00
AR A OR_ ADDRESS ENG. C`L.Pie Or"o CA 951711f SPECIALCIRCUIT 5,00 PERMIT VALIDATION
208(03 T' - CQ 3ia.Ozw EMP.METER OR POLE INS. 20.00 /
ADDRESrvT5 MOTORS SEE FEE SCH. n/(s
SERVICE CHANGE 20.00 _
was
Hoo LICENSED CONT RACI'ORS DECLARATION TEMP.POLE 30.00 CJS
'.1-
i U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
¢N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H w z Pnsfessians Code,and at,license is in full force;,,,it effect. L ❑ 1:1 ❑
z 0 w - License Class a-I Lie Number 4 a 3 'G'S-; t
'o w wn Date y�$ ie Contractor�'�
a m f �u
¢ ¢ OWNIi R-UUILDF:R DECLARATION BUILDING PERMIT
god " - MISC.- REFER TO ORD INFORMATION
K
g LL m I hereby collo that I am exempt from the Contractor's r License
F LL o¢ Law for the following reason.(Sea]031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
w0 Code:Any cityor county which requires a permit to construct,alter, (7.
r pr p y -or to its issuance,also ELEC.CONTE. LIQ NO. /.} o0O
4 improve,demolish,or repair an structure,prior ELEC.
ca
O t[ requires the applicant for such permit to file a sighed statement that TOTAL PERMIT TO
K
mhe is licensed pursuant to the provisions of the Contractor's License
Hz >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Cs 17r CAL C�U�
¢ Business and Professions Code)or that he is exempt therefrom add QTY. PLUMBING PERMIT 7� FEE U
¢ F the basis for the alleged exemption.Any violalion of Section 7031.5 }, STORIES TYPE CONSTR.'
by any applicant for a pernd subjects the applicant In a civil penalty ALTER-DRAIN IEA.) 5.b0
of not more than five hundred dollars(S500f): - -
❑ 1,as owner of the properly,or my employeeIW ith wages as BACK FLOW PROTECTDEVICE 400 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not . . '
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,,,_✓
Code:The Contractor's License Law does not apply to an owner of -
propertywhobuildsorimprovesthereon,and who docs such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that suchimprove
-
Rentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im RES IND CON PB Omer
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner al'tire property,ten exclusively Contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the Project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code: the Contractor's License Law docs 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
O lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
PCC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of conscnl to elf-insum,
\/ or u certificate of Workers'Compensation Insurance,or a certil'icd ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab.0-).
Policy No. Company IS I
0 f�Certified co pis hereby fur is'
B I FIRE SPRINK ENERGY T 24
Z Z Certified c p) is filed :th t c;y inspection division. MISC.- REFER TO ORD.
O Applinnl Y❑ N❑ Y ❑ N❑
CC W CIiRTIIsI .ATB 01'E-(lih PTION FR WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE aLu.C.
Lu �_ COMPENSATION INS URA CE•' PLG.CONTR. - LIC.NO, PLG.
Q. o (Phis section need not be completed if-tire permit is for one TOTAL Y❑ N❑ Y ❑ No
_ ::) Z hundred dollars IS 100)or less,)
0 O 1 certify that in the perfornueme of it,work it,,which this Pcr- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any Ifanner so as to
0 , become subject to the Workers'Compensation Laws of California.
E0.D Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If.after making this Certificate of Ex-
Z_ enlption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the 1-abm Code,you most forthwith complywith FEE
0 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 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
lir I errforniance of lite work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and'one tllal the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city'and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize roper yfotivesins inspection
this city m corer upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly fa inspection purpous.
(We)' a to save, in nif and keep formless the City of MISC.- REFER TO ORD.
Cupe'd ag inst liabiliti jut I cuts, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may i Any ay aouruu •uin. aid Cily in consequence of the
granlil of[ Is pe MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature Appli / If a or Date
INSPECTOR COPY