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7136 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY. BU LDING PROJECT I DENTI FICATI ON V7 PERMIT NUMBER RUI1DING APPLICATION & PERMIT ADORES SSS TEo L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 711 36 r . OwNER'S PLAN CHECK VALIDATION NAME 1( (� QTY. ELECTRIC PERMIT FEE ' (3//RG( R PHONE CONTRACTORS OUTLETS-SWITCHES-RECEP 5.00/1.00 _f""-- NAME �y�n / �� C.No.�CI l7b 9 LIGHTING FIXTURES 5.00/1.00 S CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 / �` IJe PHONE /IxJ �I PANELS 5.00 DATE OF APPLICATION ARCHITECTSIGNS 6.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 coo cis ENG' SPECIAL CIRCUIT 6,00 PERMIT VALIDATION ZIP rrEMP.METER OR POLE INS. 15.00 APPLICA TS MOTORS W SEE FEE SCH. -Z n J SERVICE CHANGE 10.00jy, o o LICENSED("ON'I RACT'ORS DECLARATION 7 G iP u I hereby aflrtm that 1 am licensed under provisions of Chaplet 9 ISSUANCE DATE w w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. wi Professions Cod an my license is in full forte 6 ©� r Z O m - license Cla s Lie.Nomm, v0 w H UutC� Contractor O < y s El BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION INFORMATION o¢ MISC.- REFER TO ORD K ;LL N I hereby allinn that I :un exempt from the Contractor's License VALUATION S/FT. ,F Ioa Law for the following reason.(Sec.7031.5,[Loinessand P,ol'es4uns PERMIT ISSUANCE - 6.00 Code Any city or county which requires permit to construct,alter, O 7 -y ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. 4LIC.N0. ELEC. -L OY/t - yK 0¢ requires the applicant lot such peril to file a signed statement that TOTAL S _- PERMIT TO A in m w he is licensed pursuant to lire provisions of the Contractor's License ^ 1 rza Law(Chapter 9(commencing with Section 70001 ofDivision 3 of the SQ44,V_,V,1 co( 41il o i O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE L Of I- o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty mre of not othan dr five hundred dollars(8500).): ALTER-DRAIN& VENT-WATER (EA.) 4.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UN$TS their sole compensation, will do lire work,and the structure is not intended or offered IYnr sale (Sac. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law does nor apply to an owner of property 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- mentsare not intended oroffered for saIt.if however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00 or improvement Is odd within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE builder will have the burden of proving that he did not build or in, RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 x ❑ 1,as owner of the property.am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct lire project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code: [lie Contractor',License U.does not apply s to an owner of property wi;o huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a commoners)llcansed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exmnpi under Sec .H.&P.C.for this WATER HEATER W/VENT 4.00 reason Owner Date WATER SYSTEM 4.00 ACC.OATE ACC.FILE NO. W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have u certificate of consent In wif-insure' ZONING. ENG.SITE NO. ar a certificate of Workcci Compensation Insurance,or u certified copy thereof(See.3x00,lab.C.l- �s.t.•1 Policy No. Company 510 ❑,Cerlil IS1q1 rcby fumi5hyd FIRESPRINK ENERGY T 24 Z Z ❑ CertiO co i�Lg,�sf}le 7th h cfmi division. O Applicant �"S ' 'uPeMISC.- REFER TOORD. Y ❑ N❑ Y ❑ N❑ MN CERRIIIFICA I'It OF EXEMPHON FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.uc. LU COht PENSATION INSURANCE PLG.CONTE. UC.NO. PLG. CL O ('this section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ Z) 2 luindrud dollar,($I00)or Icss.) U O I certify that in the performance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,1 shall not employ any person in any manner so as to �'1 U become subject to the Workers'Compensation Laws of California. y y Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } v) NOTICE TO APPLICANT: If,after making this Certificate of 6x. ? emption,you should become subject to the Workers Compensation APPLIANCE• 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M) 3.00 CONSTRUCTION LIiNUING AGENCYAIR HANDLING UNIT(OVER 10p00QEM.) 5.00 SEISMIC FEE I hereby atlurn thus there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the Performance of the work for which this permit is issued(Sec. MICROFILM 3097,a..C.). HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,0008.T.U.)7.50 . . Lender's Address ELECTRIC 1 certify that 1 have read this application and State Thal the above VENTILATION FAN (SINGLE) 3.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating.to building construction. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 hereby authorirn representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ahove-mentioned properly for inspection purposes. (We) agree to save, indenmify and keep harmless the City of MISC.- REFER TO ORD. Caper' ngainst lial I ics,j idgnhenis, costs and cxpcnses which CONST.TAX may n any uy accrue ogainsr said City in cunscyuence of the PERMIT ISSUANCE 3.00 grant g of t, a n1iL MECH.CONT. LIC.NO. MECH. trg1¢ TOTAL TOTAL / 'SlRllato,,of Applicant/Comracto Dm INSPECTOR COPY