5660 (2) APPLICANT,JO FLLL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
EUI LDING APPLICATION & PERMIT
ADDRESS
,,,4, , _,,,,/ Lot 6
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL5660
OWNER SC J ���la�, �. .n`Q^ PLAN CHECK VALIDATION
-
NAME ` f1 QTY. ELECTRIC PERMIT FEE
AcroRs UTLETS-SWITCHES-
NAME RECEP 5.00/1.00
NA
uc.rvo: LIGHTING FIXTURES 5.00/1.00
CONTRAS
ADDRESS APPLIANCES PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER / 00`
uc.No / SIGNS TRANS. 3.00
ADDR SS ENG. 7e,49 S r4QOA Dn SPECIAL CIRCUIT I S.QQ PERMIT VALIDATION
ADDRESS / is
L' PI L `nghtl 0 TEMP. METER OR POLE INS. 15.00 ✓
ADDRESS /3c'7 S /�'1144Ly Sum 1 MOTORS SEE FEE SCH.
ADDRESS ��--
C:P4 SERVICE CHANGE 10.00
00 LICENSED CONTRACTORS DECLARATION 711
au 6 hereby affirm that 1 in licensed under provisions of Chapter 9 SUANCE DATE
H rt w (eolllm'mr,with Section 7000)of Division 3 of the Business and BLDG. ELECT.! PLG. ECF.
F N z Professions Code,and my license is in full force and effect. ❑ ❑ s ❑
License Class Lic.Number
-
0 z r Date Contmcfor
a x f BUILDING PERMIT
tl:w<OWNER-BUILDER DECLARATION INFORMATION.
F o A MISC.- REFER TO ORD
1 hereby affirm that 1 am exempt from the Contractor's License
u_ ov, Law for the following reason.(Sec.7031.5,Bobarlsand Professions pERM1T ISSUANCE VALUATION SIFT.
� - Code,Any City Or county which requires a permit to construct,alter, 6.00 p
¢ ¢ £O top,ovo•demolish,nr repair any structure,prior to its issuunte,also ELEC.CONTE. LIC.NO. 431.000
ELEC.
requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m w he is licensed pursuant to the provisions of the Contractor's License
F z a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
Ei 0 Business and professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE Condos.
e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR�_
a � by any applicant for a permit subjects the applicant toa civilpenalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
n
LI not itre than five hundred dollars(8500).): 2 +i,�_-
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS t
their sole comptivw ion,will do the work,and the structure Is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Cod ,The Contractor's License Law does not apply to an owner of -
propertywho builds orimproves theROn,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGISK
. hinsscll'or through his own employees,provided that such improve-
mentsare not intended oroffered for sale,If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- 1k.0GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 O 00 BUILDING USE.
builder will have the burden of proving that he Hid not build or im- RES IND CON PB Omer
P ova for purpose of sale.). _ INDUSTRIAL WASTE INTER: 20.00 El El El ❑
k.as owner of the property,am exclusiJely contracting with
li I. d contractors to constmet the project(Sec.7044,Busirwss LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code n'I'lie 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 with a contractors)licensed pursuant to
the Contractor's License La,,, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam cxcn Pl under __.B`&P.C.for this WATER HEATER W/VENT 4.00
on7575
Owner -� Dm WATER SYSTEM 4.00 ACC.DATE PCC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or.cenifi,me of Workers'Compensation Insurance,or a certified
copy then.f(Sec.3800,Lab CJ.
Policy No. C'nmpany
O ❑ Certifiedcopyisherebyfumished. FIRESPRINK ENERGY T 24
ZZ ❑ Certified copy is filed with file city inspection division. MISC.- D
- REFER TO OR .
Q Applicant Y ❑ N❑ Y ❑ N❑
2 N CER1'1FICA'11701'EXF.MI'I'DON FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.UC.
LL > CONIPENSAT1Oxl INSURANCE PLG.CONTE. LIC.No. PLG.
d O I1 his section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollars($1001 or less)
U O 1 certify that In the 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 mannerso as to
U. becmnu subject to the Workers'Compensation Luws of California.
ED Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F_ Z_ 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 10SMC.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 5.00 SEISMIC FEE 30.17
1 hereby affirm that 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.Civ.C.). �. AY ,cam HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name A�� G HEATING UNIT(0 VER100,000B.T.U.)7.50 ELECTRIC
ZZ
Lcndcr s AJdress
I cerfily that I have read this app wmion and Mate that the above VENTILATION FAN (SINGLE) 3.00
. information is correct. I agree to comply with all city and county PLUMBING
milmanens and state laws relating to building construction, and BOILER-COMPOH.P.or 100,000B.T.U.) 4.00
hereby aWhoriee representatives of this city to enter upon the BOILER-COMP(Over 100,000 STU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD.
CoIpetlino against liabilities,judgments, costs and expenses which CONST.TAX
May m any y aceru .gains ami ity i consequen a of the
PERMIT ISSUANCE 3,00
,'anti rspennit MECH.CONT. LIC.NO. TOTAL
U � !o TOTAL 1.290.67
Ignalure of At Dal, '
INSPECTOR COPY