9320 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LOI NG PROJECT I DENT[FI CATION PERMIT NUMBER
It"RING APPLICATION & PERMIT
ADDRESS
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 9320
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
• PHONE
CONTRACTOR ncrORs UTLETS-SWITCHES-RECEP 10.00/1.00
LICND. LIGHTING FIXTURES 10.00/1.00
pONTRACTORs f PPLIANCES-RESIDENTIAL 4.00
ADDR /YJT�✓U/CW
'
r paMr.ONE PANELS 10.00
OR
DATE OF APPLICATION
RESS CHI T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
uc.No. SIGNS TRANS. 3.00
AARCW OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLI S MOTORS SEE FEE SCH.
ADDRDR ESS Ess
SERVICE CHANGE 20.00
/0``�
/
woo LICE SIiU CONTRACTORS 1 ECLARATION TEMP.POLE 30.00 -) /8
¢ v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG, ELECT. PLG. MECH.
a w
r o z Professions Code,and my license is in full force and effect. El ❑ ❑
z at `� y License Class Tic.Nuber
9 H °� smDate `�-"� 'r 7 CDnlmctor
¢ Y f -7w e /Y UA C BUILDING PERMIT
ce ¢ w O NIcR-BUILDIIR DECLARATION INFORMATION
E:
0 A H 1 hereby affirm that I am exec t from the Contractor's License MISC.- REFER TO ORD
3 u ,A y P VALUATION $/FT.
H .. 0 a Law for the following reason.(Se<.7031.5,tlusiness and Processions PERMIT ISSUANCE 10.00
Code:.Any city or county which requires a permit to construct,alter,
ce au Q Q improve,demolish,or repair any structure,prior to its issuance-also ELEC.CONTR. LIC.NO. ELEC. ,
cc
0 ¢ requires the applicant for such permit W file a signet statement that TOTAL PER
Tp
u w m" lin is licensed puramnt to lira provisions of rhe Contractors License
zi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt Beret ..as and QTY. PLUMBING PERMIT FEE
Era
¢ o lire basis for to alleged a exemption.Any violation of Section malty STORIES TYPE CONSTR.
ate _ by any applicant fora permit subjects the applicant macivilpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more titan five hundred dollars($5001.):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sale compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sce. 7044, Business and Professions. 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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such in'
mprove-
ents are not intended or offered for sale.If,however.the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement Is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have tire . . .
e burden of proving that he did not build or im- RES IND CON Pe Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the property,ant exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO., "Y J
and Professions Code!The Contractor's License Law does not apply
to all owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contraclolis)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iamexemptunder See P ,B.&P.C.for this WATER HEATER ANENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACG DATE ACG FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby afflrnl that I have a certificate cfconsent to scl Giu,noc. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.
y Policy No. Company .1T0 i e� ✓N�
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z' ❑ Certified copy is filed wit dun city inspection division. MISC- 'REFER TO ORD.
0>( Applicant Y ❑ N❑ Y ❑ N❑
CC ~ Mi PERMIT ISSUANCE 10.00 PLOODZONE A.L.U.C.
LU CIi R'I'II%CCOMPE Al[ N INS FROM WORKIiR$'
W � COMPENSA'I'I(1N INSIIRANCB PLG.CONTR. LIC.NO. PLG.
0-Z (This section need not be completed if the permit is for one TOTAL Y[:] N❑ Y F] N❑
hundred dollars($100)or less.)
0 O 1 certify that in the performance of dire work for which this per- FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to Q�Y. MECHANICAL PERMIT 'FEE
U become subject to the Workers'Compensation Laws of California.
0 d cant Date AppliALTER OR ADO TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICAN'T'. If,after making this Certificate of Ex-
♦- ? entption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit sliall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1g00DC.F.M.) 6.00 SEISMIC FEE I
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.T HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's N:u11e HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I ceRity that I Ieve read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby autmrite representatives of this city to enter upon the BOILER-COMP(Over 100,000 STU)SEE FEESCH. MECHANICAL rflf
above-mentioned property for inspection purposes.
i
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
,payCupi inany wilt accrue
liabilities,judgments, costs and expenses which CONST.TAX
coy in any way ac c against said City in e nseyuence of the PERMIT ISSUANCE 10.00 y/Vic-
grunting of this permit MECH.CONT. LIC.NO. MECH.
TOTAL moi o` TOTAL
n cure p ica C ntraclo Dat
INSPECTOR COPY