C7221 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION /7 'PERMIT NUMBER
B,,,L,,,NG APPLICATION & PERMIT ,`//
Ap �5 0 Io 404 {.0.4:Fi7F /L7221
BUI LDING-ELECTRICAL-PLUMBING-MECHANICAL
O.pM�_EI(�R'a �f �i PLAN CHECK VALIDATION
N I�A4/Y�4 L G • 2.:r. /f3�OTY. ELECTRIC PERMIT FEE / �U'/
PHONE
CONTRACTOR'S �J I
yA rr:-rlm( r,R4.7O •.T,J LIGHTING
-SWITCHES-RECEP 5.00/1.00
II''1 r00 LIGHTING FIXTURES 5.00/1.00
- rr;,pyrvr EAcron�sj� /gyp tyt7s PPLIANCES-RESIDENTIAL 4.00
/� �"� TONDO ory p PANELS 5.00
DATE OF APPLICATION
OJTSIGNS 6.01) PLAN CHECK FEE P.C.NO.
O
NE
LIc. SIGNS TRANS. 3.00
ARM.0.ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METERjOR POLE INS. 15.00 (`^
APPLICANTS MOTORS SEE FEE SCH. -/
�0 SA �JSTt�/U�
SERVICE CHANGE 10.00
-02 LICE:. SEI (( " ACO S IiCL ION
¢ U w I hereby al fir n that I am licensed under provisions nl Chapter 9 ISSUANCE DATE
yam (conn..encith, it m 7000)of Division 3 ol'Ihe Business and .--..-.-- .- B ELECT PLC. MECH.
H w z I'rolenions C01@�td y license is in fu affec �e
Z o w - License s. Ic.N a
R F Dole mrt 'lo
a a E BUILDING PEAMIT
¢ ¢w� OWNER-BUILDER DE ARATION-.� ) INFORMATION
Aoa MISC.- REFER TO ORD / U
X a_ N I hereby a ilio that I .m exempt from the Contractor's License VALUATION SIFT,
I w o ¢ Law for the following reason.(Sec.7031.5.Husiness and Professions mise.-ISSUANCE 6,00 y
NJ Code:Any city or county which requiresx permit to construct,alter, r / h/'SDOD/
w p p y for to its issuance,also ELEC.CONTR. LIC.NOJ ,l
rt rt Q o improve,demolish,or repair an structure,prior ELEC.
1-1
am O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License -
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 'I -apt 001
4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING P.ERMIT FEE /�f
¢ r 0 the basis for the alleged exemption.Any violation of Section 703 t,5 STORIES TYPE CONSTR.
i ;m by any applicant for it permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 4.00
of not more than five hundred doll...(45001.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00 OCC.GROUP RES.UNITS
their sole compernation,will do the work,and the structure is not
intended or offered for sale(See 7044. Business and Prolcssions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 so.FT.FLOOR AREA TOTALACREAGE
himselfor through his own employees,provided that such improve-
•• ment, in ,of intended ,,ml'crcd Ors ale.If.however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA.) 1.00 BUILDING USE builder will have the burden of proving that he did not build or ion - . IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the property,am exclusively contracting with E ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 aSSESBOR$vaRCEL No.
and Pmfcssions Code:'I'he ContmeR i License Law does not apply
to nn owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.1 7.00
contracts for such projects with u contructor(s)IieenseA pursuant to
the Contracmri License Law. SEWER-S NITARY-STORM EA.200ft/8.00 5 TRACT NO. PARCEL NO..
❑ lam exempt under Sec. .B.&P.C.Iirr this WATER HEATER W/VENT 4.00
crit
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS•COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a virtual,of consent to scl Ginmim' ZONING ENG.SITE No-
or a certificate of Workers'Compeymy�l.ranf}I.y[,gc.rt(ificd
copy thereof(Sec.3800,Lah.C.l.� �"`TL'Ir'u'/
Policy No. Coni Puny. Rte• '
0 ❑ Ccrti Sed copy is hvu by!uritis ed. FIRE SPRINK ENERGY T 24
z p AT'❑hLanr' - J cop fled wi the ci ins -tion ivisiouy MISC.- REFER TO ORD. , f Y❑ N❑ v❑ N❑
~ w PERMIT ISSUANCE 6.00 hp
FLOOD ZONE A.L.U.C.
CERT 9CATIi OI'1 XI:MPI ION PROM WORKERS'
LLI > COMPENSATION INSURANCE PLG,CON TR: .LIC.NO. PLG, •v/t��
CL 0 CL Z ('Phis section need not he completed if the permit is for one TOTAL 10 Y El N❑ Y ED N❑
hundred doll...($100)or lass.)
U O I certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I slmll not employ any person in any mannerso as to
U w become subject to the Workers'Compensation Laws of California.
C.. Ume Applicant ' ALTER OR ADD TO MECH. 4.00 BUILDING
} W NO'I'I C 1. TO AP PLICA N'1'. If,after making ih is Certifies lc of Ex- r
9
FZ enption,you should become subject to the Workers Tea 4.00 PLAN CHECK
pro kions of tire '
e Labor Code, you must forthwith connply with FEE 'f
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OODOF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that tlicrea a cOn cU tling agency for EXHAUST HOOD(WITH DUCT) 2.00
the ,Civ.man<c I the wo for w is ibis per is issyeJ Sea, MICROFILM
3097,Civ.C.l. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEA ING UNIT 100,000 B.T.U.)7.50 �
Lenders Narne- ELECTRIC
I certify that I have read this application and state that IIIc above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county - PLUMBING
ordinances .,,it state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)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.
Cuperl' .9.jttst liabilities,ju mems, costs and xpen�sses which CONST.TAX �..•/
may
try
ay Accrue agar t said City in ar ce the PERMIT ISSUANCE 3.00
Bra
got
I'p it- �/ � ECH.CONT. LIC.NO. MECH. /
.DTA 00 TOTAL I KI
1 �'
Signature fADplicanl/Contractor Uale
INSPECTOR COPY
-____S_._ _