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9313 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT aoOREss '� '7C73�(,19A K)f BUILDING-ELECTRICAL-PLUMBING -MECHANICAL9313 OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE . J;?CP e, PROxE CONTRACTOR s OUTLETS-SWITCHES-RECEP ],0.00/1.00 P CAL COASTfVJet! cvS� �c No L LIGHTING FIXTURES 10.00/1.00 CONTRACTOR S'�'^�AgA APPLIANCES-RESIDENTIAL 4.00 ADDRESS ER �AZAyAAI ,D� I•, PHON _ PANELS 10.00 DATE OF APPLICATION ARCRIT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO. OR SIGNS TRANS. 3.00 ENGINEER /� LIC.NO. / ARCH. VOR ESS erva. �� SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 - APPucarvrs MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 q w o o LICENSED CONTRACTORS DECLARATION TEMP!POLE 30.00 // a .0 1 hereby aril nR that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commrncing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r' Professions Code,and my license is le full force and effect. �' / C& ❑ License Class Lie Munhet - mr -X, flale�Cnntrucmr - ¢ m sAT BUILDING PERMIT ¢ � w a OWNIi R-d UILDfiR DF:CI-A AT U INFORMATION oA MISC.- REFER TO ORD w g n H 1 hereby Bolo. that 1 am exempt from the Contractor's License VALUATION S/FT. r u w J Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE JAW C.&- k Code:Any city or county which requires a permit to construct,alter, R ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. EC. I C IS requires the applicant for such permit to file a signed statement that .1 TOTAL � (ti PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)ofDivision 3 of lite �� OL.�(i"' a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE sio IL I- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES f TYPE CONSTR. Ea ate _ by any applicant for a permit subjects the applicant On civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA;COND. 5.00 Code:The Contractor's License law does not apply to an owner of �,(�(� property who builds or improves Ilio,....,and who does Such work FIXTURES-PER TRAP _5M 9L, FT FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- •N ..is are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.40TLETS 6.00 (� or improvement Is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE Q RES IND CON PIR Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 Q ❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec..7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. ( _ and Professions Code.The Contractor's License Law does not apply l/91 to un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts forslmh projects with u contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. 1 ❑ lam exempt lender Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 �D reason (� Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. jWORKS RS'COMPENSAT1ON DECLARATION WATER TREATING EQUIP. 5.00 3 1 hereby affirm that 1 have d certificate ofconseet to se fminsure. O,�- ZONING or a certificate of Workers'Compensation Insurance-ora certified ENG.SITE NO, c copy thereof(See.3800,Li b.C.). ' licy No. Company O Q_Certi tied Copy is hereby f r s e . FIRE SPRINK ENERGY T-24 Z Z D1 Certified copy is filed with the city inspection division. MISC.'rt REFER TO ORD. . ,per,\/ Applicant Y❑ N❑ ✓❑ N❑ � = Cli�CA'1'1:OF EXEMP ION FROM WORKIi RS' PERMI1t ISSUANCE IOrQO. FLOOD ZONE A.L.U.c. L COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. CL 0 This section need not be completed it the permit is for one TOTAL / Y❑ N❑ Y ❑ N❑ D Z hundred dolla,s(5I001 or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued-I shall not employ any person in any manner so as to Ow become subject to the Workers'Compensation Laws of California. BUILDING ED Datc Applicant ALTER OR ADD TO MECH. 5.00 -} w NOTICE TO APPLICANT: If after making this Certificate,of Ex- F Z emption,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 shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 1 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 ISec MICROFILM 3097,Civ.C.). QHEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender'S Name HEATINGUNIT(OVER 100,000 B.T.U.10.50 Lender's Addre 1 ELECTRIC ,L /- I certify that l havercad this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county - PLUMBING (�7/ ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives o1' this city to enter upon the BOILER-COMP(Over 100.000BTUISEE FEESCH. MECHANICAL above mentioned property for inspection purpc (We save, indemnify and keep harmless the City of MISC.- REFER TO ORD. C mo against Ilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay in I y way me against said City in consequmtce of the SII ranting f Ills p r L MECH.CONT. UC.NO. MECH. TOTAL TOTAL 6rV �U $I' C on L• � INSPECTOR COPY