6734 APPLICANT TO FILL YN INFORMATION WITHIN REDLINES — US LL POI PEN ONLY.
BUILDING PROJECT IDENTIFICATION - '_� PERMIT NUMBER
aUILDISO 22 • APPLICATION & PERMIT
Iy' ADOREs5 BUILDING —ELECTRICAL—PLUMBING 'MECHANICAL - _
, • OWNER'S _ ��=. 'PLAN CHECK VALIDATION '
ME
QTY. ELECTRIC PERMIT FEE . _ ��y=;.
PHONE -'1' `_--"L'��'7 (l
CONTRACT s J 10 OUTLETS-SWITC ESR SCEP^ 5.00/1.0
NAME
NoLIGHTIN FIXTURES 5.00/1.00X
cDNTRACTOR's` - PPLIANCES-RESIDENTIAL 4.00
ADDRESS \ k �-�
Ijl PHONE {PANELS 5,00 DATE OF APPLICATION
ARCHITECT 6.00 PLAN CHECK FEE
.ye OR -
�l ENGINEER
LIC.;. / c.No. `'• SI'�N fiRANS. 3.00 h
ARC H.OR ENG , A PERMIT VALID$ bN
ADDRESS
i SPEQIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 15.00 -I _
APPLICANT'S { /—
Iq
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
O o LICENSED CONT RACTORSUECLARATION -
a
Or U I hereby Minn that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
(comomming with Section 7000)of Division 3 of the Rusine"and B D E L E
{ m z Professions Code,and my license is in full force and effect.
License Clasx Lic.Number
o F Date Contractor { )
BUILDING PERMIT
v; ¢ cr w a OWNER-BUILDFR DECLARATION INFORMATION
o d MISC.— REFER TO ORD
--x 3 I hereby ellirm that 1 am exempt from the Contractor's License
VALUATION $/FT.
o¢ la for tie followingreason-(S c 70315 Rosi e.sand Professions PERMIT ISSUANCE t 6.00 0 /1(f•� `
Code:A y city o m ty w h' h e lul eso p ft to onstr et utleq '
1, anan Q2 improve demolish, Rep' any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC
D¢ I [s the al plsanl for su h Pe 't t n CI 'a sign d sL t ent that I TOTAL � PER T TO -
K C, he is licensed pursuant to the provisions ofthe Contractor',L cense �'/N'5� � .�q.^C�r y
r ¢ Q la (Chapter 9(commencing withSection 7000)ofDvision 3 ofthe 1, . -
Business and Professions Code)or that be s exempt therefrom and QTY. PLUMBING PERMIT FEE VJ
r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR..
r' by my applicant for a permit subjects the applicant to a civil penalty
of i t retire f Hundred dollar,($500)} ALTER-DRAIN&VENT-WATER (EA.) 4.00'
as acne f the property,or my empl y s w th ages as BACK F LOW PROTECT.DEVICE 2.00 DCC.GROUP RES UNITS
r �/ola
tli IT role comp -f t will di the work,and the siruelu is not 1 f j.
intended or offered for sale (Se 7044, Business d Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 �— ,i�
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who docs such work' FIXTURES-PER TRAP 4L00 S SO FT.FLOOR AREA TOTALACREAGE'
�. • himself or through his own employees,provided that such improve '',e
ments are.not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 INC..4 OUTLETS 4.00 a-/ ,7�q
or Improvement Is sold within one year of completion the owner- ' s
builder will have the burden of proving that he did not build or inn- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USEY'
prove for purpose of sale.). INDUSTRIAL WASTE INTER.' 20.00 RES , IND❑/'❑N .❑ ❑r�
❑ I,as owner of the property,am exclusively contracting with LSI
liem¢ed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 - ASSESSORS PARCEL NO;.
and Professions Code:The Contractor's License Law does not apply e
i.�
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA-) 1-00 ).� b `�"'�00 `I
7 contracts for such projects with a conlrndar(sl licensed pursuant to / -- -•
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TR$cr NaPARCEL No,.
- ❑ 1 am exempt der Sec. .B.&P.C.for this / WATER HEATER W/VENT 4,00
reason =""' e., tr_,..
Owner nate4 111 WATER SYSTEM 4-00 ACC.DATE ACC.FILE NO.
coli KliRS' MPENsA'I' N DE `17 WATER TREATING EQUIP. 4.00
KI RS'drM1p`1 - I
I hereby SIMON that I have a certificate of consent to w1pinsure.
or a certificate of Workers Compensation Insurance,or a certified ZONING ,ENG. ITENO.
copy thereof(Sec.3800.Lab.C.l. / /• `t•�.__..-
fv' Policy No. Cmnpany /
Q ❑ Ccrtificd copy is hereby furnished FIRE SPRINK tl,ENERGY T.P4.1
c 'Z Z ❑ Ccrtlfied Copy is fled with the city inspection division. MISC.- REFER TO ORD. +(
Q Applicant I Y;❑• ' N❑' �'.) Y O N❑-
h 'F yPERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
CERTIFICA'11:01'EXIiMI'FION FROM WORKERS'
( LU > COMPENSATION INSURANCE PLO.CONTE. LIC.NO. PLG. t
qd.� O (This action need ,of be completed if lire permit is for one - TOTAL Y❑1ti ru❑' v❑ N
p":LZ 'hundred dollars IS 100)or less.)
0, 0 I Certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W H ant is issued,I shall not employ any person in any manner un as to
U become subject to the Workers'Compensation Laws of California-
mea Date App1i°°at - ALTER OR ADD TO MECH. 4:00 BUILDING !J'
} y NOTICE'f0 APPLICANT If,after making this'Cerlificale ofEx-
F Z_ caption,you should become Subject to,the W Dkers'Compensation APPLIANCE 4.00 PLAN CHECK - -
provisions of the Labpc«Gods; you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT'(TO-I0=r_F.M.) 3.00 FEE e_ .
1
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMICFEE
-
I 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.). at HEATING UNIT�(TO 100,0008.T.U.) 4.00 _
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
r
I eUdly That I fmosecad thus appy Yon and stale that tire above VENTILATION FAN (SINGLE) 3.00
information n m' correct. 1 agree to comply with all city and County PLUMBING,
,
idinances and slat kw' ocating to build insand g otructlon, aBOILER-COMPI3 H.P.or 100,000 B.T.U.) 4.00
hereby authorife representativesof this city to enter upon the
above-mentioned properly for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANIC AL-
li (W ) egrco to save, indemnify and keep liarridess the City of MISC.- REFER TO ORD. kr-
Ci P tin a insl liabibties,judgments, costs and exp rose. which — CONST:TAX'.,,
To
in way WTT'ecrpe against sat City in eonsury o',al the PERMIT ISSUANCE 3.00
gmnlb lhisp roti 41111,61
/ MECH.CONT. LIC.NO. TOTAL / ✓ e, `TOTAL.
Si re o I idant/C Tkor
`� INSPECTOR COPY s