7296 FA2PL�xNT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDINGPR E TIDEN I;FICATION PERMIT NUMBER
BUILDING / APPLICATION & PERMIT
-/,,BU I LDING-ELECTR ICA L-PLUM13ING-I MECHANICAL 7296
PLAN CHECK VALIDATION
ELECTRIC PERMIT FEE
• ,/,7
kd�P.CNE p4A t.
i ,°r",,T iUI'S . UTLETS-SWITCHES-RECEP 5.00/1.00
NO, LIGHTING FIXTURES 5.00/1.00
I
CANIKTCTOR's PPLIANCES-RESIDENTIAL 4.00
A°
f �
pR PANELS 5.00 DATE OF APPLICATION
RC (TELT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
R
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ADDRESS E.G SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP FEMP.METER OR POLE INS. 15.00
KA t "TS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
~Ea 0 za LICIiNSI?U CON'TR CTORS DECLARATION
a v I hcrchy stfinn Ilat I ton h,rmwd under provk a la of Chapter 9 ISSUANCE DATE
y a y Iconnnen.ing with Section 7000)of Division 3 of the Burin•, d BLDG. ELECT. PLG. MECH.
r w z Professions Cod I license is in full force ❑ ❑ Elz o nn Liver Cl/// Lic.Number-
o z H Dule - Contractor
yBUILDING PERMIT
a, w a OWNER-BUILDER DECLnR ON INFORMATION
Du MISC.- REFER TO ORD
X g LL y I hereby affirm that I am exempt from the Contractor i License VALUATION
F LL o a law for the lisllowing reason.(Sec.7031.5.Businessand PGHvision' PERMIT.ISSUANCE 6.00 S/FT.
f �0f Code Any city or counly which napliruapemtil loconana'l,alleq ELEC.CONTH. LIG NO.
¢ ¢ O improve,dcnu)h,IL or repair any Structure,prim to its Issuance,also ELEC.
DLL requires the applicant for SUCK permit In(dc a signed statement that TOTAL PERMIT
A w a he is licensed pursuant to the provisions of the Contractors License
Fzi Luw(Chapter 9(commencing with Section 7000)of Division 3 of the �G
Business and Professions Code)or that he is exempt therefrom oaf DTY. PLUMBING PERMIT FEE
u, I m basis for file alleged exemption.Any violation of SvvliGr703I,5 STORIES --TYPE CONSTR.
by any applicant for o permit subjects the nppfcan t tea civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ 1,as owner of the properly,or my employees with wages as BACK F LOW PROTECT.DEVICE 2.00 OCC,GROUP PES.UNITS
their sole compensation,will do[tic work,and Ihu structure isnot
inlended or ulfered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• meets are of ughate his ownemployees.for
le.11,ed however,
such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 4:00
or uni are not intended oroffered
on fnr sale f, mpleveq Ihu huwner_
b lder will have
is held within tore year of roe did of the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the harden of proving that be did not build or im- E IND CON PB Dinner
prove for Purpose of sale.L INDUSTRIAL WASTE INTER. 20.00
❑ L ass owner
er of the properly,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors I construct the Project(Sec. does Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Lou,,d 'The Contactor'. improv Law docs not apply
to tr owner of property who builds r improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for rush pensees with a contractodA licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ l mm exmnpl under Sec. ,&&I'.C.torth" WATER HEATER W/VENT 4.00
Owner Dare WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKILRS'COMPENSA'P ION DECLARATION WATER TREATING EQUIP. 4.00
I hereby allirm that I have I cerlificate o unscn'1t to sell' nsum' - ZONING ENG.SITE NO.
cu a.chert icm•o Workers'Compcnsut ion Ins ran. ,,oa�-
copy there W.rs'Com.
Policy N Company
0 -(]�Cer111iWWTI*
unish FIRE SPRINK ENERGY T-20
Z Z IjV Cerl ificwith the 'ity inhpcction division. MISC.- REFER TO ORD.
O A Illcam ' Y ❑ N❑ Y ❑ N❑
fr - CE I'IENIPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOOZONE A.L.uc.
LU > TION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- Z This s,cflu d lot be completed if the permit is fix one TOTAL Y F] N❑ Y E] No
hundred dollars(S eeI oo)or less.)
U O 1 certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
V become,subject to the Workers'CompensationhawsofCalifornia
-
UJ Dam APpllna"t ALTER OR ADD TO MECH. 4.00 BUILDING
} to NOTICE'1'O APPLICANT: If,after making this Certificate of Ex-
Z engnion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK �(
provisions of the labor Code, you must•forlhwith comply with FEE
V atoll provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000QF.M.) 3.00
CONSTRUCTION usnrn NG AGENCY AIR HANDLING UNIT(OVER t0,000GF.M.) 5.00 EISMIC FEE
I hereby affirm that there is a construction lending agency for HAUST HOOD(WITH DUCT) 2.00
the performance of fhc work for which this permit is issued(Sec. ICROFILM
3097.Civ.C.L EATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT 100,000 B.T.U.)7.50 .33
Lender's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
• information is correct I agree to conyily with Ill city and county PLUMBING
ordinal... and stat, laws editing In building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 Sar
hereby authoriee representatives of this city to ewer upon the BOILER-COMP(Over l00,000BTU)SEE FEE SCH. MECHANICAL
ubovcmenlioned properly for inspection purposes.
(We) agree Io save, inch inIy and keep harmless the City of MISC.- REFER TO ORD.
Qgmrtmo again Imbiliti dgmm�f., cost. and czpenNa which ONST.TAX
may in any a ace, ag' est Sid City in consequence of the PERMIT ISSUANCE 3.00
in of Ii emti / _ ECH.CONT. LIG NO. MECH.
L TOT?� TOTAL
aCu •uf AnPli ant/Contac or Uute
INSPECTOR COPY