8279APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT I DENTI FICATI ON
APPLICATION &PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
8279
RDO
AI LDIN85SSc
a 77
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OWNER'S
r NAME 867-5353
hx 1 DnOw, t
f HIV U!� h/ PHONE as - . son
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLI CATION
CONNAAMERACTORS _
J� a d0C-
OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
7UNTRACTOR'S
ADDRESS 3 •W�itS
PHONCA is q p
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
OR
ENGINEER all Ms0&L+es uc. No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK'FEE P.C. N0.
g
7
SIGNS TRANS. 3.00
ARC H. OR ENG.
ADOREss jCW'Jose
28 EQs+ 6vokaw o P
SPECIAL CIRCUIT 5.00
PER"^y7wpypOTION
Q'111LJ
SEP 041985
y�
City Ot I CUpe1lI�O
ISSUANCE DATE
DG ELECT. PLG. MECH.
� ❑ ❑
EMP. METER OR POLE INS. 20.00
ADDRESST s C
loso1 es, ble AY12a ENO �(O 1r, q<7AIk1 Lp?�AO
MOTORS SEE FEE SCR.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
(eonum,neing with Section 7000) of Division 3 of the Business and
Professions CoJ nd my license is in lull foR`a and effect. p
License ClassLia Number a3 - �I"'�•m>-t
[)are __q.a_� Contractor
OWNER -BUILDER DECLARATION
I hereby alIIno that I am exempt from the Continetars License
Law for Ilia following reason. (Sec. 7031,5, ]justness and Professions
Code. Any 't orcount which requires
Y n Y Y w 4 punnir to is issuance, also
also
improves demolish, or repair any structure, prior n its issuance, statement
e is tic the applicant for such revisit to tilt a signed actor's i enseiltra
he is licensed pursuant to ing provisions of the Contractor's 3 ofthe
of t d iere r 3 of the
Law (Chapter 9 (commencing Cod with Section is exempt
Nosiness and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
byanyappl;cant fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500)J:
❑ h as owner of the property, or my employees with wages as
their wle compensation, will do the work, and the structure is not
intended or offered (or sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that ,such inpnove-
mems are not intended or offered for sale. If. however. Ilm building
or intprovenuent is sold within one year of completion, the owner -
builder will have the -burden of proving that he did not build or im-
prove Inrrmpo,cc of sa cJ.�
❑ 1, as owner of the property, an, ,xclusively emmracting with
licensed cmDracto,s to construct the project (Sec. 7044, Business
and Professions Code:rhe'Contractor's License Law dues not apply.
to an owner of property+who builds or improves thereon, and who
contracts for such projects with a contraclons) licensed rursuant to
the Contractor's License Law.-
❑ lam exempt under Sec.-. B &P,C. for this
reason
TEMP, POLE 30.00
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION
_
nTl Ei
S/FT.
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL
- PERMIT
x t
CITY . PLUMBING PERMIT FEE
STORIES /' E ONSTR.
gLTER-DRAIN-WATER IEA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP RES. UNITS
DRAINS- FLOOR, ROOF, AR EA, COND. 5.00
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00
SO. FT FLOOR AREA TOTAL ACREAGE
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDI G USE
RES IND G PB Other
El 0 ED
INDUSTRIAL WASTE INTER. _ 30.00El
LAWN SPRINKLERS - 1. INC 5 V.B. 6.00
ASSESSOR RCEL NO:
1.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA, 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Dare
WORKF:RS'COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate ofeonsemr to sel Ginsure.
or a certificate of Workers' Compensation Insurance, or a certified
copy thcros((Se, 3800. Lab.C.).
'>fiuy No. Company
WATER SYSTEM 5.00
ACG DATE
'
ACG FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
MISC. - REFER TO ORD.
❑ miil d 9 is hc, by ( Dished
J?C�ert' ied �'�p i. sl with the city inspection division.
nf�nurJln
DC 17, R' B'I CAIE IS L XBM PTION FROM WOR K Ii RS'
- C'OhIPENSATION I NSUKANCE
('chis section need mol be completed i1' the Permit is for on,
hundred dollars IS 100) or less.)
I ecrIlfy that in the performance of the work for which this per-
mitis issued, I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws of California.
Dam Applicant
FIRE SPRINK
Y o N o
ENERGY T Y4
YE) NE]
PERMIT ISSUANCE 10.00
FLOOD ZONE
Y C] NE]
A.L.U.C.
Y E] N
PLG.CONTR. 1,10. NO.
PLG.
TOTAL
CITY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
�.
-
ALTER OR ADDTO MECH. 5.00
N'OT'ICE TO APPLICANT: If, after making this Certificate of fix-
enption, you should become subject to the Worke,s' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued tSec.
3097, Civ.C.),
Lender's Name
Lender's Address
I certify slut I have read this application and state that the above
Information is correct. I agree to comply with all city and county
ce
onlinans and star, laws relating to building construction, and
hereby enthorirc representatives ins of this city to enter upon the
herebuncntionad Property for inspection puposcx.
, inde nify and keep harmless the City of
ilities udgments, costs and exrenses which
mayrue ainst said City in consequence of the
rMECH.
I
m0f,
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
-
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
aJ
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B,T.U.) 8.00
HEATING UNIT( OV ER 100,000 B.T.U.)9.50
ELECTRIC
VENTILATION FAN (SINGLE) 4.00
BOILER-COMP13 H. P, or 100,0008.T. U.1 6.00
PLUMBING
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. Y
MECHANICAL
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
CONT. LIC. NO.
MECH.� TOTALTOTAL
7,
Contractor Date
V INSPECTOR COPY