C9296 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDflssS 9296
BUILDING - ELECTRICAL-PLUMBING-MECHANICA
\y' OwNER'S 'j /�` PL N CHECK VALIDATION
•/` NAME /ZJ-Q,
QTY. ELECTRIC PERMIT FEE
PHONE
NONTRACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACADDRESSTOR APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP fTEMP.METER OR POLE INS. . 20.00 ,� )
ARMOTORS SEE FEE SCH. /L-�f!_v`,'r-A•+'�
ESS
ADDDDflESS
i SERVICE CHANGE 20.00
wEE o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00WU
YAG i n
(commencing
hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
yaw with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F D z Professions Code,and my license is in full force and effect ❑ ❑ ❑ ❑
z o m- License Class Lic,Number
0 w r w Date Contractor Id
a r E A BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
0 0 U INFORMATION
se g ¢ N 1 hereby affirm till 1 um exempt from the Contractor's License MISC.- REFER TO ORD
b s n.(Sce.70313,Businessand Professions $/FT.
F LL o J Law for the following rea o PERMIT ISSUANCE 10.00 VALUATION
Code:Any city or county which regwres a permit to construcl.alter,
a ¢ < improve,denwlish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
- o ¢ requires the applicant for such permit to file a signed Statement Illat TOTAL
u w m a he is licensed pursuant to the provisions of the Contractors LicensePERMIT TO
rzi