C8127 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
/l BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
1 (WILDING APPLICATION & PERMIT
ADDRESSIPA n 7
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 8 7157 G
'1 O ER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
ONE
H°
"7R c ° UTLETS-SWITCHES-RECEP 10.00/1.00
1 Q Ic.No. LIGHTING FIXTURES 10.00/1.00
cON*AAGTOR's
ADD ss PPLIANCES-RESIDENTIAL 4.00
�y+�'.tCQvy
7 I L PHON ^7 PANELS 10.00 DATE OF APPLICATION
ARC C PLAN CHECK FEE P.C.N0.
OR Lk:>iy�-�(�b.�{{�ayy� PANELS (OVER 200 AMP) 20.00
ENGINEER
Ic.No. SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. r SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
IP EMP.METER OR POLE INS. 20.00 i•
A Uc T - MOTORS SEE FEE SCH. /S
AooREss
- SERVICE CHANGE 20.00 Xy woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
G U U I hereby alfinn that I um licensed under provisions of Chapter 9 ISSUANCE DATE
4 w (coonencbtg with Section 70001 of Division 3 of the Business and
Ci Q w nBLD ELECT. PLG. MECH.
H w z Professions Code,and my license is in full force trod effect F
z O w - Liwns Clas�tic Number F ❑ ❑ ❑
0 ¢ H Date Convacto
a , f BUILDING PERMIT
¢ ¢ w a OWN: -BUIL DECL RA'1't N'
A o a u INFORMATION "
w I hereby al'finn that I am exempt front the Contractors License MISC.- REFER TO ORD
.. O v, Law for the following reason.(Sea 7031.5,Businessand Professions VALUATION $/FT.
H - g PERMIT ISSUANCE 10.00
vv Code:Any City or county which requires a permit to construct,alter.
]
� a> � improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEG 3�U"VD
- D¢ requires the applicant for Such permit to file a signed smtenhent that TOTAL
n PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License
w
Law(Chapter 9(commencing with Section 7000)of Division 3 ofth•
i 4o Business and Professions Code)or that he is exempt therefrom anJ` DTV. PLUMBING PERMIT FEE AFu
¢ H e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aim by any applicant for a pemtit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not noire that five hundred dollars(55001.1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their Sale compensation,will do the work,and the stn c re is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who bnilds or Improves lherco,and who does Such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself re through his own ren Io
g p yees,provided that such improve-
menlsmvemenotnttcnoldor wthinoneyearsale.oIt,mplhowever,tion the the ower- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of pi°vmg that he did not build or ire- BUILDING USE
prove for purpose of sale.). RES IND CON PB Otner,
❑ I,as owner of the property,ren exclusively.invading with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
licensed contrddun to construct the project(Sec.7044,Business ILAWN SPRINKLERS- 1 INC 5 V.B. 6.00ASSESSORS PARCEL N0.
and Professions Code The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA,200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
❑ I am exempt under See. ,B.&I'.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
�y I hereby affirm that I have a certificate of consent losIh-incur,.
or a certificate of Workers'Coppet n n Insurapce,o,a certified 4 ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.C.l
Policy ere Company
z Z ❑ CeO it, copy's here y is c . ,
❑ Certifi'd Cot s f Il city inspection vision. FIRE SPRINK ENERGY T24
O APPhc:,nt MISC.- REFER TO ORD. v ❑ N.❑ v ❑ N❑
W CERTIFIC. h: F :. IL1PT1 a17ROM WORKERS' PERMIT ISSUANCE 10.00 PLOoO ZorvE A.L.U.c.
LL C)MPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
= Z [This section need not be completed jf-(he p tis for me TOTAL Y❑ N❑ Y❑'NO
C7 O handled dollar,IS 100).,1...,)
I certify that in the perfonnan of the Sao f ell Illi TY. MECHANICAL PERMIT FEE FEE SUMMARY
Iy F " mit is issued,1 shall not employ ny p San in s to
(] w hecot so c he Workers' ati n ia.
y Dat BUILDING
ALTER OR ADD TO MECH. 5.00 BUILDING
�- 0 NOTICIi T A I'.CANT: If,a r t Ex-
FZ rmption,you should become subject >a1heW ke.C1Comp anon APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Codc, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.MI 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency fm' EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lenders Address ELECTRIC
- [-certify that 11lava read thisapplicatmo and state that the above VENTILATION FAN (SINGLE) 4.00 - '
infornmtion is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize repr etativ of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ac-mentioned prop for i pection purposes,
e) gree trt .eve anR fy and keep harmless toe City of MISC.- REFER TO ORD. -
1 'r[i against a h If,in Pounds, costs and expenses which CONST.TAX
a in ny way of said City in consequence of the PERMIT ISSUANCE 10.00
g It of this t I MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL -1 q
7
S' ur o pli ret 6 ntmcth r Ute
INSPECTOR COPY
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