8756 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
aDILDING APPLICATION & PERMIT 8756
ADDRESS
T .. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
F
OWrvER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
• /> /
NAME Acroas UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. ILIGHTING FIXTURES 10.00/1.00
CONTRASACToas
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10,00 DATE OF APPLICATION
ARcarrecr - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
oa
ENGINEER '
l.Y sec.No. SIGNS TRANS. 3.00
AARCH,OR DDRESS ENG. `x 1e - SPECIALCIRCUIT 5,00 PERMIT VALIDATION
Zlv TEMP.METER OR POLE INS. 20.00
APPLI MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 (\'02 LICENSED CONT'RACTORS DECLARA'PION TEMP.POLE 30.00
a .u I hereby affirm that I ten licensed under provisions of Chapter 9 ISSUANCE DATE
H Q is, (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG MECH.
F D z Professions Code,and fly license is in lull force and effect.' ❑ El
0 m - License Class Lie.Nunnbcr
0 m 0 Dotc Contractor
a rBUILDING PERMIT
¢ ¢ ¢ OWNFR.BUILDFR DI:CLARArbON
¢ w u INFORMATION
w'; LL H 1 hereby affirm Ilia( I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION
LL o Low for the following reason.(Sec 7031.5,Business and Professions PERMIT ISSUANCE 10.00 $/FT.
r� g Code:Any city orcounty whichrequiresaperuld toconstrucUalter,
¢ 2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO. ELEC.
¢ onGires the applicant for,such permit to file a signal statement that TOTAL PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's Lfcese
au Law(Chapter 9(comntenciagwith Section 7000)of Division 3 of the
E 0 Business and Professions Code)or(hat he is exempt tlmrefrom and CITY. PLUMBING PERMIT FEE
¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 ST[RIES TYPE CONSTR.
by any applicant for a pennit subjects One applicant toacivil panty ALTER-DRAIN&VENT-WATER (EA.) 5.00
.four more than five hundred dollars($500).:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
sole compensation,will do the work,and the structure 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 builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
merits are not intended or offered for sale if.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completionthe owner- GAS EASYSTEM-OVER 4 IEA) 200
builder will have the burden of proving that he did not build or im- - . . .
BUILDING USE
prove for purpose of sale). RES IND CON PB Orher
INDUSTRI LWASTE INTER. 30.00
1,as owner of the property,he exclusively.7044,Bu with ❑ ❑ ❑ ❑ ❑
andPro contractors m construct the project(Sec.7044,Business LAWN SPRINKLERS-11 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves(hereon,and who LAWN SPRINK ERS-OVER 5 IEA.1 1.00
contracts for M¢h projects with a contractors)licenxd pursuant to SEWER-SANITARY-STORM EA.2001t/10.00
the Contractors License Law. '� TRACT NO. PARCEL NO.
❑ lame emptunder Sea_ B.&P.C.for this - WATER HEATER W/VENT 6.00
reason
'Owner // // are WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0.
/ zz,4 :, 'R LCAAR'I> I WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate o1'coI'll nt to seIN..ure.
or a certificate of Workers'Compensation Insurance,or a cert Icd -
ZONING ENG.SITE NO.
copy tlrereof(See.3800,LaDCA
Policy No. Company
O ❑ Certified copy ishereby furnished. FIRESPRINK ENERGY T 24
z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ NO
~ m �ra PERMIT ISSUANCE 10.00 FLOOOZONE A.L.UC.
� CF:kTI PICKPL•iUI'd>Xlihl P'I'TON�RDM WORKERS' y '
LU > COMPENSATION INSURANCE { PLG.CONTR. LIC.NO. PLG.CL 0 Y❑ N❑ Y F] N❑
CL Z (This section need not he completed if the permit is for one TOTAL !L
bund red dol to is IS 100)or less.)
0 O 1 certify tial in the pertixmance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I slmll not employ Iury ..cram in any manner so us to
U become subject to the Workers'Compensation Laws of Calif innia.
UJ OL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOfICIi TO APPLICANT, If,after omking this Certificate of Ex-
F Z emption,you should become subject to 0u Workeo'Compensution APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith coni ly with FEE
CJ ' such provisions or this permit Shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is It construction landing agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued tSem MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and state that 0m above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state lows relating m building construction, and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuper tiR against liabilities,ju tti encs, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may any way acTIC agail ai try ' onsequence of the
ti Of"is permit- MECH.CONT. LIG NO. MECH.
TOTAL
G _ TOTAL
't r A unmajI. lr c or f
INSPECTOR COPY