C8800 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BLULDINGS APPLICATION & PERMIT 880
BUILDING -ELECTRICAL-PLUMBING-MECHANIC
r'\ O E '$ PLAN CHECK VALIDATION
PHONE
"A TV. ELECTRIC PERMIT FEE
• t / /
O
MEATDRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
coNTRAcroR's PPLIANCES-RESIDENTIAL 4.00
CONTRA
�.� e4 e �Ci HorvE r,2 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. - SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH. ^
A 1` �w
SERVICE CHANGE 20.00 ^/�f ,f
w 0 0 LIC17NSIiD CONTRACTORS DECLARATION TEMP.POLE 30.00 44 1 V1'/�yT ''
S,U v 1 hereby affirm that I am licensed under provisions of Chapter') ISBUANCE GATE
mG w (commencing wi h Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r N va Professions Code and my license is in full force and effect. EJ 1:1
❑ E]Zo 0 'M o License Class Lic.Number
Date Contractor
a x ac BUILDING PERMIT
er tete OWNER-BUILDH"R DECLARA'rl ON
d 0 A. u INFORMATION
X ; N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o¢ Law for the following reason.(Sec.70)1.5.Businessand Professions VALUATION $/FT.
2 mom Code:Any city orcounty which requires a permit m construct,alter,
PERMIT ISSUANCE 10.00
¢ improve demolish,or repair any'structure,prior to its issuance,also ELEC.CONTR. LIC.NO ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PER TTI
wm he is licensed pursuant to the provisions ofthe Co"Ir:mtor's License D
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation Of Section 7031.5 'STORIES TYPE CONSTH.
n ; by any applicant for a permit subjects the applicant m a civil penalty
ofmot more than five hundred dollars S500).):
- ALTER-DRAIN -WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and th
e structure is ,of OCC.GROUP RES.UNITS
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 tq 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-
mems are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA ) 200
builder will have the burden of proving Ikon Ice Aid not build or ice . . .
- BUILDING USE
pr or purpose of sale.l. INDUSTRIAL WASTE INTER. 30.00 RES IND CDN Pa One,
I,as owner of the property,am exclusively contracting with 0
lice d contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
a rofnssions Code: rhe Contractor'sLicenu Law does not apply
{ an owner d property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
/contracts fuisuch projects with a conlractorls)licensed pursuant to SEW ER-SANITAR V-STORM EA.200ft/10.00
the Contractors License Law. TRACTNO. PARCEL NO.
-*IRkLR"ON'I'PLIW:t7��
under ?p/f4 ' ,B.&P.C.1orthis WATER HEATER ADVENT 6.00
wnWATER SYSTEM 5.00ACC.DATE ACC.FILE NO.
NSATIOL,)RATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec 3800,Lah.C.).
Policy No. Company
O ❑ Cerilied copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy,is fled with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y� IN v EJ NE]
~ rn PERMIT ISSUANCE 10.00
Cr - CIiRTIEICCOMOPIiAEION IONFROh1WORKFSRS' FLOOD ZONE A.L.U.C.
W 7 COM.011 be cmN INSURANCE PLG.CONTR. LIC.N0. PLGCL . Y❑ NE] Y ❑ N❑
D O (This doth. aced not be completed if it,, permit is for one TOTAL
LL0 Z Imndmdfy that IS 100)pe less)
O I certify that h the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O L) become subject to the Workers'Compensation Laws of California.
CL Dme Applicant BUILDING
} w NOTICE TO APPLICANT: If,alter making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F Z umplion,you should become subject to the Workers'Compersaliun APPLIANCE 5.00 PLAN CHECK
provisions of tle Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the per otorance of Ore 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.)9.50
Lender's Names ELECTRIC
I certify that I have read this application and nine that the above VENTILATION FAN (SINGLE) 4.00
® information is correct. I agree to comply with all city and county PLUMBING --
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
ordinances and state laws relating g m building ConstructS,on He t:
hereby enti oriie representatives moves ec this city to enter upon th° BO'
LER-COMP (Over 100,000 BTU(SEE FEESCH. MECHANICAL
abovemenlinncd property for inspection purposes.
yith
to save, indenmil'y and keep harmless the City of MISC.- REFER TO ORD.
Cfast liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
mw accrue against said City in consequence of the
grProfit. MECH.CONT. LIC.NO. MECH.
!/u TOTA i TOTAL �f
Siy are of Ai; 'ant/Co f' 9or Date
INSPECTOR COPY `
, T