09722 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING GJ APPLICATION & PERMIT O9722
OORESS, ^
Il- BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
WNER'S PLAN CHECK VALIDATION
ME /{ 1n QTY. ELECTRIC PERMIT FEE
. I V 1 PHONE �LI '
NrRAcrons OUTLETS-SWITCHES-RECEP 10.00/1.00
NA- f Z LIGHTING FIXTURES 10.00/1.001
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
'^
// S �, _ PRONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
' LIC.No. SIGNS TRANS. 3.00
AARCH.OR
DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 �y
APPLI...Ess MOTORS SEE FEE SCH. /
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a vu 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG- ELECT. PLG. MECH.
F D i Professions C de d my license is in full f r an if t
0 o= - License lush=�'.CL Lin Numhc
a z H D Date Lie,N Ito
¢ y s )Ch BUILDING PERMIT
¢ ¢ w a
OWNER-BUILDER DECLARATION INFORMATION
La MISC.- REFER TO ORD
w LL H I hereby affirm that I am exempt from the Contractor's License VALUATION $JET,
I• LLD4 Law for the following reason.(Sec,7031.5.Bisinessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct.alter,
¢ K ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wm" he is licensed pursuant to the provisions of the Contractor's License
Hit
Law(Chapter 9(Commencing with Section 7000)ofDivision3Bribe M�
n ' a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F o the basis for the alleged exemption.Any violation of$eahm 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
fittoi nmro than five hundred dollars($500).1: I
❑ I,as owner ol'the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 1 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r
Code:The Contractor's License Law dos not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR E$-PER TRAP 5.00 / SO.FT.FLOOR AREA TOTAL ACREAGE -
• himself or through his own employees,provided that such imprmre GAS-EA:SYSTEM-1 1 NC.4 OUTLETS 6.00
menti are not intended or offered for sale.IL however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA!) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
proveforpurposeofsaleJ. INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer
.
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's Lice...0 Law. TRACT NO. PARCEL NO.
❑ [am exempt undenSec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dace WATER SYSTEM 5.00 ACC.DATE -ACO.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to sell'-in,uure' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insumncc or a Certified
copy theft J(PACo,Lah.0 )nR r/�,/JI)
1'olicY N< Company