8236 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LOI NG PROJECT IDENTIFICATION PERMIT NUMBER
IMING - APPLICATION & PERMIT
'AooREss /� f�(1
BUILDING - ELECTRICAL-PLUMBING -MECHANICAL I8 V•(p6
IT RS
NAME PLAN CHECK VALIDATION
'~. CAc
s w� 1 I u�oNE
COOTY, ELECTRIC PERMIT FEE
CONTRACTORS
NAME34�,� OUTLETS-SWITCHES-RECEP 10.00/1.00
TITFJLIJRT�O't�ltl, LIC.NO. LIGHTING FIXTURES 10.00/1.00
coNTRACTOR PPLIANCES-RESIDENTIAL 4.00
AooREss
PHONE PANELS 10.00
DATE OF APPLICATION
ORcmTe PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
- AR.GR ErvG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS Ts MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
09 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 Q
a u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Business and BL G. ELECT. PLG. MECH.
w Z Professions Co}� a in license is in full fss '
-o i m o Liccnsc Class S.:� Lic.NumheVa' \ -- ❑ ❑ ❑
H m H J Datc Contractor
J - BUILDING PERMIT
¢ Q w ¢ OWNER-BUILDER DECLARATION
O A u INFORMATION
w ;LL I hereby affirm Eliza I am exempt from the Contractor's License MISC,- REFER TO ORD
., o a Law for the following reason.(Sec.7031.5,Businessand Professions I VALUATION - SEPT.
H _ PERMIT ISSUANCE 10.00
mMl
E > P Code:Any city orunty whichregmresapr
onit toconstruel,alter, O"
EC w a ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE.. LIC.NO. ELEC.
r a K D rt requires the applicant for such permit to file a signed statement that TOTAL
w m u he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H z r
Law(Chapter 9(commencing with Section 7000)of Division 3 of the '
¢ Business and Professions Code)or That he is exempt therefrom and QTY. PLUMBINGIPERMIT - FEE
¢ E. o the basis for the alleged exemption.Any violation of Section 70315" STORIES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant to a civil penalty y �ALxI-E,R-DRAIN,&{VENT;WATER-(EA`.) 5.00
of not more than five hundred dollars(55001.1:
O 1,as owner of the property,or my employees with wages as KZ:::BACK�FCOW-PROTECT.DEVICE r 4:00
their Sale compensation,will do the work,and the structure is not - OCC.GROUP RES.UNITS
intended or offered for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor License Law does not apply to an owner of
property who builds m improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTALACREAGE
himself or through his own cmplo,c ,provided that such iniprose-
memsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
• prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PS Omer
❑ 1,as owner of the property,am exclusively contracting with . .
❑ ❑ U ❑ e❑
licensed contractors hs construct the project (Sec.7044.Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESS7SPIARCEL NO.
and Professions Code:I'lie Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,End who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
t the Contractors License Law. TRACT NO. PARCEL NO.
yS_- ❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
yeason
Owner Date WATER SYSTEM p 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COM PP-NSATION DECLARATION WATER TREATING EQUIP. 5.00
I I hereby affirm that I have a certificate of CORISEHto sol Ginsure. ^
or a certificate of Workers Compensation Insurance.Or a certified ZONING ENG.SITE NO.
h copy thereof(Sec.3800,Lab.C.).
r} Policy No. Company
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
z ❑ Cerr 1 n, f i d i j l e 'Iv sp r Rien. [:] ❑ ❑ ❑
f- 0 "dicast//ppn��E1pp �2I�cC t- U MISC.- REFER TO ORD. vN ' v N
�' - CP.R'ttF*fZ,lTItOWI�RT! � �Bohf TvO�KIiRS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.UC.
LU > COMPENSAIN'INSURANCE PLG.CONTE. LIC.NO.\ PLGCL .
O (Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ v❑ IN E]
Z hundred dollars IS 100)or Icss.) -
U O 1 certify that,in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
Uy 1- mit is issued, I shall not employ any person in any manner,,as to
O L) become subject to the Workers'Compensation Laws of California.
ED Date Applicant BUILDING /
} tn.• NOTICE TO APPLIG\NC If,after making This Certificme of Ex- ALTER OR ADD'TO MECH. 5.00
FZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. q AIR HANDLING UNIT(TO 10,000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L H EATI NG UN IT (TO 100,000 B.T.U.) 8.00
Lend"',Name
Addyss
Lenders AddreHEATING UNIT(OVER 100,000 B.T.U.)9.50
/ ELECTRIC
I certify that l have read this appliculion and stale 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 100,0008.T.U.) 6.00
ordinances and state laws relating to building construction, and
hereby enthoriec representatives
for
inspection
this city to soler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
a vices authorize
property forimsp ofth i purposes.
(We) agree to save, indenmil'y and keep harmless the City of MISC.- REFER TO ORD.
its against )4i] • menus, costs 'ed expenses which CONST.TAX
may i a way ac a gains id City in consequen of the PERMIT ISSUANCE 10.00
granti o Ihls p mi �/ MECH.CONT. LIC.NO. MECH.
czw L LS TOTAL TOTAL Qj1;2
Sig �turco Applica / ontrac r Dale
INSPECTOR COPY