8590APPVCANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY (�
BUI LD1 NG PROJECT I DENTI FICATION
APPLICATION & PERMIT
U DING -ELECTRICAL- PLUMBING -MECHANICAL
II
FERMI U BER
8590
BUILDING
ADDRESS
1 201 Torre Ave.
DWNER'G �
NAME „UNE 328-0851
c
-
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION
CONTRACTORS
NAME
LIC.NO.
UTLETS-SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
r, 's
ADDRESS
2162 Prune Ave. PHONE 657 -6822
APPLIANCES - RESIDENTIAL 4.00
--PANELS 10.00
0PCRIiECT
ENGINEER
LIC. Na.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE
SIGNS TRANS. 3.00
ADDRESS ENG'
' ZIP
SPECIAL CIRCUIT 5,OQ
PERMIT VALIDATION
i
ISSU' NCE DATE
BLDG. ELECT. PLG. MECH.
❑ ❑ 19
EMP. METER OR POLE INS. 20.00
AS
ADDREDDRESSS
MOTORS SEE FEE SCH.
SERVICE CHANGE - 20.00
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I and licensed under provisions of Chapter 9
(commencing with Section 70001 of D,ision 3 of the Business rid
PRNessionx Cod d m license is in full ford ul 'ffcct.
License Class - Cic. Nmnber
IJatc Conlmctor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for lire followingreasoa(Sec. 7031.5, Business and Professions
Code: Any city or county which reyuiresa permit to construct, alter,
improve, demolish, Of repair any structure. prior to Its Issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of0ivision 3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of Bot more than five hundred dollars (55001.):
❑ I, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and the structure Is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds of improves themon, and who does such work
himself or through his own employees, provided that such improve-
mentsamnotintendedorffered for sale. If, however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden Of proving that h e did not build or im-
prove for purpose of,ahc.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
contracts for such projects with a contractous) licensed pursuant to
file Contractors License Law.
❑ 1 ant exempt under See ,B.&P. C. for this
reason
TEMP. POLE 30.00
BUILDING PERMIT
INFORMATION
MISC.- REFER TO ORD
PERMIT ISSUANCE 10.00
�]
VALUATION
-
$/FT.
ELEC. CONTE. LIC. NO.
ELEC.
TOTAL
PERMIT TO
M C LW,
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
F IXTUR ES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00
GAS - EASYSTEM OVER 4 (EA) 200
. -..
BUILDING USE
RES IND CON PB Omer
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
,
LAWN SPR INKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date
WORKERS'COMPENSA'I' ION DECLARATION
1 hereby affirm that I have u certificale of consent to sdfmin,um,
or a certificate of Workers' Cont.......tion Ii-ouanee, or a certified
copy thereof (Sec. 3H00, Lab.C.).
Policy N Company
Cl Mtified coy It 1, cby for '
❑ ertificd c is -lu h u c inspection division.
Applic t
' 1'IFI ATE O1' iXEMI'1' ON PROM WORKERS'
COMPENSATION NSURANCE '
is sect n need not be, completed if the permit is for one
hum dred d ars (5100) arks..)
I - y that in the performance of the work for which this per-
mit is issued, I shall not .nl Ploy any person in any manner so as to
become subject to the Workers'Corspensation Laws of California
Date 'Applicant
WATER SYSTEM 5.00
ACC.OATE
ACC. FILE NO,
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
FIRE SPRINK
Y ❑ N ❑
ENERGY T-24
Y ❑ N❑
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOOD ZONE
V [:] NE]
A.L.u.L.
Y ❑ N❑
PLO.CONTR. LIC. NO. _
!PLG.1
TOTA.0
QTY. MECHANICAL PERMIT -'At �FEES-
FEE'.SUMMARY
BUILDING
<
ALTER OR ADO TO MECH. 5.00
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the workeri Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
I CONS'T'RUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work lot which this permit is issued (Sec.
3097, Civ.CJ,
APPLIANCE 5.00
PLAN CHECK
FEE
AIR HANDLING UNIT (TO 10MOC F.M.) 4.00
AIR HANDLING UNIT(OVER 10000.F.M.) 6.00
SEISMIC FEE
`
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
1 certify that I have read this application and ssatcthat the above
information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby Bulhoriz. rc Perryll at rues of this city to enter upon the
above-mentioned properly for inspect ion purposes. (We
Oreo sme, ind.iont y and keep hornless the City of
rtino nst liabilities 1 ..rents, costs and expenses which
in way uecjue ug: ul s id City in consequence of the
of fix icn lS
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER-COMP(3 H.P. or 100,000B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU( SEE FEE SCH,
MECHANICAL
V V
MISC. REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 10.00
MECH.CONT. LIC. NO.
CH. �p,�/ TOT�AL ✓ V
ttr,M
TOTAL
.. pP trl0on wet r e