6902 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINTkPEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT
°PRESS a//co ParK I00�390
�Oy3 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL62
PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
�ercialJEX rpSNE
CONTRACTOHS [I y� OUTLETS 5.00/1.00
NAME n//eNajnlrls l
COMMerel6� LIC.NO. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR RESSE PPLIANCES-RESIDENTIAL 4,00
ADpooR`�Ej55�� { ll/ewQ r K C(I-
/ Oils-'�/ /1 err ST PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.500 I PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIc.No. SIGNS TRANS. 3.00
ADDRiESS ENG. SPECIAL CIRCUIT 5.00 PERZ(DATION
ZIP EMP.METER OR POLE INS. 15.00
APPLICANT'$ MOTORS SEE FEE SCR. / X
ADDRESS -
SERVICE CHANGE 10.00
wO C LICENSED CONTRACTORS DECLARATION
lE I hereby affirm chat I am licensed under provisions of Chapter 9 ISSUANCE DATE
y a (commencing with Section 7000)of Division 3 of the Business and BLD ELEC PLG. MECH
H 0 z Professions Cod,, my license is in full li�e.jt�•,and office{{. 1
a o H -� License Class_ G�Lic.Number 3[r7J 4
9 z H o/ Da1c Contmae
a y s 1 BUILDING P RM7T
he w c OWNI'R-BUILDFR DECLARATION
REFER TO ORD INFORM TION
w ;u y I hereby affirm that 1 am exempt from the Contractor's License MISC.- VALUATION $/FT.
R .. o a law for the following reason.(Sec 703 1.5,Business and Professions PERMIT ISSUANCE 6.00
WCode:Anycity orcounty which requires a permit to construct,aller, rs„0 /
QO improve,demolish,or repair any structum,prior to its issuance,also ELEC CONTR. LIC.NO. ELEC. [/�q/� W
D u requires the applicant for such permit to file a signed statement that TOTAL / ✓ �r PERMIT TO
wro a- he is licensed pursuant to the provisions of the Contractor's License
Hz>
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
rc E. o the basis for(11e alleged exemption.Any violation ol'Section 7031.5 5 1 S1 TYPE C
aim by any applicant for a permit subjects the applicant toa civil penally ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(5500).): l 1
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure Is not .I
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 I
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 4.00 SD.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mcntsarenutintended oro0'ered forsdle.Ifhowever,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING SE
rl builder will have tire burden of proving that he did not build or im- RES IND PB Omer
Prove for purpose of sale.).om - INDUSTRIAL WASTE INTER. 20.00 ❑ El El El❑ I,us ,.net of the property,aexclusively ccut.acting with
licensed conlmetors to construct the project(See 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORRCEL Na.
and Professions Cods:'I'he Contractor's License Law does not apply
to an owner of property whoi holds or improves fiercer,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts fur such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for On, WATER HEATER W/VENT 4.00
Reason
Owner Date WATER SYSTEM 4.00Acc.DATE ACC.FILE NO.
WORKERS'COMPENSA'I ION DFCLARA'TION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a ech-nfcaleofconsent to sel Ginsurc. ZONING
or a certificate of Workers'Compensation Insurance,or certified ENG.SITE NO.
copy threerrcol'�(Seecc,338000,Lab.C-.). p�//IpuIicyY
O ❑y(!/rh liJ es,K hereby F`7,hcd. F�
FIRE SPRINK ENERGY T 24
F � ❑ CeryF copy 1z •d �Jhe;ity in ect� ion division MISC.- REFER TO ORD. Y N Y N
O npplicam 1 • 4_ ?oc ❑ ❑ ❑ ❑
w ,LPERMIT ISSUANCE -6.00 FLOOD ZONE A.L.UC.
Lu - aCIi R'I'IIICC0 ONSAFI MIFROM WORKERS'
W >_ COMPENSATION INSURANCE PLG.CONTR. sec.NO. / ❑ ❑ ❑ ❑
d 0 1'I'his secompleted need not be mplefcd if tire TOTAL
e pennil is for one Y N Y N
Z Imndred dollars(5100)G,Tess)
U O I cc,(,Iy Our in tie pc,funnancc 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 become subject to tire Workers Compensation WoCompensation Laws of California. yid
y DateApplicantALTER OR ADD TO MECH. 4,050 BUILDING )(/
} ED NOI ICE TO APPLICANT: If,after making this Certificate of fix-
Z enlpuon,you should become subject to the Workers'Conrmmatlun APPLIANCE 4.00 ,-
PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SMC.F.M.) 3.00
CONSTRUCDON 1.1'NDING AGENCY AIR HANDLING UNIT(OVER 10)"C.F.M.) 5.00 SEISMIC FEE 47/
I hereby affirm that there is d construction lending agency lotEXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this hermit is issued(Sec.
MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)7.50 1 ELECTRIC
Lender's Address
I certily that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
• information is correct. I agree to comply with all city dad county PLUMBING
ordinances and state ]uses relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby autlmri a representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE F EE SCH. MECHANICAL
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupenino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00
gra mg of thispe MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 1.2-41-0111vep
S gI arc pA,011crodlConfinii ea Dram
INSPECTOR COPY