C8577 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NeirrG PROJECT I DENTI FICATI ON PERMIT NUMBER
iBUILDING
APPLICATION & PERMIT 8577
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
0 ER'S PLAN CHECK VALIDATION
i •`� NAME /^2 X OTV ELECTRIC PERMIT FEE
L//
PHONE 77
/
NAMERAc Rs ITLETS-SWITCHES-RECEP 10.00/1.00
LiC.No, LIGHTING FIXTURES 10.00/1.00
ADDRESSTORS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESSTs MOTORS SEE FEE SCH.
SERVICE CHANGE
Hoo o
FH
oo LICENLICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
< v I hereby affirm that I am licensed under provisions of Chapter
y G a (mnvncncing with Seel ion]0001 of Division 3 of the Business xnA ISSUANCE DATE
H w i Professions Code,and my lirense is in full corm and effect.
BLDG. ELECT. PLC. MECH.
o 0 m o License Class Lie.Number ElEl El-
m H Date Contractor
y Z
BE c ¢ OWNEB-BUILDER DECLARATION BUILDING PERMIT
E o a 0 INFORMATION t '
w g ILL" H I hereby infirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o V Law for the following reason.(Sec 7031.5,Business and Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
EO > E Code:Any city orcounty which requires a permit to construct,alter,
E]
rt at Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEG �U
S mu requires the applicant for such permit to file a signed statement OUR TOTAL
a w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Fi5- Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe nn
5i o business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE P4-r/V CO V k..
a, I- IIIc basis for the alleged exemption.Any viulution of Section 7031.5 STORIES TYPE CONSTR.
a- 3 by any applicant for a permit subjects the upplicam ton Civil finally ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than.five hundred dollars(S500f):
❑ Las owner of the property,or my,and the
with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS
their role , of erention,will(S the work,and the structure is not
Code:Tterded or offered for sale sect. 7044. Business and n owner
DRAINS-FLOOR,ROOF,AREA,COND. 5.00
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 5.00• SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- t
ants are not intended or offerul for sale If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will[nave the burden of proving that he did not build or im- BUILOI NG USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON O Dar
❑ I,as owner of the property',am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
Did Professions Code: I'lie 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 contractorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00TRACT NO. PARCEL No.
I ❑ I am exempt under Sec. ,11,A1'.C.for this
reason WATER HEATER W/VENT 6.00
Owner �3I(If 1 D
WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORI:ERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a ecrtil'icate of consent to self-insure,
or certificateof Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
Copy lhereof(See.3800,Lab.C.).
pricy No. Company
O ❑ Certified copy is hereby furnished. RE SPRINK ENERGY T 7<
z Z ❑ Certified copy is filed with the city inpectior division.
F-' O Applicant MISC.- REFER TO ORD. Y E3NE] Y ❑ NE]
CC W ;1 °.CER'ITFICATI:01'EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLooD ZONE A.L.U.C.
IL > COAM'ENSAI'ION INSURANCE PLG.CONTE. LIC.NO. PLG.
1 a (This section need not be completed if the permit is for one TOTAL Y❑ N� Y[J N�
D 2 hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any It erso xs to
O become subject to the WorkerTConnpensat ion Laws of California.
U y Oat` Applicant ALTER OR ADD TO MECH. 500 BUILDING Sp
>_ so NOTICE '10 APPLICANT: If,after making this Cetlificate of fix-
Z ennplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must tortlnwitb comply will,
U such provisions 0,this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000CF.M.) 4.00 '7
FEE /
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE'
I hereby affirm that there is a construction lending agency fix EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000
Lender's Name
Lender's Address H EATI NG U N IT I OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree(a comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COME(3 H.P.or 100,000 B.T.U.) 6.00
here601 LE
Ruled
rcpresfives Of this city to enter upon the LER-COMP(Over 100,000 BTU)SEE FEE SCH.
Ub -m
u ce Rfid pmy t r y o inec
grnon purposes. MECHANICAL
( e) Bett s v isd nil' red keep harmless the City of MISC.- REFER TO ORD.
Cape i again I a ilii s, d n ts, costs and expenses which CONST.TAX
ma i any,sues c rue a ms s d City in consequence of the PERMIT ISSUANCE 10.00
g 1 Inns p nn MECH,CONT. LIC.NO. MECH.
_ TOTAL TOTAL
Signa[ureo t/Con clot Uatc
- INSPECTOR COPY
1