8799 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON - PERMIT NUMBER
BUILDING APPLICATION & PERMIT ry ry
ADDRESS y y
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
L OWNER'S PLAN CHECK VALIDATION
NAME W U) -�afL• OTY. ELECTRIC PERMIT FEE
• � PNONE
CONTRACTORS AMEUTLETS-SWITCHES-RECEP 10.00/1.00
LAC,No, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
ADDRESS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
On PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALI CATION
ADDRESS SPECIAL CIRCUIT 5.00
2m TEMP.METER OR POLE INS. 20.00
APP IRCESS
AODRE55 MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
o o LICENSED CON TRnCT'ORS DHC1.nRnT10N. TEMP.POLE 30.00 1-/-7/j f
¢ i w I hereby aftinm Ihal I am licensed u oder provisions of Chapter 9 ISSUANCE DATE
(commencingwith Section 7000)of Division 3 of the Business and
vl-i ¢ h BLDG. ELECT. PLG. MECH.
7 z Professions Code,and my license is in full force and.effect.
0 ❑ ❑ ❑ ❑
z v, dClass oNumber
O m w Dtc Contractor� O rlu Cont rador
a m s BUILDING PERMIT
¢ ¢o OWNER-BUILDER DECLARATION INFORMATION
I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F LL 0 4 Law for the followingreason.(Sec.7031,5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
,Ar Code:Any city orcounty which requiresapurmilmconstruct,idler, // �U
¢ a ¢ 0 improve,demolish,or repair any structure,prior t.its issuance,also ELEC.CONTE. LIC.NO. ELEC. i
aB
¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e an m IIre is licensed pursuant to the provisions of the Contractor's License
r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �/
Ei o Business and 1'rofcssions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE K�Cv`�a 6,•t I,
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a _ by any applicant for a permit subjects theapplicant to.civil pcoulty ALTER-DRAIN -WATER (EA.) 5.00
of not more than live hundred dollars(55001.):
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do rte work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions 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 50.FT.FLOOR AREA `TOTALACREAGE
libisellor through his own employees.Provided that such improve-
intents are not intended or offered for sale.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-EASYSTEM OVER 4 IEA.) 2.00
builder will have tire . -e burden of proving that he did not build or im- BUILDING USE
prove for purpox.fsaleJ' INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑ I,as owner of the property,ant exclusively contracting with . .
❑ ❑ ❑ ❑ ❑
licensed contra,(.,, to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Cow does not uPply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 s
.contracts for such projects with cot tractorts)licensed pursuant to
the Contract ;License Law. SEWER-SANITARY-STORM V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I um rapt un `Sec. �.B.&P.C.for Ili is WATER HEATER W/VENT 6.00
reason
Owubr Dat WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
'ORKIS S'CO.MPr:N SAT'ION DECLARATION WATER TREATING EQUIP. 5.00
I h eby affi`m Hurt 1 have u certifcale ofconsenI to self-insure. ZONING
or
a certificate nl Workers'ConmeosatioI Insurance,or
certified ENG.SITE NO:'
copy thereof(Sce,3800,Lab.G).
Policy NN. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z_ Z ❑ Certified copy is filed with tire city inspection division. MISC- REFER TO ORD.
0 Applicant Y ❑ IN Y ❑ No
~ PERMIT ISSUANCE 10.00
� -
CERTIFICATEOIF NSAI ION
PROhf WORKERS' FLOOD ZONE A.L.U.C.
W need of be completed
INSURANCE PLG.CONTE.. LIC.No. PLG, ❑ ❑ ❑ ❑
❑ hundred
section need not be conmlded if the permit is for one TOTAL Y N V N
� Z hundred dollars(S 100)or less) `
U 0 I certify that in the performance of lire work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
11, F Or is issued,I shall not employ any person in any manner so as to
0 w become subject In the Workers'Conipenmtion Laws of California.
Dale A beam BUILDING /
} ED NOTICH TO APPLICANT If,after making this Certificate of 1!x- ALTER OR ADD TO MECH. 5.00
F ? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of tire Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.EM.) 6.00 SEISMIC FEE /L
r
1 hereby affirm that were is a construction nit is
agency for EXHAUST HOOD(WITH DUCT) 5.00
the ,Civ.performance of the work for which this permit is issued(Sec. MICROFILM
30nder's .am HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and stale-ilial the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with ell city and county PLUMBING
ordinances and slate laws relating to building construction, aW 801LER-COMP(3 H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives of tris city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes
(We) .gree m save, indemh
nify and keep ar.mless the City of MISC.- REFER TO ORD.
Cup it B against liabilities 'udgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in y way accrue a rest said City in consequence of the
grintil .Rhus pe til. MECH.CONT. LIC.NO. MECN.
\[ TOTAL TOTAL
/- S' ulun of A pliean C tractor ate --"
l - INSPECTOR COPY
1