9118 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.t BUILDING PROJECT IDENTIFICATIONPERMIT NUMBER
BUILDING �.�'. B
APPLICATION & PERMIT 8118
ADDRESS '/91
4 UILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S N W01 fA RA PLAN CHECK VALIDATION
NAME `V' OTY. ELECTRIC PERMIT FEE
lart Packard ONE
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
n( LIC NO Lit LIGHTING FIXTURES 10.00/1.00
ADDRESST HS'JO8 SAN6jo QOS) PPLIANCES-RESIDENTIAL 4.00
CIA PHONE PANELS 10.00 DATE OF APPLICATION
RCHrtECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.flO.
OR
O
ENGINEER
LIC.No. SIGNS TRANS. 3.00 4
GS j PERMIT VALIDATION
SPECIALC(RCUIT 5.
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'$ /I
ADORESS 4,` MOTORS, SEE FEE SCH. 1\I
\sh SERVICE CHANGE 20.00
wo o LICENSED CON'I'RACTORS DECLARATION TEMP.POLE 30.00
a v I I hereby affirm that 1 am iicmued under provisions of Chapter 9 ISSUANCE DATE
ya w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
z H m z Professions Code.and my license is in full force, and effect ❑ ❑ ❑ ❑<
O w License Class G- Contractor
O z F Uale�J���Contractor
I' ¢ x s `�'�� CC-�� BUILDING PERMIT
¢ IS w ¢ OWNER-BUILDER DECLARATION INFORMATION
wC A D MISC.- REFER TO ORD
3 LL H 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
F u o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
2 a ¢ o improve,demolish,Or repair any structure,prior to its issuance,also ELEC. LIC.NQ ELEC. - 3�OOO
LL requires the applicant for such permit to file a signed statement 0ra1 TOTAL
PERMIT TO
w $ he is licensed pursuant to the provisions of life Contractor's License
H z ¢ Law(Chapter9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Fire S rinklere
¢ e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant turn permit subjects the applicant toa Civilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 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 the work,and the structure is not
intended or offered for site (Sec. 7044, tlusincss and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to on owner of
properly 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- I
mentsare not intended oroffered for sale.IC however.the building GAS-EA.SVSTEM-1 6.00 I
or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or im GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING uSE'ARES IND CON, v8 Omer
L
prove dor purpose of sale.). INDUSTRIAL WASTE INTER. 3000 ❑ 0 ❑ 0 O
❑ as owner of the properly, exclusively contracting with .
licensed contracture m construct the
clnr icen La does,of apple LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and n owner ns Code:The Contractor's License s does not apply
to tr owner of property who builds tr improvesthereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts .I.,',h projects with a contractors)licensed pursuant m -
IheConvaaohLicenselaw. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l um exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dane WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent la edr-imsore, ZONING ENG.SITE NO.
or a certificate of Workers'Co'*ensation Insurance.or a aerli0ed
/ copy thereof(Sec.3 .)1 C�21610%-I�/3t0�
Policy No. ompany
Q \z ❑ Certified co is hercb lit `d�- FIRE$PRINK ENERGY T-20
,,Q Cerl iI nd is file with t to it nzpect ion division. MISC.- REFER TO ORD.
o A�icanl Y N Y 0 N
CERTIFICATE 017 -.'F:.\IP FROM WORKERS'
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
4L COAIPENSA'1'10N INSURANCE PLG.CONTR, LIC.NO. PLG.
CL Y�
O (This section need not be.completed if the permit is far one TOTAL
9 Z hundred dollars 181001 or Ices.) ` i
U O I certify that in the perturniance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY r
LL F' mit is issued;I shall not employ mry person in any mummer so as us '
U U become subject to the Workers'Compensation laws of California. ( r
Go
BUILDING
o. Date Applicant ALTER OR ADD TO MECH. 5.00
} 0 NOTICE 1'0 APPLICANT: If,after making this Certificate of I's.
F- Z emption,you should become sobject 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 6a11 be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUSTHOOD(WITH DUCT) 5.00
so
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING`UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
1 certify that I have read this applicminn mul stat,that the uheve VENTILATION_ FAN (SINGLE) '4.00
information is coriect. I agree to comply Willi all city and county PLUMBING
ordinances dnd state laws relating to building construction. and BOILER-COMP,(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) te, indemnify and keep harmless the City of MISC.- -+v vd, 'REFER TO ORD.
Cupeililies,judgments, costs' and expe see which CONST.TAX
may r against said C' in a..I"p, ce of the PERMIT ISSUANCE 10.00
grantiInc + '/ MECH.CONT. LIC,NO. MECH.
q TOTAL TOTAL
Y Isign.mic"ct.,ctor D ,, ` 64402
\ INSPECTOR COPY ,
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