C7279 APPLICANT TO FILL IN INFORMATION WITHIN REDLINES = USE BALL POINT PEN ONLY
BUILDING P OJECT IDENTIFICATION :' PERMIT NUMBER
T .BDILDING APPLICATION & PERMIT 7279
�s�DG}y(-�O/ cE }�y� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S M1 k/77 Z� Y�F�n ¢ PLAN CHECK VALIDATION
NAJe 4�8 CITY. ELECTRIC PERMIT FEE
r/I/;497 CA(� ' y,-/l[.0k PHONE
coN I HAc I UK s UTLETS-SWITCHES-RECEP 5.00/1.00
NAME n
R /6✓ `,uc rvo LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
xqADQDRErrSS/ tr (k Z35(./ HON / .J/- / PANELS 5.00 DATE OF APPLICATION
. ARCHITECTlf. r SIGNS 6.00 PLAN CHECK FEE P.C.NO.
TOR %r
ENJIINEER
LIC.NO, SIGNS TRANS. 3.00
\X ARCH.OH ENG. PERMIT VALIDATION
�( ADDREss St447A RIR /C SPECIAL CIRCUIT 5.00
zHP 97-_)b TEMP.METER OR POLE INS. 15.00
APPLICANTS _ MOTORS SEE FEE SCH. y
ADDRESS
SERVICE CHANGE 10.00 j
..D SE
0
Foo LICENSIiU COKI'RACTORS DECLARATION
a ewi u I hereby al❑on that 1 and licensed un der provisions of Clmpter 9 ISSUANCE DATE
R y (conun,ncing will,Seelioo 7000)of Division 3 of the Business and SLOG. ELECT. I PLG. MECH.
F y z Professions Code,a I my license is in full force to ^ofzr�•µy'
z O to License C ss _�Lic.Number_0 I-2� ❑
9 z o' Uatc Contractor _may
¢ m wf "'YYY _/" E��="'�'�1 BUILDING PERMIT
w OWNER-BUILDER DECLARATION INFORMATION
F
0 A 1 heathy affirm that I am exem 1 from the Cnntraator i License MISC.- REFER TO ORD 11
3 u H p _ VALUATION $/FT. Ps
H g o J Law lonhu hilcity
owingr,y which
requires
emit U,and Pr)fcsafons PERMIT ISSUANCE 6.00
4ad 2
Code:Nly<ity or county which requiresu permit loconstructalLL•q _ �� OA
Q Q si O II11pDoo.dcumltdL or reflalr any Structure,prior ID It$issuance,aIRt ELEC.CONTR. LIC.NO. ELEC. / r
to
O IL require$the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w lie is is licensed pursuant to the provisions of the Contractor's License
rzi
Law(Chapinr9(coon
unccing with Scctiun l D
7000)oivision 3ofthe
a Business and Protissions Code)or tat he is exempt thcretrmn and QTY. PLUMBING PERMIT FEE �/^/0/3 C C
F o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of ml more than five hundred dollar,($500t):
❑ 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 .
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code'[it,Contractor's License Law docs not apply to an owner of
properly It.build,or improves the dint and who docs fod,Work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve-
ments are not intended oruff ered for sale.If,however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or inlprovern,nl is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
buildcr will have the burden of proving that he did not build or int- RES IND CON PB Omer
Prove for purpose.hate.). - INDUSTRIAL WASTE INTER. 20-00
❑ I,as owner of the property,am exclusively contracling with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and profession,Code:l'he Contructm,v License Law dont not apply
to an owner of property wilt)builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a coneactotfsl licensed pursuant to
file Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
'. Owner Date WATER SYSTEM 4.00 ACC.DATEACC.FIL ENO.
-WORK ERS'COM I'P-NSAT'ION DECLARATION WATER TREATING EQUIP. 4.00
I hereby ATinn it I lids,n cerlil'icme of cooleilt l011.11-insure. ZONING ENG.SITE N0.
or a certificate of Workers'Compenmlion Insurance.or a certified
capy Ih,rco!(Sy388000LAC.)..).
Q 'olicyNrM� wny
❑ Cerlitiedcopyixhcrchyfurnisli1 FIRESPRINK ENERGY T"24
Z Z ❑ Certifiepd copy filed with the city inspection division. MISC.- REFER TO ORD.
Q / Applicant-y/QLD �, S; Y❑ N❑ Y ❑ N❑
MN\ _ CERIIFICATE Oh IiXFMPIION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C.
LU > CUYIPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL (Phis section need not he completed if the permit is Or one _ TOTAL Y❑ N❑ Y ❑ N
Z ❑
hundred dollars IS 100)or less.)
U _O 1 certify that in the pertorinunce of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ F- mit is issued, I shall not employ any person in ally nmnncr so as to \ �
U -
become subject to the Workers'Compensation Laws of California.
a Dam Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} N NO"OCI:TO APPLICANT': If,after making this Certificate of Ex-
)..- 2 emphon,You should hecumu subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U Incl pov
risions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO I0=C.F.M.) 3.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 S
the performance of the work for which this permit is issued(Sec. MICROFILM y
3097,Civ.C,). / HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT IOV ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read[his application and slate that the above VENTILATION FAN (SINGLE) 3.00
infonnation is correct I agree to comply with all city dnd county PLUMBING
ordinaoccs and stn, laws relining to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby autlmriee representatives of this city to enter upon the
S --ine ,p�ledp pity for inSpeC\on purposes. BOILER-COMPIOver 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to ave, i� c n11// and keep harmless the City of MISC.- - REFER TO ORD.
Cu •rti/ i ainst liabilitic 'uJ nem costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
ma 'n y wayl Sri;
ca inst 'id dy in consequonce of the
gran' isp itV MECH.CONT. LIG NO, MECH. /
TOTAL TOTAL
%� Signature u plic t un rdctor Ute � '�"
INSPECTOR COPY