0928 APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES - USE BALL POINT PEN O '
I
BUILDING PROJECT I DENTI FICATION I E IT NUMBER
17a_J40
APPLICATION & PERMIT
Yle, ZID� BUILDING — ELECTRICAL—PLUMBING—MECHANICAL O928
--�_ — - - - - - _• _i - -�__ --� PLAN CHECK VALIDATIONDTV. � ELECTRIC PERMIT FEEOUTLETS-SWITCHES-RECEP 5.00/1.00
Llcry LIGHTING FIXTURES 5.00/1.00
CONT/ O/RRACTORsl!/
AO APPLIANCES-RESIDENTIAL 4.00 "
HONe7 PANELS 5.00 Dore oFAPPucnnoN
ARCHITECT - SIGNS 6A0 PLAN CHECK FEE P.C,N0.
OR
ENGINEER
LC,NO. SIGNS TRANS. 3.00
ADRCHORDRESS ENG. SPECIAL CIRCUIT 5,OQ PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 15.00
APPucANTTS MOTORS SEE FEE SCH. '-
' Es '
SERVICE CHA 10.00
r
o o LICENSED CONTRACTORS DECLARATION
Q U u hereby.(finis Ilial am licensed under provisions of Cmpler 9 C\ ISSUANCE GATE
H < i (commencing wit Sec un 7000)of Division 3 of the`)11$i ess apd BLDG. ELECT. PLG. MECH,
F DO i Professions Cad iceilse rs in full fo 1YJVY S
o i H O License s Lle.Number ❑ ❑ ❑
Date Conlreclor
`¢ y -a'. i_� BUILDING PERMIT
¢ a w¢ OWNER-BUILDIik UECLA RATION INFORMATION
dors " REFER TO OR
I hereby affirm that I am exempt from tiro Contractor's License MISC.— D VALUATION 5/FT.
F u. O ¢ Law for the following rcasmt.(Sec 7031.5,Rosiness and Professions PERMIT ISSUANCE 600
m Code:Any city orcounty which requiresan
penittoconslru .
ct.alter, rJ QT
-¢ Q 0 improve,demolish,or repair any structure,prior to its issuance,olxu ELEC.CONTR. LIC.NO: ELEC.
a. - O , requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
' ve m he is licensed pursuant to the provisions of the Contractor's License
Fzi