2102 (3) (CANT TO FILL IN INFORMATION WI1'IIIN RED LI .-
PER t js
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 2L1O 2
rulNr. ;. F.,�_ - _t BUyLDING - ELECTRICAL-PLUMBING -MECHANICALOw a/J ;jnlFr ¢ ^Vr' 7PLAN CII CK VALIOA
CITY ELECTRIC PERMIT'i 1? I yt J� FEEI17 I
aiorvE
,a., f�LIrI i:nfp,a hi.
ron' OUTLETS-SWITCHES-RECEP 5.00iY1,00 , MAR 29 1993
_LIGHTING FIXTURES 5.00/1.00
rnNmnaon's APPLIANCES-RESIDENTIAL 4.00 C(1Y Ur l:UYCrl l hive
nDD FaS�Q y. "F
55 f(j}D� PANELS 5.00 DATE OF APPLICAT ION
PLAN paECN FEE P.C.NO.
-Anum uTaSIGNSOR
8.00 o�pD
ENGINEER SIGNS TRANS. 3.00
LIC.NO. PERMIT VALIDATION
A11%SS ENc. SPECIAL CIRCUIT 5.00
exons$$
zIP CMP.METER OR POLE INS. 15.01 �nX
nrrucANr's MOTORS S FEE i /-
nomas$
SERVICE CHANG 1 1 0
LICENSED CONTRACTORS DECLARA'f ION
I hereby affirm that I am lie cnscd under pmvisio,ts or Chapter 9 [ ISSUANCE DnTE
(cmmmmnCing with Section 7000)Of Division J or the Bu$iuess mol 6111A1 UG ELECT. PLG. ,MECH.
I'wfcsslo s Co 1y.li9 c�sc it In full forpyl�I§��.7 __ 6111
Lica CI 11�'Ve-W- Lic.Number F'1 =!5(l./_Af/j�a`
Datny-ContraclorJ, SV JUL p�8- BU LDING PERMIT �i }}..�a
OWNER-BUILDER DECLARATION 1 Z REFh TO ORD (¢INFORMATIOMp:WIPWri
I hereby affirm that I a.,exempt from IIIc Contractor's License MISC.- VALUATION $1FT,
Law for IIIc following reason (Sec.7031.5,llusiuessand]'lures sinus PERMIT ISSUANC 6.00 ka, D00�
Cade:Any city or county wbltb regniresa perlmh lOConE1rUCI,aIICL CLEC,CONTfI. 1(fQ/
improve,demolish,or repair any structure,prior In Its Issuance,also ELEC. �o
requires tilt applicant for such permit to file a signed start...C311 like( //PERMIT TO
Ile Is licensed pursuant to lilt provisions of the Contractor's License - f
Law(Chatter 9(commencingwith Section Division of -: PLUMBING PERMIT4(+` i 4yG '�h FEE}'
Business and Profession Code)or that he is exempt Il,eref eno and
CITY. _ ,v I a �f 1 Itp 3V�' STORIES TYPE CONSTR.
the basis for the alleged exemption.Any violation or Section 7071 5
by any applicant for a permit subjects the applicant to a civil Penally ALTER-DRAIN & VENT-WATER (EA.) 4.00
or not more than five hundred dollars(S500)J:
❑ 1,at owner of the properly,or my employees Willi wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP I .UNITS
Ihalf sole compensation,will do the work,and lIIe structure is not �}ry�
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR, ROOF,AREA,CON D. 4.00
Code:The Contractors License Law does n01 apply Io an ower of
properly who builds or improves thereon,and who dues such work FIXTURES-PER TRAP 4.00 SO.FT.FLOC TOTAL ACREAGE
n
himself or through his own employees,provided That such improve- I GAS.EA.SYSTEM-1 INC.4 OUTLETS 4.00
's are mol intended or offered for sale.If,however,Ihc building
nrovmnenl is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
:r will have the burden of Proving that he did not build or im RES IND . CON PB Omer
prove for purpose of sale.). y INDUSTRIAL WASTE INTER. 20.00 0 0 0 ❑
❑ 1,as owner of the properly,am exclusively conlracli"&with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of properly who builds or improves thereon,and who LAWN SPR IN KLERS-OV ER 5 (EA.) 1.00 0
contractsfor such projects will,a contractor(s)licensed pursuant to SEWER-SA\1ITARY-STORM EA. 200f1/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ Iain attempt under Sec. ,B.&P.C.for this jjJ07WATER HEATER W/VENT 4.00
ra
[)are
- Owner WATER SYSTEM 4.00 ACC,DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hemby affirm Ihal I have a certificate of consent Io self-in sur., ZONIN� ENG.SITE NO.
or a c,Uiritau,of Workers'Compemalion Insurance,or a certified
copy it'.ry m �-
Polic)'NS 4C6 P•FA•q�.4111/l.Pi?4--.�V�
❑ C. cds py libcrcby ufnhi ` .wapG-Lag4[IK ENERGYT]4
❑ Cerl real Ile I n a vision MISC.- REFER TO ORD. Yvjv',�,(I rv�
A TIP licanI 7 � ^'
PERMIT ISSUANCE 6.00 FLOOD ZONE ?a-
CERTIPICATEOF EXEMPTION FROM WORKERS uG-.�I
COMPENSATION INSURANCE rALTER
LIC NO PLG Pi Y 0 N
(Phis section need not be completed If Ibe peen It is for one TOTAL
hundred dollars(1100)or less) ,H( Xj i:^ } A ' G:$:."k Ra-• ^
y P pc a " '-FEESUMMARY a'pi0 tr;$:
I certify that in the erfonnence or IIIc work for which this rECHANICAL PERMIT '' I +vof FEE ♦mil isissued,I shall molempioY any P«son In any manner so as to become subject to the WorkeriCompensation Laws of California. BUILDINGDine Applicam ADD TO MECH. 4.00
NOTICE TO APPLICANT: If,after making this Certificatef Ex-
emplion, you should become subject to IIIc Workeri Compensalion 4.00 PLAN CHECK
provisions of (he Labor Cade, you must forthwith comply will,$,tell provisions or Glis permit sliall be dttmcd invoked. NG UNIT(TO 10=C.F.M.) 3.00CONSTRUCTION LENDING AGENCYG 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
the perrornalce or the work for which this permit ]s issued(Sec. MICROFILM
3097.0,,.C.). - �Q HEATING UNIT LTO 100,000 B.T.U.) 400
Lender's Name- HEATI NG UN IT(OV ER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address _ '
I certify that I have read This application and star Thal Gm above VENTILATION FAN (SINGLE) 3.00
7R.,c-olentioned
rnation is correct. I agree to comply will, all city and county PLUMBING
%Mees and stale laws relating la building construction, and BOILER-COMP(3 H.P.or 100,000 0.T.U.1 4.00
, ty auOlorian rcructentaliati of this city to enter upon Olt BOILER-COMP IOve,100p00BTU)SEE FEESCH. MECHANICAL ai
properly for inspection purposes.
eageesaveindemnify anA keep ha nn less the Cily of MISC. - REFER TO ORD.
nin againbi li lies jlid glum a, COSI$ and en parses which CONST.TAX
In lywayaIislsaidityIa conscqucncc ofIhcPERMIT ISSUANCE 3.00lin8 of Ii penal MECH.CONT. LIC.NO. MECH. '}4" ,�i*fd& ,I4O
7TOTAL � dc,�• �},,of APPlican llCP el or I7ar, •-.i>�; ^'�YiB.V^