2935 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.USE BALL POINT PEN ONLY
BUILPROJECT I IDENTIFICATION ' PRMIT ER
BUILDING ' 4�2 �� APPLICATION & PERMIT
A}O E 2935
BUILDING-ELECT"
RICAL-PLUMBING-MECHANICAL '
AW
O NEN' a{/�y /y PLAN CHECK VALIDATION
NAME 1Y� i� OTY, ELECTRIC PERMIT FEE ..
v +
NTRACTOR'S
1.brAME . OUTLETS-SWITCHES-RECEP 5.00/1.00
uc.No, LIGHTING"FIXTURES 5.0.0/1.00
DREScaDR's
AD - APPLIANCES-RESIDENTIAL 4.00
CONTRACTOR
ONTRA
PHONE PANELS 5.00 DATEiOF.APPLICATION
ARCHITECT - SIGNS 6.00 PLAN CHECK FEE PSCC..NO.
OR
- ENGINEER
LIC.NO. SIGNS TRANS. 3.00
r AARC DDREOR SS ENG.' - SPECIAL CIRCUIT" 5.00 PERMIT VALIDAATTI]]]OONNJJJ
ZIP EMP.METER OR POLE INS. 15.00
OOCC h f(/jr���
' APvucnrvrs - -
ADDRESS MOTORS SEE FEE SCF. '
-
SERVICE CHANGE 10.00 _
,02
0o LICENSED CONTRACTORS DECLARATION '
< U au sa ,I hereby affirm that I am liceew'd under provisions of Chapter 9 NCE DATE
N < m( commencing with Section 7000)of Division 3 of the Business and BLD PLG. MECH.
H N z Professions Code,and my license is in full force and.effect. El 13o Z A W License Class Lic.Number
,A H Dere Contractor -
¢ 1C ¢ a OWNER-BUILDER DECLARATION - PL-U 610I D ERMIT
g o L' Q - MISC.,- REFER TO ORD INFORMATION
E:
; e- n I hereby affirm that I am exempt from the Contractors License
Huo,¢ Law for the following reason(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 6.00 LIE QQQ S/FT.
Code:Any city or county which requiresa permit to construct,alter. �7
rc ¢ a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.'� LIC.NO. ELEC.
O M requires the applicant for such permit to file a signed statement that
TOTAL PERMIT TO
a'w$ he is licensed pursuant In the with Secti of the )o(DiskContractor's License &40W'
HiQ Law(Chapter 9(commencing with Section 7000)rf Division3of the' IJ�ENi/
E 4 O ^Business and Professions Code)or Dol he is exempt therefrom and GTV. PLUMBING PERMIT FEE
at H$ the basis for the alleged exemption.Any violation of Sceti.B 7031.$ STORIES- `TYPE CONSTR.
n , by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.) 4.00 r ^ �u
of not more than five hundred dollars($500f): .JIT•?•
❑ 1,as owner of the property,ar my employees with wages as. +. BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for Sale (Sea. 7044, Business aBit Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who huilds or improves thereon,and who does such work FIXTURES-'PER TRAP 4.00 SD.FT.FLOOR AREA TOTAL ACREAGE
.himself or through his own employees,provided ever,t h improve- 'y
hj s are not intended or offered for sale.IL however the bw sting GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
nprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA,) 1.00 BUILDING USE
bilder will have the burden of proving that he did not build or im RES D CON PB Omer
1,as
prove as owner
of sale. INDUSTRIAL WASTE INTER. 2000 �❑ 1:1 13 ❑
fill ❑ I, ownerr p of the property,am exclusively contracting 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 dues not apply, - w
to an owner of property who'builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 7j� x10+
contracts for such projects with a'contractorls)licensed pursuant to biz ��7
the Contractor's License Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO.. PARCELING
❑ Ian.rAxem rt un r ` ___.B.&1•.o.fnrlbis WATER HEATER W/VENT 4.00 �^�/0
dc
reason IS=
�^ WATERSYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKS RS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers Compens lion Insurance,or a certified ZONING ENG.SITE NO.
copy Ou rcof(Sec 3800,Leh.C.). - ) / ....�•
Iblicy Nn. 'Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
.Z Z ❑ Certified copy is filed' with the city inspection division. MISC. REFER TO ORD.
O Applicant Y ❑ Y IN
F
Lu r - CERTIFICATE 017 I AIFROM WO- RKi1i5' PERMITISSUANCE 6.00
FLOOD ZONE
W COMPENSTION INSURANCE �wR•.+f•6.••r
PLG.CONTR. LIC.N0. PLG.
d 0 _ (This'section need not be,'completed,if the permit is for nnp TOTAL Y❑ N
- Z) Z , hundred dollars IS 100)or Tess.) 11
L) O 1 certify that in the performance of the work for which this pen OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any mannerso as to
0
U became subject to the Workers!Compensmion Laws of California. BUILDING p V
W , Date Applicant r ALTER OR ADD TO MECH. 4.00
�- to NOTICE TO APPLICANT: If,after making this Certificate of fix.
F Z emption,you should become subject to the Workers'Compensmion APPLIANCE _ 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith can.ply wish FEE
C7 such provisions or this permit shall be deemed revoked: AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 5.00SEISMIC FEE ` 6
I hereby affirm that there is a construction lending agency fin EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cis,C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's.Name - HEATING UNIT(OVER 100,000B.T.U.)7.50
Lender's Name s- ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3,00
41-1 information is,correct.I agree to comply will,all city and count)' PLUMBING
Ices and state laws relating to building construction, and - BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
r mauthorise represenlutives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL
entioned property for inspection purposes.
tpe,�.,Litm
agree to save, indemnif yy and keep harmless the Cit of MISC.- REFER TO ORD. CONST.TAX
-a against acct a ag inst aidis, costs and expenses which PERMIT ISSUANCE - 3.00s may waY accrue against said City in consequence of the ofthispermit. MECH.CONT. ;LIC.NO. MECH.rALTOTALue f Applican on roc or Date
- OFFICE¢OPY