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13567 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDINS PROJECT IDENTIFICATION PERMIT NUMBER BUILDING. APPLICATION & PERMIT ADD ESS � 1356-7 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL O ER'6: PLAN CHECK VALIDATION NAME rr//�� OTV. ELECTRIC PERMIT FEE ` 12 PHONE CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME 1 _ f OZZ LIGHTING FIXTURES 10.00/1.00 CONT ACTOpPLIANCES-RESIDENTIAL 4.00 ADORES 20-ag Q1 '' �/ �r fZpHaNe�D PANELS. 10,00 DATE OF APPLICATION ARCHITECT I p /q9 PANELS (OVER 200 AMP) 20,00 PLANCHECKFEE P.C.NO. ENGINEER �`�'• S uc.No. SIGNS TRANS. 3.00 ARCH.ORENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 APPLIANT'S MOTORS SEE FEE SCH. rDATE AOOR E59SERVICE CHANGE 20.00o o LICENSED CONTRACTORS DECLARATION0u u 1 hereby affirm Thal I am licensed under provisions of Chapter 9 ISSUA z w (commencing with Section 7000)of Division 3 of the Business and BIRD gLT. PLG. MECH. ' 00 N i Professions Co ,a license is in full for ry� ly Or f�jfn " z o m— License Class.._ II Lic.Number I�I Y 2 m f w to Contractor a y 2 -- BUILDING PERMIT ¢ ¢¢ O I' -BUILDER DIiC INFORMATION woa" MISC.— REFER TO ORD ; w 1 hereby affirm [hal I am exempt from the Contractor s License VALUATION SIFT. coo¢ Lawforthefollowingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 0 Code:Anychy orcounty which requires a permit to construct,alter, Q Q Q 0 improve,demolish,or repair any structure,prior to Its issuance,also ELEQ CONTR. LIC.NO. ELEC. — D u requires the applicant for such permit to file a signed statement that TOTAL PE IT TO w$ he is licensed pursuant to the provisions of the Contractor's License Fri Law(Chapter 9(commencingwith Section7000)ofDivisinn 3oFtbe Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE sio ¢ s- D thebasisthea ora ermit subjects ubjetstheaplica n tGaclion703L5 DRIES TYPE CONSTR. s3m by any applicant forupermit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): - ❑ 1,as owner of the property,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 to(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property 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- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im. RES IND CON PB Other prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 El ❑ ❑ ❑ 1:10 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves Thereon,and who ILAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts for such projects with a contractor(s)licensed pursuant to - $TORM EA.200ft/10.00 the Contractor's License Law. SEWERSANITARYTRACT NO. PARCEL NO. ❑ I am exempt under Sec.—,B.&P.C.for(his WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG,SITE NO, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab,C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z O Certified copy is Bled with the city inspection division. MISC.- REFER TO ORD. Y❑ N❑ v ❑ N[] p: Applicant CERTIFICATE va PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. LU > COMPENSATION EXEMPTION FROM WORKERS' W _ COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. CQ TOTAL Y❑ N❑ Y❑ N❑ (This section need not be completed if the permit is for one L) Z hundred dollars IS 1IessJ U the pe O I certify that in the performance of the work for which(his per- QTYMECHANICAL PERMIT FEE FEE SUMMARY mit is issued,I shall not em toy a terse i anner so as to U become iu-bjejtmJ�}fyFI Workers' ens o L sof California. BUILDING LLP p a Date_�gY.( L4 pplicant - ALTER OR ADD TO MECH. 5.00 } In NOTICWTO PP CANT: 1 , to mak this Certificate of Ex- L.. Z emption,youshould become subject to the workers'Compensation qpp LIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or(bis permit shall be deemed revoked. AIR HANDLING UNIT(TO 1 ,QOO QE,IL'1.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 . .M.16.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD( IT 'DUCT) 4.,_ ,5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100, 00 d:T!U.I" 8.00 MICROFILM 3097,Civ.0 J. Lender's Name HEATING UNIT(OV F}I OB.T,U.19.50 ELECTRIC Lender's Address • I certify that 1 have read this application and state that the above VENTILATION FAN IS NGL o, 4.00 information is correct. I agree to comply with all city and county BOILER-GOMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building Construction, and hereby authorize representatives of this city to cn ter upon the BOILER-COMP IOver 100.000 BTU)SEE FEE SCH. MECHANICAL about-memio property for inspection purposes, (We) to save, indemnify and ep harmless the City of MISC.- REFER TO ORD. Capert' o gainst 'a lilies,judgm s osts and expenses which PERMIT ISSUANCE 1400 ©o CONST.TAX may ' any way a we City in consequence of the gra ng oft is it. MECH.CONT. LIQ NO. MOEOq. w TOTAL �l0 ori a re o pplicant/ on( k or Data / OFFICE COPY