Loading...
6000 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENT]FICATI ON PERMIT NUMBER EDILDING APPLICATION & PERMIT 6000 0 O O ADDRESS �0 6' e BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ..NEEx - I PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE / / /L PHorvE L}--j .t/0 CONTRACTORS rvnmE / n UTLETS-SWITCHES-RECEP 5.00/1.00 /,<CU r PG LIC.rvo.J-. L IG TI NG FIXTUR ES 5.00/1.00 nooeess uTORS G q PPLIANCES-RESIDENTIAL 4.00 �/ 4 � ` PHONE Z 2ZF�i - ' PANELS .5.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 ENGINEER LIC.NO, SIGNS TRANS. 3.00 ADUREss ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 GO o LICENSED CONTRACTORS DECLARATION ¢ u U I hereby affirm that I am licensed under provisions of Chapter 9 y a N (commencing with Section 7000)of Division 3 of the Business and ISSUANCE GATE w Z Professions Code,and, y]feense is in full force and offt�( BLDG. ELECT. PLG. MECH. z o w- License Clan C'-- Lia Number 1Y_ 2 z 1- w Date 4/i/ Contractor �, rC ¢ a w e OWNER-BUILDER DECLARATION S 1 [ 7 BUILDING PERMIT o a " X ;¢ y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION .. o G Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. - PERMIT ISSUANCE E > - Code:Any city or county whiny structure permit totssa alter, i ¢ a0 improve,Jemulirh,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. LL requires the applicant for inch permit to file a signed statement that TOTAL A w m he is licensed pursuant to the provisions of the Contractors License PERMIT TO FZQLaw(Chapter 9(i,mrmencingwith Section 7000)ofDivision3oRhe J(CRO©C s i o Business and Professiuns Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢I C, the basis for the alleged exemption.Any violation of Section 7031.5 h/�/TORIE$ TYPE CONSTR. u 3 - by not applicant fora permit subjects $500).licant loacivil penalty ALTER-DRAIN St VENT-WATER (EA.) 4.00 sfYE-{.3-V of not more than five hundred dollars(my em: ❑ I,as owner of the property,m my employees with wages as BACK FLOW PROTECT. DEVICE .,pC their sole r offered fo,will(S the work,and the structure is not tIIIU 0.G P RES.UNITS Core:Ttended or ofur sale (sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CONDI 4.00 ��/E/ f4, Code:The hContractor's buildor License Law does not apply to an owner of property who builds or improves thereon,vid who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- _ o nts improv not intended sold or within son(or year .If.complhowever the the o nes- GAS-EA.SV$TEM-11NC.40UTLETS 4.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving(hat he did not build of im- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE prove for Purpose of,adc L INDUSTRIAL WASTE INTER. 2000 REs IND CON PB Omer ❑ I,as owner of the property,am exclusively contracting with . licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS- 1 INC 5 V.B. 5.00 gSSEESOR$PgRCELNO. and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.)- 1.00 contracts for such projects wish a contractors)licensed pursuant to the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ lam exrmpt under Scc. ,B.&P.C.7or finis WATER HEATER W/VENT reason 4.00 Owner Date WATER SYSTEM 4.00 ACC.DATE ACC,FILE NO. WORKERS'COMPENSATION DGCLA RATION WATER TREATING EQUIP, 4.00 1 Iwreby affirm that I have a certificate oI reinsert to self-insure, or a certificate of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE NO, copy thereof(Sec.3800,Lab.C.1. Policy No. Cmnpany - 0 ❑ c Hificd copy is herebyfurnished, FIRE BPRINK ENERGY Z Z IY Ccrtifitd�' py is lilt�witlr'e cilY inspection division. 24 FO Applicant. G'L11 d -� -e l - MISC.- REFER TO ORD. Y� NO YE] NC] CCN CER'I'IFICA'rl!OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE a.LU.c. LU 1 COMI'IiNSATION INSURANCE PLO.CONTR. LIC.NO. PLG. d (This section need net he completed if the permit is for Ont TOTAL Y.[] NC] Y CJ ry� hundred dollars 100)or less.) UO I certify that in the performance of the work for which this per- QTY - MECHANICAL PERMIT FEE SUMMARY LL F mil is issued,I shall not employ any person in any manner so as to FEE U become s jc t t the Wurkeri Compensa(ion.Ul sf California. 0 u Dam Applicant /•- e(/G-C-G-;:A` _ ALTER OR ADD TO MECH, q-00 . BUILDING �� } Ed NO'I'IC i l APPLICANT: If,after making this Certificate of Ex- 2 emption,you should become subject m the Workers'Compensation. APPLIANCE _ - 4.00 PLAN CHECK provisions the Labor Code, You most forthwith comply with U such provisions or This permit shall 4 deemed revoked. AIR HANDLING UNIT(TO IOJI(1DGF.M) 3.00 FEE CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MCF.K) 5.00 'SEISMIC FEE ej'O 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2,00 the performance of(he work for which'this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT ITO 100,000 B.T.U.) 400 Lender's Name . I.cndds Address HEATI NG UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC I certify that l have read this application and state that the above VENTILATION FAN,(SINGLE) 3.00 -10 information is correct I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-OOMP(3H.P.or 100,000B.T.LL) 4.00 hereby authorize representatives of (his city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. above-mentioned properly for inspection purposes. MECHANICAL (Wc) agree to suve, indemnify and keep harmless file City of MISC.- REFER TO ORD. CupeRinu'momliabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against mid City in consequence of the PERMIT ISSUANCE 3.00 gm/n(Jin,of'Id 'm �/• / MECH.CONT. LIQ NO. MECH. Signature npphcanl/C�nImLiorr�. 9"d1C/7�� TOTAL TOTAL OFFICE COPY