9489APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
8
BUILDING
ADDRESS
2Z0-2-"/ L p C -Z
OWNER'S
NAME
/ 4/4:7S •./
9 PHONE Y
Q� ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION
NiRACTOR'S
"ME
G/i JI IY91 uc NO 10%
OUTLETS -SWITCHES -RECEP 10.00/1.00
,.o LIGHTING FIXTURES 10.00/1.00
'FACTOR s 'Y.�.V
ADDRESS Aoo R Es//( PHONE
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT V
on �( C..�-
ENGINEER
uc. No.
PANELS (OVER 200 AMP) 20.00
LAN CRECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ADDRESS ENG.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 20.00
ZIP
n /)
APPLICANT
ADOREss
MOTORS SEE FEE'SCH.
SERVICE CHANGE 20.00
fy
LICENSIiDCON'IRACfORS DECLARATION
TEMP. POLE 30.00
I hereby affirm that 1 um licensed under provisions Uf Chapter 9
(cununencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect
License Class r e •iL 2. Number 'P
ISSUANCE GATE
BLDG. ELECT. PLG. MECH.
❑ ❑ ❑ /
)ate
f�� ��'
15 �-a'Cmal,otor
" "
OWNER -BUILDER DECLARATION
I hereby affirm that I anh exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5. Business and Professions
Code: Any city or county which requires a permit to construct, alfeq
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION
$/FT.
ELEC. CONTR, LIC. NO.
ELEC. _
TOTAL
improve, demolish, or repuirmy structure, prior to its issuance, also
requires the applheant for such parmit to file a signed satemvat Uhul
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (emnmeneing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
PERMIT TOI
QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption Any violation of Section 7031.5
STORIES:
TYPE CONSTR.
by any applicant l'.r. permit subjects the applicant to a civil penalty
of not more Chun five hundred &dLrs, S500)J:
ALTER -DRAIN -WATER (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure Is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00
so. FT. FLOOR AREA
TOTALACREAGE
property who builds or improves thereon,' and who does such work
himself or through his own employees, provided that such iniprove-
meats are not intended or offered for sale. If, however, the building
GAS-EA.SVSTEM-l 6.00
or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or int-
prove for purpose ofsale.).
I, as owner of the property, am exclusively cting with
ID 1,
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Omer
11 ❑ 11 - ❑ Ellicensed
. .
INDUSTRIAL WASTE INTER3000
contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon. and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
,
,
contracts for such projects with it contmctons) licensed pursuant to
the Contractors License Law.
SEWER-SANITARYV-STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
O Iarrlexelnpt under Sec. ,B.&P. C. for this
millon
_
WATERHEATER W/VENT 6.00
Owner - Date
WATER SYSTEM 5.00
'ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORK Ii RS'COMMiNSATION DECLARATION
1 hereby affirm that I have a certificate of consent to sell -insure,
a certificate IF",01kers' COmjPrsa a or a certified
copy She'ilW SecI1 .3M . Lab.C.l.
I'oliC Company
Ce ified copy is hereby fum¢hed.
Cer fed corny is fled w' If the ci s spectiun division.
ApplieatMISC.
044419 eeee,�
I
ZONINGor
ENG. SITE NO.
FIRE SPRINK
Y❑ N❑
ENERGY T-24
v❑ N[]CERTIFICATE
, - REFER TO ORD.
OI' EXEMPT10N FROM WORKERS'
COMPENSATION INSURANCE
iph is section need not he completed if the peril is for one
PERMIT ISSUANCE 10.00
FLOOD ZONE
Y ❑ N❑
A,L.U.C.
Y ❑ N❑
PLG. CONTR. LIC. NO.
PLG.
TOTAL
hundred deltars(S 100) or less)
I certify that in the performance of the work for which this per.
alit is issued, I shall not employ any person in any manner so as to
OTY MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: It, after making this Cert ificme of 1:
ALTER
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
FEE
you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10MC.EM.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirnh that there is a ....Unction lending agency for
EXHAUST HOOD (WITH DUCT) 5,00
the performance of the work for which this permit is issued (Sec.
3017, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lvm0i Address
HEATI NG ON IT (OVER 100,000 B.T.U.) 9.50 t'('
ELECTRIC
I certify What l have read this application and state that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER -COMP .(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP IOver 100,000 BTU) SEE FEE SCH.
MECHANICAL
7
hereby authorede representatives for ins inspection
this City es enter upon the above
hen,by authoriz property tat inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
�ul rtma against liabilities, judgments, costs and expenses which
may n any way accrue against Said City in consequence of the
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
It ing of this permit.
MECR. CONT. LIC. NO.
y
MECH.
TOTAL 4i.
TOTAL
biglmtWcdf+ ppli t tivE[br Oate '
INSPECTOR COPY