6897 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
v BGoRF G wA��
AooREs BUILDING - ELECTRICAL-PLUMBING -MECHANICAL `v vv
Gb78 I C-UJ
OWNERS PLAN CHECK VALIDATION
NAME ,1 y�/ (' QTY. ELECTRIC PERMIT FEE
• {J G Fit.L PHONE 494'I'V58 ��-
NONTRAGToes
NAME 49-1 OUTLETS-SWITCHES-RECEP 5.00/1.00
fl
//gi •�L02S LG.No.e409 S LIGHTING FIXTURES 5.00/1.00
CONTRACTOR
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
S CC
S. -,S �'J/(, �QPHONE�V�.OQ V V PANELS 5.00 PATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.N0,
O
OR
ENGINEER ate^- sec.No. SIGNS TRANS. 3.00
AARCH.OR ENG. - SPECIALCIRCUIT S.DD PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANT
GOFFes
A - MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
oo LICENSED CONI'RAM ORS DECLARATION
u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N
H ¢w (Cummeacmg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MEDIA,
Vi 1'rdessions Code. A m license is in full furs-n ul ef[eet. ❑
z o `r,1' - Licens Qlas _ Lic.Number /
0 Uaa•�_( --1'Y Contractor
BUILDING PERMIT
e, w p OWNER-BU ILDIiR DECLARATION INFORMATION
w 0' I hemh affirm that I xns exem t from Bm Contractor's License MISC.- REFER TO ORD
u Y p VALUATION $/FT.
F LL o¢ Law to,the following reason.(Sec.7031.5,cusinessand tL sinus PERMIT ISSUANCE 6.00
Code Any city or county which rcquimsu permit In cmisl,a,nmt,ullcq
QQ Q Q Improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NQ ELEC.ra
is
- K reunites the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w m ba is licensed pursuant In the provisions of the Contractor's License - [�
F z a
Law(Chapter 9la+mmmncing with Section 70000of Division 3 of r he S'K L/(-/•f
i ct Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
I-o the basis for flit,alleged oxemptian.Any violation of Section 7031.5 STORIES TYPE CONSTR.
u i by any applicant Ior a permit s,Ibjccts the applicant t as ClvilpL'nally '
ALTER-DRAIN (EA.)
ofnot more than live hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 \
Code:The Contractor's License Law does not apply to an owner of
property who buildsser improves rIIercon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT FLOOR AREA TOTAL ACREAGE
himself or thiough his own employees.Provided that such improve-
mentsare not intended oroffered for Sale.If,however,thebuilding GAS-EA.SYSTEM-11NC.40UTLETS 4,00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden urinating Ileal he did not build or im-
prove for purpose ofsale.). INDUSTRIAL WASTE'INTER. 20.00 RES IND CON PB on+e,
❑ I,as owner )I tire property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to coustruet the project(See. 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
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for xmh Projects with i contract.,(,)licensed pursuant to
dic Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under See - ,B.&I'.C.for this WATER HEATER W/VENT 4.00
reason
Owner Dam WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'HUN DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have u certificate of consent to sell-insure ZONING
or a certificate of Workers Compensation Insurance.or a certified ENG.SITE N0.
-�/ copy thereof(See,3800.Lab.C.).,,L_ /� 0
Policy N..(�Y��L`onymiiY �7p.IS Lhe
O ❑ Certified copy
yisshhereby furnish ed. FIRE SPRINK ENERGY T 24
Z Z [�CerliDed is file�witn flit city inspection division. MISC.- REFER TO ORD.
O APpbcant dr ��..-- Y❑ N❑ Y ❑ N❑
CC CER'1'lF1CA1'EOF EXEMPTION FROM WORKS RS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. v❑ N❑ YE] N❑
d O (ilii, section need nor be completed if IIIc Penal is for are TOTAL
Z hundred let 100)or les.)
V O 1 certify that in the performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I O all Got anplo,any person in any manner so ars 1. v
O litp' ace subject to the Workers'Compensation Laws of California. �p
a D.IY ATTlicam ALTER OR ADD TO MECH. 4.00 BUILDING a�
} 0 NO'RCI: '10 APPLICANT If,after mlking this Certificate of lix-
� Z enipdomsyau should beeome Subject to the W.,ke,x Compensation APPLIANCE 4.00 PLAN CHECK
provisions ofC�the Labor Code, you must forthwith comply with FEE
U 'wcb pruvisi2s'rlhis permit shall he deemed revoked. AIR HANDLING UNIT(TO 10SWC.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby anon that t ork is u hick this
mit is
agency fur EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this Tenni, is issued(Sec. MICROFILM
3097,Civ.C.l. IIL� HEATING UNIT(70100,000 B.T.U.) 4.00 r..
Lender's Name HEATI NG UN IT 100,000 B.T.U.)7.50
Leidcrk Address ELECTRIC
I certify that I have read(his application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct, I agree to comply with all city and county PLUMBING
ordinances and Stam laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby amhurize represent. Ives of this city to enter upon the BOILER-COMP (Over 110,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned Trope ,inspection purposes.
0` , a ro-s _ , !,,den rl�j and keep harmless the City of MISC.- REFER TO ORD.
Cu o agai Fd i'e's, ents, costs and expenses which CONST.TAX
y in an w ai t said City in consequence of the .PERMIT ISSUANCE 3.00
genua, th�p i MECH.CONT. LIQ NO. MECH.
TOTAL TOTAL a 1-�
'gn o ppllcan[/Co ctor Date
INSPECTOR COPY