C 6271 APPLICANT TO FILL'IN INFORMATION WITHIN RED LINES -:USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION ERMIT NUMBER
ritnU INo - . YT �o APPLICATION & PERMIT ^^n
AooREss b
36 ✓4�/✓�L� '.{. LgN�. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL G I
� 1„ '4 y PLAN CHECK VALIDATION
Iva �'Bn�_$, . 'RICi Th MI1T1 , c �FE�E
T y. *ELECTRIC�PERMIT i ,R
PHONE
CONTRACTORS UTLETS-SWITCHES-AECEP 5.00/100
Me /LQ S.EI ucSNo. (03 LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S APPLIANCES-'RESIDENTIAL 4.00
ADDRF s .. _ J D/�
P ONE �JPJ PANELS 5.00 DATE OF APPLICATION
ARC IT cT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER -
LIC.No. SIGNS TRANS. 3.00
ADD Ess ENG. - -- - _ _ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
I. zip TEMP.METER OR POLE INS. 15.00 (/\���
ADDRESS MOTORS SEE FEE SCH. \ {fJ"��
ADDRESS - ' wLL
SERVICE CHANGE .10.00 C
wo o LICI!NSF.D CONTRACTORS DECLARATION
a o U I hereby affirm that I am licensed muter provisions of Chapter 9 ISSUANCE DATE
vHi a vAi (commencing with Section 7000)of Division 3 of the Business and BLDG. E ECT. PL ME
, w z I'mfieseiore Cade, my license is in full force' ,�f
'z, i,,,o Licmum Lic.Numhf1hComme
32*9 RAI
9Datc-, �.aContractoaBUIL ING PMa a OWNF.R-IIUILUT:R DECLNAoa,u q. L )R_M_A_•iIOwg LL I- I hereby affirm that I am cxcmpt from is License MISC.- REFER TO 0
w VALUATION $/FT.
_ , o a Law for the following reason.(Sec.703 1.5,Businessand Prolelvamns PERMIT ISSUANCE s 6.0
Code:Any city or county which requires permit W construct,alter, Y V'0
R ¢ ¢ p improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.N0. ELEC.
a requires the applicant for such permiwo file a signed statement that TOTAL PERMIT TO
a w he hs licensed pursuant to(he provisions of the ContractorCa u. 's License '
i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
io Business and Professions Code)or that he is exempt therefrom and DT*. 4 < PLUMBING.PERMITiol' f. c IF'1f,
¢ H $ the basis for the alleged exemption.Any violation EI Section 7031.5 k ,ry h, ,w g
ST
ay� " +✓t �;" 'tt k�'{^#�. ORIES TYPE CONSTR.
a3 by any applicant for a permit subjects the applicant to a civil penalty Y. ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars($5001.): S/✓
❑ I,as owner of the property;or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES UNITS
their role compensation,will do the work,and the.structure is not. '- n
in
tended or Edified for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Cade:The Contractor,License Law floes not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 4.00 50.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided thud such int provN
.nients are not intended,),offered for sale.IL however,the building GAS-EA.SYSTEM-ZINC.4 OUTLETS 4.00 3A7 '7
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have(he burden of proving that he did not build or im-
ProveforpurposeofsalcJ. - - - INDUSTRIAL WASTE INTER. 20.00 S IND CON Pe Omar
❑ 1,as owner of the.property,im exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors lE construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Codp...pe y hit builds
o License Law neon.notdapply
who � �� 0�
to un owner of properly who builds or improves w does td who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contructons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.20011 TRACT NO. PARCEL NO.
❑ lam exemptunder Sec. ,B.&P.C.Iuthis
assn I WATER HEATERW/VENT 4.00
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 4.00
I hereby affirm that I have a'certificate of consent to self-insure, ZONING ENG.SITE NO.
l
or a certificate eof Workers Compensation Insurapce,ora certified
copy hereof(Sfc.380Qluy_. /\ L//O�'L.�fl y/,-��"yA
I'ol No. _Comparny_ -
0 ertifiellfcolly is hereby fuRd5 FIRESPRINK ENERGY T-24
ertifie co is fed it th city )nsper/ton division.z MISC.- .REFER TO ORD.0 Applicant LL�•L Y ❑ N❑ Y ❑ N❑
M N CERTIF ' TE 0I7 IiMPT N FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
lL,� OhIPI'N ATION SURANCC PLG.CONTR. LIC.NO. PLG.
1 z (Th s sectio need not be oompleted'if R p tan Is for on TOTAL Y❑ N❑ Y❑. N❑
Z h dr d dollars $100)or kss.l y
U O" I snify that(in the performance of the work for which this{cr y- t a s Y i I.5 ` rryy;;FEE SUMMARY
OTY_ ,_MECHANICAL`+PERMIT . "� '+. -FEEL ..G*<s�$r:,.. .R.... A
LL I- mit is Issued,I shall not employ any,person in any manner so as to -v a "\ 4,araE,
U be come subject l o the Workers'Com pencil ion Laws of California: «-a*..
y Date Applicant - ALTER OR ADD TO MECH. 4.00 BUILDING - 5--4
}
an NOTICE TO APPLICANT': If,after making-this Certificate of Ex-
Z cartoon,you should become subject to the Workeri Compensation APPLIANCE 4.00 PLAN.CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
U such provisions or(his permit shall he deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.)- 3.00
CONSTRUCT ION LENDING AGENCY - AIR HANDLING UNIT OVER 1000DC.F.M.) 5.00 SEISMIC FEE /O
I hereby affirnh that there is a construction Ienling.agency for EXHAUST.HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sea MICROFILM -
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UN IT ER 100,000 B.T.U.)7.50
Lender's Address - ELECTRIC -
_� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply withall.city and county 'PLUMBING
ordmances'and state laws relating to building construction, and BOILER-OOMP(3 H.P.'Or 100,000 B.T.U.) 4.00
above-reby enentioned property for inspection purposes.tri
orepresentatives of this city to enter upon the BOI LER-COMP (Over 10Q000 BTUI SEE FEE SCH. MECHANICAL
heh
6anti�'
agree to save, indemnify and keep harmless the City cL Misc.- REFER TO ORD.
no against liabilities,judgments, costs and expenses which PERMIT ISSUANCE ' 3.00 CONST.TAX
any way Seer gainst said City in consryu cc of the
of this permit MECH.CONT. LIC.NO. MECH. n',*
TOTAL
azure of Ap icen ,actor
OFFICE COPY - -