3503 ''APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.' USE BALL POINT PEN ONLY .
BU I LDING PROJECTIDENTIFICA710N "
PER"IT'APPLICATION & PERMIT [.O�
'A T S BUILDING ELECTRICAL-PLUMBING MECHANICAL r J
PLAN CHECK VALID ATION
NAME - :03 ,QTY. ELECTRIC PERMIT FEE
Mr. �1ebel. PHDNE�
Come ACTDR'S �0 ,OUTLETS-SWITCHES-,RECEP 5.00/1.00 _
uc.N0 4 2�d5 TJ C LIGHTING FIXTURES 5.00/1:00
CONTRACTOR'S ;ST - APPLIANCES=RESIDENTIAL,•,. 4.00 `
ADORES (nj -
Ir PHONE S &"-(g-1 ^ I PANELS 5.00 "DATE OF APPLICATION
e PLAN CHECK FEE P.C.N0.
wacwTECT,, ISIGNS 6.00
OR
ENGINEER -
,.�nuc NO ,.SIGNS TRANS. - 3,00 �
.ARCH.ORCNc. +t SPECIALCIRCU5.00IT PERMIT VALIDATION. •:,
'ADDRESS .; '.
zip TEMP.METER OR POLE INS. 15.00.
• -APPLICANTS - _ MOTORS SEE FEE SCH.
ADDRESS ��•• '
SERVICE,CHANGE "' 10.00
- 0 0' .LICENSED CONTRACTORS DECLARATION /
Qt-'•U ie - 1 hereby'afllrni that I am liccrstd'und ,,ovl mnS afChapLLr 9 - ISSUANCE DATE ^
r ¢ (commencing with Section 7000) f DI i ion 3 of the business and - BLDG. ELECT. PLG. MECH.
o z- Pmtessions Code pntl'my license is in full force, py�,�fj�•gl.' / ❑ • ❑ -�71�
z o r" - License Clas �'Z L'c Yunrbe
D z H Dal, mom _ - - -
a Y p I .'•; .. BUILDING PERMIT r ,
F IL ¢,¢., . OWN F.R-BUILDER DECLARATION - INFORMATION
o ° .MISC:- REFER TO ORD ,
x 3 LL'�.% I hereby affirm rthatoar I am exempt from the Contractor's essose - VALUATION ' ,$/FT.
HLLoa Law for the following reason.(Sec.703L5 BusmescandProfessi l = , PERMIT ISSUANCE 6A0 ^
Code: e,de demolish,
Countywh icy requirese permit mco issuancealter, _
¢ ca K < 0 improve,demol sir or repair any structure prior to its issuance:also ELEC.CONTR. -.LIC.NO. TOTA
0,¢ requires the.applicant for such permit to file i signed statement that. TOTAL - PERMIT,TO
X m i- he Is licensed pursuant m the p o is'ons`of the Contractor's Lic n '-' .- - _ � p
H'i,i: Law(Chapter 9(commencingwOh Section 7000) fD'dsion 3ofthe 4r - .P�06
¢ business and Professions Code)or that he is exempt[herefrom.und OTV.• • PLUMBING PERMIT - 'FEE
the basis for the alleged exemption:Any violation of Section 7031.5 _ STORIES TYPE CONSTR.
by any applicant for-a Hermit subjects the applicant to u civil penalty' ALTER-DRAIN&-VENT-WATER IEA.) 4.00 r'
of not more than five hundred dollars(8500)). - '
❑ 1,as owner of the properly,oCmy 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
. ,intC.d',d or oRnred for sale (Sec -7044„Business and Prof e..ions. DRAINS-FLOOR,ROOF,AREA,COND. 4.00 '
- Code'.The Contractors,License Law does not apply to an owner of. - -
Property whoi build"on
Improves there.rL and who does such work ' FIXTURES'-PER TRAP 4.60 SO:FTr FLOOR AREA TOTAL ACREAGE.
himself or through his"-a
employees,provided that such improve ,
I impis are not imendedproffered for sale If,however,lire building ":F•",GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
,or improvement is sold within one year of completion,tare owner= GAS-;EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not huild'otim qEs IND CON PB Otber
prove for purpose-of sale). v INDUSTRIAL WASTE INTER. '20.00
❑ I,as owner of the properly,am.exclusivelY,contracting with ❑, ❑ ❑ ❑ ❑
licensed contractors to Construct the'prnject(See.7044,.Business LAWN SPRINKLERS- 1,INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code.-The Contractor's License Law does not apply - -to an owner of property'eho builds or improves thereon,and wird LAWN SPRINKLERS:,OVER 5(EA.) 1.00
contracts for such projects witha contractor(s)lice_ used pursuant In
the Contractor's License Law, .- SEWER-SANITARY-STORM EA.200ft/8.00 TRACTNO. '.PARCEL No.
❑, taro exempt under Sec` .b.&P.C'for this WATER-HEATER'W/VENT- .. 4.00
reason
Date Ovincr' r< WATER SYSTEM ,• 4; 4.00 ACC.OATE_ ACC,FILE NO,
WORKHRSI COMPENSATION DECLARATION ''' - WATER TREATING EQUIP. 4.00 "
1 berths,affirm that I heave a.certificate of consent to sell-insure C , ZONING ENG.SITE NO:
or a certificate of Workers'Compensation Insurance,or a upmtied
Copy hrKYS3.8fQQ[0
PolicYN
❑ C ifcpane�reuby Snsh^di
-
-
FIRE SPRINK ENERGYT-24
Z pp
'�1-C rtif d copy is Ele ' th the city inspection division. MISC. REFER TO ORD.
O APPhea t - Y ❑ N❑ Y ❑ N❑
PERMIT ISSUANCE 6.00 ,FLOOD ZONE A.L:U.C,
'CLRTI!'I- EXEMPTION FROM WORKERS' '
W COMPE COMPENSATION INSURANCE PLG.CONTR. LI .N0. PLG. O 00 . -❑
CL 0 (This dollars($
not:be comple[cd;if the permit is for nnc TOTAL
L) Z Hundred dollars(8100)or less.) ` ' , ' - s
• U O I certify thin in the-performance of circ work for which this per- OTY. 'MECHANICAL PERMIT. -FEE FEE SUMMARY
LL H• .mit is issued,I shall not employanyperson in any,manner so as to. _ -
U 'become subject to the Workers'Compensation Laws of California.
ED - Dute - '-A licant' BUILDING;`
a pp ALTER OR ADD TO MECH. 4.00 -
} N NOTICFITOI-APPLICANT'. If,after nmking•thisCertificate'bfYx-
Z emption,you should become subject to the Workers Conapensali n APPLIANCE - 4.00 P,LAN,CHECK
provisions of the Labor,Cbde you must forthwith comply with FEE -
U 'such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000QF.M.) 3.00
CONSTRUCTION LENDING'AGIINCY,. AIR HANDLING UNITIOVER 10,Oo0GflM.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction]coding agenLy t r -EXHAUST HOOD (WITH DUCT) 2.00 -
the Performance of the work for which this I rout is issued(SecMICROFILM .
3097,Civ,CJ. - HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name , HEATING.UNIT(OVER 100,000B.T.U.)7.50 `ELECTRIC
Lender's Address 1;
A
N (SINGLE) 3,00
I eertlly that)have read thus apph anon and ta4.tlmt the above VENTILATION FA (S G ) ^ 40,10
information is m etPolon to comply with all City and county BOILER-COMMI-I.P.01100,000B.T.U.) 4.00 PLUMBING �Ov,
I' n sand state laws relating t buildingconstruction, and
hereby authonu mpres ntah sof Hiscityto enter upon the BOILER-COMP (Over 100,000STU)SEE FEESCM. MECHANICAL ,0'�
ilovc mentioned Property for Inspection purposes ., _ C.�
(We)agree to s ve, indemnify and keeP.Jo 11 s tl .City of MISC.- - ' REFER TO ORD:
Coffer into against iabililius,j dement: cost, turd expenses which CONST.TAX' 1
may in any way Iaccrue;against said•City'In et ssey Cie ce;of•thc PERMIT ISSUANCE 3.00 3e
gm fig of this permit ' MECH,CONT - LIC.NO: MECH. , q
TOTAL
f•l� ��)-{�^J� TOTAL d
Sim a Applicant (infractorDate ������ �
.. e-
- • OFFICE COPY