NO PERMIT NUMBER APPLICANT TOFILL |mINFORMATION WITHIN RED LINES - USE BALL< ., I hereby affirm that I am licensed under provisions ofChapter 9 1 Ssz�c
I- Z (commencing with Section 7000)of Division 3 of the Bush MECH.
,
BUILDING PROJECT I DENT]FICATION
BUILDING APPLICATION & PERMIT
/)a BUILDING ELECTRICAL—PLUMBING—MECHA,
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.0011.00
LIC NO LIGHTING FIXTURES 10.00/1.00
ADDRESS APPLIANCES-RESIDENTIAL 4.0�
PHONE PANELS 10.00 DATE OF APPLIL..
ARCHITECT PLAN CHECK FEE
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
AFCHON END. 5.00 PERMIT VALIDATIO�_
ADDRESS SPECIALCIFICUIT
ZIP TEMP.METER OR POLE INE 20.00
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
-.00 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
° � Professions Code,..it my license is in full force and effect. 12�0
'0 0. License Class-Lie.Number
OWNER-BUILDER DECLARATION
a.I I hereby affirm that I am exempt from the Contractor's License JUL (RqF V_�6;MNFORMATIONW4
< Law for the following mason.(Sec.703 1.5,Busirestand Professions
Code:Any city or county which requires a permit to construct,alter. PERMIT ISSUANCE 19.80
improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.
a Ce require the applicant for such permit to file a signed statement that city FTUP
he is licensed Pursuant to the provisions of the Contractor's License
se
Law(Chapter 9(commencingwith Section 7000)offlivision 3 ofthe ��v�"14 -Y1,
Business and Professions Code)or that he is exempt therefrom and QTV: C-p" Y
M I— STORIES TYPE CONSTR.
. �? the basis for the alleged exemption.Any violation ofSection 7031.5 MWFUx's
a. by any applicant for a permit subjects the applicant toa civil penaltyof not mom than five hundred dollars(SSOO).): TLTER-DRAIN&VENT-WATER IEA.) 5.00
0 1,as owner of the property,or my employeel with wages as 13ACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITStheir sole compensation,will do the work,and the i ructure is not �
intended or offered for Sale(Sec. 70", Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Ode:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SG.FT.FLOORAREA TOTALACREAGE
himself or through his own employees,provided that such improve.
ments am not intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion the owner.
builder will have the burden of proving that he did rol'build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
0.4,as owner of the Property,am exclusively contracting with INDUSTRIALWASTE INTER. 30.00
licensed contractors to construct the project(Sec,7044,Business El 1:1 1:1 1:1
and Professions Code:The Contractor's License Law does not apply LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
to an owner of property who builds or improves(hereon,and who LAWN SPR INKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ttIl 0.00 TRACT NO. PARCEL NO.
am exempt under Sec..,B.&P.C.for this WATER'HEATER W/VENT 6.00
mason
Owner Date
r- WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
COPY thereof(Sec.3800,Llb,C.).
Policy No.-Courpary
0 0 Certified copy is hereby furnished.
Z Z 0 Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T 24
0 Applicant misc.- REFER TO ORD. Y [] No Y C] N
LO CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 U.C.
LU
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> COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PL'