4494 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL- POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 4494
AOOR 710776 W. Estates Drive BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
XOWNERS PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
Rita Mobilia ,„DNE 742-7471
" Nome ACTORS UTLETS-SWITCHES-RECEP 5.00/1.00
�L Peterson IS Jenkins LID.ND.330486 LIGHTING FIXTURES 5.00/1.00
ADDRESS rolls APPLIANCES-RESIDENTIAL 4.00
�C 861 Warrington Ave. PHONE 365-0803 PANELS 5.00 DATE OF APPLICATION
ARCHITECT �1•�� _j /rt tY, CA 94063 SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR Ip'f Y_a.1
NGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00 _
ADOCA
RE SSTs MOTORS SEE FEE SCH. S/
SERVICE CHANGE 10.00 `'
F o o LICENSED CONTRACTORS DECLARATION
a o U
z 1 hereby affirm that I am licensed under provisions of Chapter 9
H w ISSUANCE DATE
(commencing with Section 700e)i of Division 3'o�yf1the feBpu��sCiness and
H w 2 Professions Code,e1gy license is in full force JVf40Y BLDG. ELECT. PLG. MECH.
4 o WA
Dlatense Class Cie Numbe V4C ❑ ❑ ❑
9� te� g C • ( L Z7�3 VA
¢ ¢ w 4 OWNER-BUILDER DECLARATION BUILDING PERMIT
o A D INFORMATION
X ; y I hereby Anti,, that I um exempt from the Contractor's License MISC.= REFER TO ORD
0 VALUATION
.. o rt Law for tic following reason.(Sec.7031.5,Businessand Professions' S/FT.
I- - PERMIT ISSUANCE 6.00 d� n
Code'.Any city or county which reymrcsa permit to construct,, ter,also ELEC. 4t 3>>OO.OO
¢ ¢ ¢0 improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0.
O ¢ c,.iTcs the applicant for such permit In file A signed statement(hat
A'w m w he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT TO
Hi>
Law(Chapter 9(commencing with Section 7000)of Division 3 Dille
f i o Business and Professions Code)or that Ile is exempt therefrom and OTY. PLUMBING PERMIT FEE R Re-Roof
¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE Dry$TR,
a ; m byany more
fora permit dollar, $500T)icum macivil lenalry -ALTER-DRAIN &VENT-WATER (EA.) 4.00
af not marc than five hundred property,
o (my cru1: is/JN
❑ I,as owner of lite property,or my emNoyces with wages as BACK FLOW PROTECTDEVICE 200
their sole compensation,will do the work,and the structure is nut . .
OCC.GHOUP AES.UNITS
tended or offered for sal,(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,CON D. 4.00
Code: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 4.00• so.PT FLooR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve-
mentsarenutintended or offered fur sale.If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is Sold within one year of completion,lite owner-
builder will have the burden of proving irat he did not build mins- GAS-EA.SYSTEM-OVER 4 (EA,), 1.00 BUILDING USE
prove for purpose o f wle.). RES IND CON PB Ott or
❑ I,as owner ut the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ryy ❑ ❑ ❑ O
licensed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'rhe Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
❑ l am exempt under See ,B.&P.C.for this WATER HEATER W/VENT
reason 4.00
Dale Owner _ WATER SYSTEM 4.00
ACC.DATE ACC.FILE NO,
WORK 1iRS'confPENsnTION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that 1 have a cenifsme of consent to self-insure.
or a certificate of Workers'Compensation Insurance.of a certified ZONING ENG.SITE N0.
copy pity STE�89coHt-�P)17 S_to Comp.
tlif dvo Is hcrcby furnish,) IRE SPRINK ENERGY T24
Z Z ❑ ertilied tt y R-tiled wit t y Ins ion livision.
� O APplic' MISC.- REFER TO ORD. y NC Yo No
� N CERT119CA'lli Ol'EXEAf Pr oN l'ROM WORKERS' PERMIT ISSUANCE- 6.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
2 (This section need of be completed if the permit is for one TOTAL y[] N( V ry�
O hundred dollars IS 100)orless.)
I certify math the performance of the work for which(his pet- QTY. MECHANICAL PERMIT FEE SUMMARY
LL U mit is issued,1 shall nobemlloy any person in any manner so As to FEE
Ow become subject to the W'orken'Compensation Laws of California.
a Date Applicant - ALTER OR ADD TO MECH. q 00 BUILDING '44 SO
} In NOTICE TO APPLICANT: If,after making this Certificate if nix.
F Z call[ion,you slmuld become subject to the Woekers'Com,,,r u(ion _ APPLIANCE 4.00 PLAN CHECK
U suchiprov provisions tile
or this labor
permit shade ll be deeOU med coked with comply with AIR HANDLING UNIT(TO 10 FEE
=C.F.M1 3.00
CONSTRUCTION LENDING AGENCY . AIR HANDLING UNIT(OVERJOMC.EM.) 5.00 SEISMIC FEE .s0
I hereby affnn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
tie performance of the work for which this permit is issued(Sec.
3097.Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
Lender's Name
Lender's Address - HEATING UN IT(OVER 100,000 B.T.U.)J.50 ELECTRIC
Iceral'ythat II.,,read-this application and,state that the anove VENTILATION FAN (SINGLE) 3.00
information is cHrr,d. I agree to comply with all city and county
oanPLUMBING
rdinces and state laws relating to building construction, and BOILER-COMP H.P.or 100,000 B.T.U.) 4.00
hereby anth.,irere presenmtives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
agree to save, indemnify keep harmless the City of MISC.- REFER TO ORD.
Cupetlin against liuhilities,jut hent Costs and expenses which CONST.TAX
may in 'ry way accru,&an conseNuence of(hc PERMIT ISSUANCE 3.00gmn[ing thislentilMECH.CONT. LIC.NO, MECHm OTALTOTALf_ Signature Applicant/C Date w S.O
OFFICE COPY