1686 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES= USE BALL POINT PEN ONLY
vJ BU LDI NG PROJECT I DENTI FI ION PERMITNUMB�E
R„ILOING APPLICATION & FWIT
ADDREss /'
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
686
OWNER'S -/' - - PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
No EIRAcroUTLETS-SWITCHES-RECEP 5.00/1.00
L/UC(f- GZ uc.No. 3%/fid LIGHTING FIXTURES 5.00/1.00
CONTRACTOR. PPLIANCES-RESIDENTIAL 4.00
AO Ess 1Lj N �,!FHONE Y( /✓� PANELS 5.00 DATE OF APPLICATION
ORLHITECT SIGNS' 6.00 PLAN CHECK FEE P.0
ENGINEER u1?4
c.No. SIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
AooRESS SPECIALCIRCUIT 5.00
zIP EMP.METER OR POLE INS. 15.00
APPLIDROss
DDRa
AE6MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
00 o LICENSED CONTRACTORS DECLARAI[ON
SII a i n I hereby affirm that I am licensed under provisions ol'Chapter 9 - .IssUANCE DATE
< (commencing with Section 70007 of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F m i Professions CodE,a, d W license is in full for' nJ effe
o i w o License Clas _Lie IF 0 DD�'� '�
H w ti Doc Contractor
It ISa IS a OWNER-BUILDER DECLARATION BUILDING PERMIT
a v - INFORMATION
K
H I hereby affirm that I ant exempt from the Contmnors License M ISC.- REFER TO ORD
Fuoa law for the following reason.(Site 7031.5.Bminessand Professions PERMIT ISSUANCE 600 vALUAT10y� S/FT.
Code:Any city or county which re,,naefa permit tocorutrucLalter. j �/
re6;Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. fJV
u requires the applicant for such Pemtit to File.signed sat<nrenl tint TOTAL PERMIT TO
E
$ he is licensed pursuant to the provisions of the Contractor's License
r• z a Law(Chatters)(commencing with Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
I- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any upplimnt for a p<mut subjects the applicant In.civil Nrully }� -
ofnot mom than Lvehundred dollars; S500L) ALTER-DRAIN& VENT-WATER (EA.) 4.00
❑ 1.as owner of the property.or my employees with wages as BACKF LOW PROTECT. DEVICE 2,00 OCC.GROUP RES,UNITS
sole compensation,will do Ore work,and the st nature is not �_,
tended or offered for sale (Sec. 7044, Business and Professions DRAINS'-FLOOR,ROOF,AREA,COND. 4.00 •��
Code:The Contractor's License Law Jon not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 s0.FT FLUOR AREA TOTAL ACREAGE
. himself re of:nth his own employees,provided that such improve- 1 �'
merits are throuhh is oro hired lees,provided
however,tm building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00 . a'-
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 of proving that he did not build or im-
proveforPurposenfsalc.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB Div,
❑ I,as owner of the prol'city,ato exclusively cmVrucling with ❑ ❑ ❑ E - Q
licensed contractors R,-,.mtmct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Pit.m.ons Code:The 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 u ontractono licensed pursuant 1.
the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
-' ❑ tem exempt under Sec. .B.@I'.C.for this WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
W'ORKIiRS'COMPENSATION DECIARA'fION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have.ccNil e.N of consent to self-:.sure. ZONING ENG.SITE NO.
or a certificate of Workers'Comperodion Insurance,or a certified
to
thereof(Sec.3800.Lab.C.l. .�� VEA
Policy�I�'oO�E(�91 Company
/X Certified copy is hemhy furnished. FIRE RINK ENERGY T 24
Z,Z ❑ Cert:fico copy is Illcd with the city inspn9lun division. �,�--
O Applicant MISC.- REFER TO ORD. YE] NE] vN�
cc
y CERTIFICATE OP EXEMPTION FROM WORKIiRS• PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.c.
.' I.W.NO. PLG.
Z (This Section need not be completed if the permit is for one TOTAL
LU > . COMPENSATIONINSURAICH PLG.COINER N Y Cr N
hundred doll...IS 100)or I.,)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued, I shall not employ any perwo in an),manner w as to
O become subject to the W'orkcrt Compensation Laws of California.
O WDate Applicant ALTER OR ADD TO MECH. qOp BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
,
? cmption,you should become subjeeLto the Workers'Conipens n.n APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U wch provisions.,this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 3-00
CONSTRUCFION LENDING AG17NCY. , AIR HANDLING UNIT(OVER 10=1C.EM,) 5.00 SEISMIC FEE
I hereby that wore is r construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the ,Civ.mantt of the work for which this'permit is issued(Sec.' MICROFILM
I.,r Civ.am Awg I HEATING UNIT (TO 100,000 B.T.U.) 4.00
Leader's Name HEATING UNIT(OV ER I DO,000 B.T.U.)7.50
Lender's Address t ELECTRIC in
1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
. information is street. 1 s me to comply with all city and county BOILER H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and est.to laws eluting to building construction, and my
hereby nth representatives of thin city to enter upon the BOILER-COMP IO.er 100,000 BTU(SEE FEE SCH. MECHANICAL
abov men ne prop oy for inspect tun purposes.
(V�'')agree indemnify and keep harmless the City,o1 misc.- REFER TO ORD.
-
Cup (t' o ago A obit' hies,judgmorrts, costs
and expenses which CONST.TAX
may a ay accrue against Said City in con ucnfffe of the PERMIT ISSUANCE 3.00
tlm n8 01 this nni{�1�' MECH.CONT. LIC.N0. MECH.
TOTAL TOTAL
rRnaturc of Applicant/Contractor Date
%OFFICE COPY
I _