18545APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION &PERMIT
-ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
` 18545
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ADOREss
'BUILDING
Or".E.'$
NAME Q
e oN /}/� p
Pt'7
QTY ELECTRIC PERMIT FEE
PLAN CHECK VALI^p ION
\r1 ` •P{,�r
`� 1` 0O
5O
7
G/
CO.,. RS
Vv-LIC..O
OUTLETS - SWITCHES -RECEP .10.00/1.00 I �(�
r
LIGHTING FIXTURES 10.00/1.00
ADDRESS TOR's
PPLIANCES- RESIDENTIAL 4.00
PHONE
PANELS 10.00
DATE OF APPLICATION
ARCHITECT
ENGINEER �
OR Y06
LIE. NO
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO. .
SIGNS TRANS. 3.00
ARCH Ess ENG.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 20.00
ZIP
_
c
Vl
noonDSsrs
MOTORS SEE FEE SCH.LokUp
SERVICE CHANGE 20.00
LICENSLD CONTRACTORS DI-.CLARATION
D
I hereby affirm t ria
that I am licensed under provisions apt.r
(commencing with Section 7000) of Division 3 of the Bus' •ss a
Professions Cole, and my license is in full force addeffec
License Class Lie Number
L. E D
.ISSUANCE DATE
BLDG.
ELECT.
PLG.
MECH.
,s
2 uy CU. _
Date Conrado,
OWNER UILDF,R D[CLARA'TION OAT
BUILDING PERMIT
I hereby affirm that I am exempt from the Contractor's License
- EFER TO ORD
INFORMATION
PERMIT ISSUANCE 10.00I
VALUATION
, 1
ILA r
SIFT.
Law ]or the following reason.(Sec. 7031.5. Businessand Professions
Code: Any city or county which requiresa permit toconstrucl, alter.
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractors License
ELEC. OONTR_ LIC. NO.
ELEC.
TOTAL
PERMIT TO
Law (Chaptcr9Uonmencing with Section 7000) of Division 3(if tire
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5by
thc0p.): anttoacivil penalty
for ive hundred dollars
ofno, more than
of not more than five hundred dollars (5500).):
`fd I, as owner of the property, or in, employees with wages as
t Bt, sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec, 7044. Business and Professions
Code The Contractor's Licmtse Law does not apply to an owner of
�� I
OTY. PLUMBING PERMIT FEE
ALTER -DRAIN (EA.)
'24010
STORIES
TYPE CONSTR. -
BACK FLOW PROTECT. DEVICE 4.00
DCC. GROUP
'
RES. UNITS
_
DRAINS -FLOOR, ROOF, AREA, CON D. 5.00
FIXTURES - PER TRAP 5.00 O
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
property who builds or improves thereon, and who does such work
himself' or through Ills own eanployers, provided that such improve-
mentsaremotintendedorofferedl'ar sale. If. however, the building
or improvement is sold within one year of Completion, tire owner-
builder will have the burden of proving that he did not build or am-
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
convectors to construct it,, project ISec. 7044, Business
and Professions Code; The Contractor's License Law docs not apply
5(]. Fr. FLOOR REA
GO
TOTALACREAGE
'
BUI 'DING USE
RES IND CON PB Omer
-E-1licensed
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
to an owner of property who builds or improves thcr"" and who
contracts for such projects with a contractons) licensed pursuant to
the Cmifmclor's Licen se Low.
rea❑ Imo exempt under
`��'C
%%''TT C /
SEWER -SAN ITAR V -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Dute -
WORK I:RS'C'OMPI'NSATION DECLARATION
1 hereby affirm that 1 have a certificale of consent to self -inure,
WATER SYSTEM 500 {7
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
or a certificate of Workers' Conlpensution Insurance, or a certified
copy thereof (See. 3800, Lab.CJ.
ZONING
ENG. SITE NO.
Policy No. Company
❑ Certified cup, is hereby furnished.
FIRE SPRINK
El
ENERGY T-24
Y � NEI
❑ Certified copy ix filed with the city inspection division.
Applicant
4ORD.
MISC. - RYElN
CI?Rl'11%GATE OI' EXIiMPIION PROM W'ORRERS'
C'OMPENSATION INSURANCE
section need hill be completed if the permit is for of
hundred dollars IS 100) or less.)
PERMIT ISSUANCE
FLOOD ZONE
Y ❑ No
A.L.U.C.
Y ❑ NE]
PLO. CONTR. LIC. NO.(This
OTY MECHANICAL PERMIT FEE
FEE SUMMARY
1 certify first in the performance of Ute work on which this per-
mil is issued, 1 shall not employ any
c P Y Y person in any manners. to
become subject to the Workers' Compensation Laws of Calif ornia.
is
Date Applicant
NOn
'CH TO APPLICANT: If, after making this Certificate of I?x-
�7
BUILDING ' 1�
1
-
ALTER OR A DD TO MECH. 5.00
emplion, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
ro
such pvisions., this permit shall be deemed revoked. -
APPLIANCE 5.00
PLAN C
FEE
AIR HANDLING UNIT (TO 10,000C.F.M.) 4,00
CONSTRUCT ION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued fSec.
3097, Civ.C.).
Lender's Name
AIR HANDLING UNIT (OV ER 10=C.EM.)6.00
SEISMIC FE A hr0�
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000B.T.U.). 8.00
Lender's Address
(certify thatlhuvo read this application and state that IT, above
information is correct. I agree to comply with all city and county
ordinances and Slate laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
agree to save, indcnl and keep harmless the City of
perp against liabilities, J lents, costs and expenses which
may n ny way Beer a ins lair City in consequence of the
gm inf this
'l 6 Z9 -%O
o pphc t Deactor Date
HEATI NG UN IT(OV ER 100,000 B.T.U.) 9.50
G
,ELECTRIC 0 a
VENTILATION FAN (SINGLE) 4,00 0
BOILER-COMPQH.P.or100,000B.T.U.) 6.00
PLUMBING ad
BOI LER-COMP (OVer 100,000 BTU) SEE FEE SCH.
MECHANICAL 3 D x fVll
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
E11. CONT. LIC. NO.
MECH.
TOTAL v/
D.. 6
TOTAL Til+
OFFICE COPY