18520 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LOI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
eulLowc , - Jr - N� AL ' - - 'j : APPLICATION-& PERMIT „ �• ^,O
ADDRESS - - (+
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NAMEOWNEflt BONNII� M��I✓N� �277 - PLAN'CHECK VALIDATION
TY. ELECTRIC PERMIT FEE j
PHONE
CONTRACTOfl'S
/ NAME - _ UTLETS-SWITCHES-RECEP 10.00/1.00
bc,N.C316 11313; LIGHTING FIXTURES , 10.00/1.00 '
ADDRESS TORS " APPLIANCES-RESIDENTIAL 4.00 "
NE PANELS 10.00 'DATE OF APPLICATION '
OR ITET
PANELS 200 AMP) 20.00 PLAN CHECK FE/E� -P.C..No.'
Sec.No. ISIGNS TRANS. : 3.00 <
ADDRESS OR ENO - SPECIALCIRCUIT 5.00 1 - -PERMITVALIDAT,IOON
-
ZIP TEMP.METER OR POLE INS. 20.00 �'�
APPLICANTS
ADDRESS - MOTORS SEE FEE SCH'.'
SERVICE CHANGE 20.00 v �„
o a i ^, 1
Foo , LICENSED CONTRACTORS DECLARATION _ CST
'Q u Fj I hereby affirm that I am licensed under provisions of Chapter 9 ' "
F Z w ISSOAN CE DATE.
(commencing with Section 7000)of Division 3 of the Business and r BLDG.•; ELECT. PLG.. MECH.�z Professions Code,and my license is in full force and effect ❑, ❑• ❑ ❑
0 H License Class Lic.Number
o W
Data Contractor
St st p 0 a O OWNER-BUILDER DECLARATION BUILDING PERMIT
w ; u H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
H,a_ 0< Law for the following mason.(See.703 1.5,Business and Professions PERMIT ISSUANCE y 10.00 VALUATION /FT.
Code:Any city or county which requires a permit to construct,alter,
0 improve,demolish,or repair any structure,prior to its issuance,alto ELEC.CONTE. LIC.NO. ELEC. '
i x m LL requires the applicant for such permit To file a signed actor's i that TOTq L' _-^„1 TO
w he is licensed pursuant To the provisions of the Contractor's License 's/J's"'I(/J_
2 Z 't
Law(ChapterProfessions
Codeng With tendon is 00)exempt
erefrom the
W4 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r$ by basis for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
ate _ by Got ny
that fora permit subjectsthe($500tlicannou civilpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
- their sole compensation,will do the work,and the structure is not -
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. -5.00
Code:The Contractor's License Law does not apply to an owner of
propertywho builds or improves Ihereon,and who docs Such work FIXTURES-PER TRAP. 5.00 50.-FT.FLOOR AREA TOTALACREAGE
menta are through his own employees,provided that such improve-
mmselflenotintended of employees,provided
e. ed that such
building GAS-EA.SVSTEM-11 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or am- GAS-EA.SV STEM'-OVER 4(EA.)-. 2.00 BUILDING USE
prove,for purpose of Sale.). •• ' RES IND CON PS Other
❑ I,as owner of the property,am exclusively,contracting with INDUSTRIAL WASTE INTER. _ 30.00 El ., El 0 El
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1. INC 5 V.B. 6.00 - ASSESSORS PARCEL NO..
and Professions 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 a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SAN IT,ARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.-
❑ Pam exempt under Sec. ,B.&1'.C.for this WATER HEATER W/VENT X6.00 '-
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE - ACC.FILE NO.
-WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 t
hereby affirm that 1 have a certificate of consent to self-insure,
or a certificate of Workers Compensation Insurance,or a certified s eK e W ZONING' ENG.SITE NO.
- copy thereof(Sec.3800,Lab.C.).
Policy No. � Company
O ❑ Certified copy is hereby furnished.
Z Z ❑ Certified copy is Ned with the city•inspeclion division. FIRE SPRINK ENERGY T 24
� O Applicant - ' MISC. REFER TO ORD. Y,,❑• ND Y ❑ N[]
T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE IZ.0 .1 -M 2 aj FLOOOZONE, 'A.L.UC.
LU > COMPENSATION INSURANCE PLG.CONTE; LIC.NO. PLG.
CL
Z (This Section need not be completed_ if the permit is for one TOTAL OD Y❑ NEI Y 13 IN
hundred dollars($]00)or less.)
U O I certify that in the performance of the Work for which.this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O W become subject to the,Workers'Compensation Laws of California.
Date Applicant - FFEE
S---�
a ALTER OR ADD TO MECH. 5.00 _
} m NOTICE TO APPLICANT:es after making this Certificate of Ex-
� Z eruption,you should become subject to the Wprkeii Compensotibn APPLIANCE 5.00 K
provisions of The Labor Code, you,must,forthwith comply with. - -such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C-FM.) 6.00 -
I hereby affirm that there is a construction lending agency I'orEXHAUST HOOD(WITH'DUCT) 5.00the performance of Ne work for which this permit is issued(Sec.3097,Civ.C.): HEATING UNITATO 100,000 B.T.U.) 8.00
Lender's NamAddr H EATING UN IT(OV ER 100,000 B.T.U.)9.50 LendaCstNddress - VV
'l certify that l have read this application and state that the above VENTILATION FAN-(SINGLE) '•.4.00
information n correct I agree ti comply with all city and county PLUMBINGI
ordinances and state laws relating to ly with construction,c county
BOILER-COME(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby nuthorize representatives of this city to enter upon The BOILER-COMP(O100000 BTU)SEE FEE$CH - MECHANICAL
above-mentioned'property for inspection purposes.' ver , .
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
.. . _, upertirib against liabilities,judgments, costs and expenses which CONST.TAX'
may in any way accrue against said City in co sequence of the PERMIT ISSUANCE 10.00
ranting of this permit MECH.CONT. - LIC.NO. MECH. I
'r-.27-n TOTAL TOTAL 06
. Signature of Ap nt/Contractor Date e. -
OFFICE'COPY.,',