5638 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
IEUILDING APPLICATION & PERMIT
Q, BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
5638
Ow L I �', .f J I, I I 1' F , 1^ PLAN CHECK VALIDATION
NPM! 1 ! 1', 1 !1' I I r l� �,4
D PHUNEF QTY, e'(y(��J,r+��{ELEC7RICZPERMITI'Ivt��1i31I�iSy lyzi
+iFEEi�
NAME UTLETS-SWITCHES-RECEP 500/100
1j ���GiHT C.No. LIGHTI NG FIXTURES 5.00/1.00
roNTBACronS
AOONESS G, PPLIANCES-RESIDENTIAL 4.00
Q�/y�d/ ,/Jf✓
PHONE - PANELS 5.00 DATE OF APPLICATION
tlCNITEC `-V fff/// PLAN CHECK FEE
uR SIGNS 6.00
ENGINEER
uc.NO SIGNS TRANS. 3.00
Alltl.Oe[NG. PERMIT VALIDATION
ADDIIESS' SPECIAL CIRCUIT 5.00
a,P EMP.METER OR POLE INS. 15.00
AUDI CANT MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
Foo LICENSED CONRACTORS UECLARA'I'ION r C( 0
ru u~Oi I hereby ullinn that 1 am licensed under Praviaions of Chapter,9
2
m¢ 4 (Cmm�mncn,K wish nun Scl7000)of Uivi,ion 3 of Ile Ilminca ISSUANCE DATE and tlLDG. ELECT. PLG. MECH.
F N 2
z¢ V1.11
_»ium Ccuh.w.
_Illy seit,
Iu11
0m Li,,rla ,
0 Contractor-
)FR
onlracfor-
3 ❑ B IL❑DING;P❑ERMI7'❑,
¢ ¢ a OWNI. 1111LER UF.CLA RA'I'IUN I mil1l,
d O s U MISC.- REFER TO ORD1,t;{:+t;INF,ORMgTION'+k,M! IS:11^!;
w r I hereby,,tiro, Ihw I ani cxcntp[ lint the Cuntrael Orz Licuuo VALUATION SIFT.
F . o J Luw I'ur the fulluwln,nasal...(Sec.7031.5,Bu,ines,and Vrolessiona PERMIT ISSUANCE 6.00
n Cadeun
'.Any city or county which requires Permit to construe,alter, G
rt ¢ ¢ a mpruvc.Jernulish,o,repair any snucluuc,Prior to its issuance,also ELEC.CONTII. LIG NO. ELEC. G�
G C raplin,,the applicant lin,rich permit lO Ille a signal,ba,nicut that TOTAL A 1MPERMIT TO
w m he is Iiccn ed"'silent I.It,p,.vmiuns al the Ceum;mur,License _
Law'Cleapmr 9 lemnnlenein,will,Section 7000lo1 l lii,minn Sol the - �
o o Bloit,s,aria Pnificssien,Tote,m mat he I,cxnnpl[herenom and QTY. L. PLUMBING PERMIT n •.1(L. �FE
(C F the half,for the alleged caun V'im,.Any viulalion of Semen 7031.5 , }a"" f TYPE CONSTR.
o3m by any applicant lit apenni[aubjee[,tire xppllc'ennuu eivll penalty ALTER-DRAIN -WATER (EA.) 4.00
of nal Inure Than live hune«d dullun 115001.1:
❑, I.a o'u"..1 me pon"rY ur.my ealpWyec,.with wagnas BACK FLOW PROTECT. DEVICE 2.00 t1CC RES.UNITS
their sole compensation,will Ju[he work,and the structure is nn[
in
C'lmnd,d or ollered til tilsale (Sec. 7044, BUI.D111 and PIUI11i.N1 DRAINS-FLOOR,ROOF,AREA,COND. 4.00
LII:The Con Huc[or's Licunec Law Jon not apply to an uwncr of
pr)pnty who builds o, lo,p«wes thercun,aril wit dues such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
Ilitscll or through Its own employees,Provided that Such In4Nuvo
nwnt,are nal loh'nJW ur nllb«'J fur vie.if.Itwce,.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
lnpruw,vrhneu ls-odd wiNln one
year of Congte0an,the o GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
bradZ ill have the bolero al pruv'ng Iha[he didu I build or inr HES IND CON PB Omer
pr1 liupursucl of sola'.1. INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
I] d as uwncr al I,,Njon.,t n: crojecty S, .tdruolilg wiW
a'Clua'J cm•[nrmn m cun,[ma me pricer (Sec..1044,.,apes LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and it 11.111,.1('ndc:1, l unb build,
a Lia'n,.'Law Jun nm apply
[u tr owner of ll pros y who builds t r im"s)fi mason,and who LAWN SPRINKLERS OVER 5 IEA.) 1.00
am Cont lar Such,cow s with a cunlracwRsl licenwal Punuam to
[he Contractor',Linrose Luw. SEWER-SANITARY-STORM EA.2001t/6.00 TNACT NO, PARCEL NO.
u Imo au'mpl under Seo ,B.&It('.69 this WATER HEATER W/VENT 4.00
rcusull
uw,a,, D:1« WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ISRS'COMI'IiNSAT10N DECLARATION WATER TREATING EQUIP, 4.00
1 1....by allilt Ilia[ I have a vicHil ical,of comm,to WiFinsure, ZONING ENG.SITE NO.
rt IbIlle of Wurkeri('ompenaatimi Inutanec.o . mili.•J
,.ryalhercnl l Scc.3800.1 h.C.l. }C � C
Policy No._ Co'nPm'y
Q ❑ Jcr[ilicd CUVy i, lueby lu uhaJ' FIRE SPRINK ENERGY T 24
Q I ('emit rid copy led with the y=m union Aivisiom MISC.- REFER TO ORD, y 0 N Y 0 N
PERMIT ISSUANCE 6.00
T CERTIF9('Al li IF FAIT •'ZION 'RUM W'ORKI IS' FLOOD ZONE A.L.U.C.
LL COWIPENSA'I' IN INSURANCE PLG.CON FR. LIC.NO. PLG.
CL 0 1Thi, ,vniein need not be 'ompleled if [he perhnil 1' nnc TOTAL V❑ N❑ Y❑ N❑
2
trend...I dollar,IS 100)o11u, , -
U O I eddy Ihsl h the pato,oanan nl [hew rk I I 1 'his 1 r' QTY. - i MECHANICAL PERMIT tp A 'FEE ' FEE SUMMARY •a!t!I
0 U nal is .nicl ,hall out n,o,' any Pawl Y t r to
_ a tl ., `
O w hcun,se suhiec[to Ib.1Vmkui C'ohnpemal inn Lawz of(alilinnu - -
a. Ute- Apl'1'e'anl ALTER OR ADD TO MECH. • 4.00 BUILDING /•' S�
} w NO I'ICIi 10 AI.1•LICAN'I': II,alter nuking this Ccrlilicalc ul Lx-
F Z c litiun,you should became subject to the Workeri Congmnsatlo l APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Cute, you Inust forthwith comply with FEE
U x¢II provisions or this pennil shall be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSI'RUCUON LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.F.M.) 5.00 SEISMIC FEE
I hereby a li«n till there is a con vrictlon lending agency Ian EXHAUST HOOD (WITH DUCT) 2.00
the Perlirmanee GI the work for which This Verinit is issued(Sec. MICROFILM
31597,(Iv.CT. HEATING UNIT(TO 100,000 B.T.U.) 4.00
1-tilde;,Name HEATING UNIT 100,000 B.T.U.)7.50
LCnde ',Add«'» ELECTRIC
1 cenily that I have real[his application and,buc mat the above VENTILATION FAN (SINGLE) 3.00
�- infuriation is Correct.I agree,to comply with all city and County PLUMBING
ominaoees and state laws relating to building cm11[rnction, unit BOILER-COMP Q H.P.or 100,000 B.T.U.) 4.00
hereby atillurroc eprneribowt, of this city m enter upon tie BOILER-COMP Waif 100,000 BTU)SEE FEE SCH. MECHANICAL
,burs-Nientiourd prupcny lin inspection purposes.
(we) agree to sive, inden lily and keep harmless me City of MISC.- REFER TO ORD.
C'upeninu against Iiahililic,,judgments, costs and expanse,which PERMIT ISSUANCE 3.00 CONST.TAX
may in an way accnlc againsl said G Yin c.nseyucncc .1 [lie
goading f its PenuiLECH.e ECH,CONT. LIC.NO. MTOTAL
1tG _ �� _ TOTAL`
tSi �pf it/CI Onaor Uu
OFFICE COVY