18760O
Z Z
HO
CC
LU _
CIL 0
Z) Z
00
LL l-
0 w
} a
h ?
A
�i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
Q
BUILDING
ADDRESS
�%Jy55 S//�f(Q4J,(�1Q
OWNER'S
NAME
CITY. ELECTRIC PERMIT
PLAN CHECK VALIDATION
1 hitIj
CONTRACTORS
NAME
OUTLETS - SWITCHES -RECEP 10.00/1.00
�J' QLuc. rvo,
b.EEb
LIGHTING FIXTURES 10.00/1.00ASCIISss
oR'ssu>ln ua
PPLIANCES-RESIDENTIAL 4.00
k/ PHONE (31�
OF APPLICATION
PANELS 1Q.QQDATE
ORCHITECT
ENGINEER
uc. No.
PANELS (OVER 200 AMP) 20.00PLAN
CHECK FEE P:C. NO.
SIG NS. 3.00
ARCH OR ADDRESS ENG.
SPE RCUIT 5,QQ
PER IT VALIDAT
ER OR O E•INS. 20.00
zap
APPLICANT '$
ADDRESS
T R SEE FEE SCH.
S (/
RVICE CHA G 20.00
LICENSED CONTRACTORS DECLARATION
If
E l/
r 1 ft�y�
1 hereby allium that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Cod • and ny license is in full force and ejjgpl� �,
License Class Lie. Namber_ Zr&,
Date 1��G_ Contractor C2 SRdL�
ISSUANCE DATE
BLDG. ELECT. PLG. ME
❑ ❑ ❑ O'
II,
BUILDING PERMIT
BUILDING INFORMATION
OWNER -BUILDER DBCLARATIOh'
I hereby affirm .that I am exempt from the Contractor's License
Law for the following reason (See 7031.5. Business und Professions
Code: An 't or count
y city y which structure,
improve, demolish, or repair any structure, prior i. its issuance, also
prior to construct, also
requires the applicant Ibr such permit to file a signed statement that
he is licensed m to the provisions of the Contractor's License
to t
+F+m OS Q
LW
I C. - REFER TO ORD
10.00
PERMIT LANCE -Ci
VALUATION $/FT.
/ O O
pE MIT T
9^
FLED COrvTR. LIC. NO.
ELEC.
TOTAL -d �
9puts (co
Law (Chapter 9 (commencing
ng with Section 7000) of Division 3 of the
&
Business and Professiore Cade) or that he is exempt therefrom and
OTV. PLUMBING PERMIT FEE
the basis for the alleged exemiplion. Any violation of Section 7031.5
(fire permit subjects S5 applicant toacivil penalty
by any more
of not more than live hundred dollars (my
STORIES
TYPE C
ALTER -DRAIN -WATER IEA.) 5.00
em):
❑ Las owner at the property, e my employees with re I, not
their sole compensation, will do the work, and Iho structure rs not
BACK FLOW PROTECT. DEVICE 4.00
OCC - GROUP
RES. UNITS
intended or offered for sale (Sec. 7044. Business and Professions
Code: The Contractors License Law does not apply to an owner of
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00
Property who builds or improves thereon, and who does such work
Ili ntsell or through his own mnpla,ses, provided far such imprrve-
ments are not intended or offered for sale. If, Imwever, the building
$D. FT. FLOOR AREA
TOTAL ACREAGE
Or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that h e did not build or im-
prove for purpose of sale.).
❑ I, as owner of Ilia property, um avchu'ively contracting with
licensed Contractors to construct the project (Sec. 7044, Business
and Professions Code:' I' he Contractor's License Law docs not apply
- . -.
GAS EASYSTEM OVER 4 IEA) 2.00
BUILDING USE
RES IND CON PB Other
Q ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
In an owner of property who builds or improves thereon, and who
Contracts for such projects with a conlmcOrls) licensed pursuunt to
the Contractor's Liceme Law.
❑ lam exempt tinder Seo. ,B.&P.C. for this
lial'ur
SEWER-SANITARY-STORMEA.200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORK ERS'COMPENSA'fION DECLARA'I' ION
I hereby affirm that 1 have a cratifinde ol'eooscnt to self -insure.
or a certificate of Workers' Compensation Insurance, or a certified
copy thereol'(Sce. 3800, UDC).
ZONING
ENG. SITE NO,
Poli No. Company
Certified copy is hereby furnished.
❑ certified 'upy III c�yy Ih he 'it y inspe' divY on.
Applicant- ///ice �nseal iP
MISC. - REFER TO ORD.
FIRE SPR INK
v N E
ENERGYT2G
v � N�
CIiRT'IIICCOMPIF SA iION ION pROS1 WORKERS'
COAIPIiNSA'TIOh' INSURANCE
('f his seclilin need not be completed i( the permit is for one
hundred dollars IS 100) or leu.)
PERMIT ISSUANCE 10.00
FLOOD ZOrvE
Y ❑ N0
A.Lu.C.
V ❑ NO
PLG. CONTR. LIC. N0.
PLG
TOTAL
CITY MECHANICAL PERMIT FEE
FEE SUMMARY
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in arty manner so as Io
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
BUILDING
O
ALTER OR ADD TO MECH. 5 QQ
emption. you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
APPLIANCE 5.00 _
AIR HANDLING UNIT (TO 10MC.F.M.) 4.00
PLAN CH CK
,FEE
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 )
SEISMIC
EE
k
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sc,.
3097. Civ.C.). -
Lenders Name
Lender Address
EXHAUST HOOD )WITH DUCT) 5.00 2
HEATING UNIT (TO 100,000 B.T,U.) 8.00 I��
/MI ILM
HEATI NG UNIT (OVER 100,000 B.T.U.)9.50 I
ELECT IC
QO
VENTILATION FAN (SINGLE) 4.00
BOILER- COMP(3 H.P. or 100,000 B.T.U.) 6.0 x'
I certify that I have read this application and state that the above
information is correct, I agree to comply with all city and county
ordinances and state laws relating m building construction, and
hereby uuthorite representatives of this city to enter upon tlm
above-mentioned property for inspection purposes:
, (We) -give to save, indemnify and keep harmless the C� of
.Perrino against liabilities, judgments, costs and expenses which
Bay in any woy accrue agenin# sal City in Consequence of the
PLU BING
-
BOILER -COMP (Ove. 100,000 BTU) SEE FEE SCH.
ME HANICAL
MISC.- REFER TO OR
PERMIT ISSUANCE lQ QQ
CO T. TAX
renlin Ii curd.
MECH. CONT. LIC. NO.
MECH.
Torg.
TOTAL
�1. 3
Signature of Applicant/Conhador Date
OFFICE COPY
u
J
O
Z Z
F O
X
w_
0-0
0 z
UO
U_ I-
0 0 w
} vai
� z
u
•
rt
I
.. .,I , .. .I,A HED LINE,, U::, !,',I I I I ,dLY
BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
APPLICATION & PERMIT _ O
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
CHECK VALIDATION
OTV. ELECTRIC PERMIT FEE
_CEP 10.0011.00
BUILDING - /
nI,I,H LS•; jt ^`/J J S/L{/fr"��O
OWNLIr'S77PLAN
MI
Tyres
ClINIIiACIII.1^,
II n
F.
LIGHTING FIXTURES 10.00/1.00�'
7�B/U'•((y�e ��f�
ruN nr nr, un':.
�nun,uss :�.i •tN
PPLIANCES- RESIDENTIAL 4.00
o�D
/yv.:���-t
/�i C7 I �l Lu l ✓ r.1oNr x-36 -q%zi
t0
PANELS _- .00
OATE OF APPLICATION
mrcNnLCI
oR
_
PANELS (OVER 200 AMP) 20.00
--
PLAN CHECK FEE P.0NO.
.
I NrIINI LR
SIGNS TRANS. 3.00
_--___---
SPECIAL CIRCUIT 6.00
_u; nu
n IH LNG.-_
nmmus
PER Il Vn LIUAI
iu•
TEMP, METER 013 POLE INS. 20.110
MUTORS SIDE FEE SC H.
nuuuuS
/
/O`-tl fj �.�, r ✓t_5�,��(�fL[
_
SERVICE CHANGE 20.00
I.R FNSLI)(ON'TRAf J IR% UE(' LARA'I'R N'
I larch}' ,pion Ihm I :1 n, liccnv'J uB,l., P..n.. "ll -I Cl.q,Hr I,
lie lmRv,BhSO;Iwu,,Meeh uIIg,nlun 1 Ill III, 11'.,ii na,,:u..
P„lon,I od ...... I I, It.., .. u, lull LI ll b lI.'JJp I
I-ia-I nd r • fl:o, �,_ U __ �N11111h. (/-Z, jJ`�i7ii n
04-7.'1
ISSLNNCE DATE \
--
X 11
III-Lti. ELECL PLG. MECH.
-
❑ ❑ ❑ ❑
OBN'1 R-IU111.111 Bill' ARA'I N N'
I II'll by mlinn Ibm I .. , cS,u. innll Iht 1'nlu u; mr', Li:.u,.
_ �+- .I�l
MISC. - R-
REFER TO ORU
BUILDING PERMIT
INFORMATION
Law I'll Ila I'ollox'illg Ica 1�n, Itic'I 71111, i_ Il lnln.,, "Il Rulr„ABI,
Cud,: An' c Boyd ;uunty whlth ... -
Pur. va pcunu In a„n,InI; L.,In.
iln,,,,\a',,t'„a,1i,1.rnl'll,.,il:llll',Illlill,la. Drnn lel it, ,,,111, I,ia. aRB
B, :1 PP...B (ul,uG, PcIUI'il lu 111,',1 ,11;uaJ ,1u,cNiulllLl
♦lion calla, 11 e,Ila'Pr,\,Iu„uI Ili. 1'unuai lerl Li;nnc
I II(-h'aPlc {{I'uu unP wOhlSailinn 7110II„lll,v,iuulul lLc
u , n.,, and M,Rb,..... rud,v ,,, till ll. i..,'IIIPI 1 heelrn1I111... I
Ill,'I",'Inn„\uy vulnlhw ul la';liun'1111 L5
�by lyppec:lrn lu„r,Bn,ubioa, Hia:n'Pl:allnu., d,i1l,.uaily
ol, nave lh:m Lon"mJ Jolla 1, UiUULI:
Vn LUAiIUN
PERMIT ISSUANCE 10.00 0 O
LL((:. 1:1)N 111. LIC. NO, LLLC
TOTAL U _44_ 1'EHMITi
`uC
u
DTV. PLUMBING PERMIT FEE �� ell e
I SI OII,ES TY ECL 1,
ALTER-DRAIN&VENT-WAT .0
wl, u, uwu. i the Pn1p.1ly, ur Illy vmpluyec, will ogee a,
11 de tun . Ilion, x111 Ju Ili, xvnk. anJ Ili. ,Nut tum n nm
udal .d h„ ,,,I, IS'- 11144. Ru,in,,, :BBL[ Prw,,,h1I„
nla: 'I'b vaaur'. Lr. a„c Law Jur, nm :, 11p1y Ina Bi
nqm y build+m inlpunc, lhcra'on. anal whu JUh,TO, work
lhinuc nwlgh hi, own cm Ploy..., pluvul.J IIIA u
nini,.L iIIIPmm
nmol 1 ...., or lHis,d,... a1c, H. huxever. the bod,llnp
wanin nna ycul 4 ;nllll,I'll 11,E Ihr n.....
�mli 'r a have Ill, hwdao ul Pro,,Ins UI:,1 ha did till hold en I'll -GAS
pm Ir u w I, cl.
❑ I, I a l Ic I1rDp,Dl. a,B c,dmivay' C,uvnl.I int{ wish
t, o ,uII,Du,I 11„ rI"i.a Is.e. 'load, u1,,,,,.",
a J Pru u.n l'u e:' I' Ill 01DN:,l'I.11 I Liwuw'.Law d ." nal .qq,I,
1, m, a `r B ,perty whu build, ur i,Bpn.... R,...,,n. 1md wen
'I EG,11 'I"Pmlvi 1, wi11.1 ;uldntlullH hacBwJ Vw,u.lnl to
Iha('uB or', Lic.•na Law.
n
❑ I .Iu1111Ind,r See_, lar lei,
rra, n
BACK FLOW PROT.EC+T�UEVI .00
.__
DRAINS -FLOOR. R EA, COND. 5.00
FIXTURES - PER TRAP 5,00
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
- EA. SYSTEM -OVER 4 IEA.) 2.00
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
--
SEWER -SANITARY -STORM EA. 20Ott/10.00
WATER HEATER W/VENT 6.00
WATER SYSTEM 5.00
WATER TREATING EQUIP.- 5.00
i OCC. GROUP RES. UNITS
s2 Fr. PLooR AREA rornL ACREAGE
BUILDING USE
RES IND CON Pe o
❑ ❑ ❑ ❑ ❑
. . ASSESSORS PARCEL NO.
TRACT NO. PARCEL NO.
I
ACC. DATE ACC. FILE NO.
ZONING ENG. SITE NO,
I 1 uula'
wo KERS'( OMPENSA I [ON uccl.n Rn'ru1N
I herehy al lien Ila, I have a cert ii icam ul ,inane to vdl-i n,ur..
ora rrtilu.w l't wn, k,,,'OlnpcB...l iuB ln,r
v,nutc. ur .l 'w"d
tuPa
yl hcrcul (Ser. JHWI, lab.('.E
I'uliyy No. C,unp:u,y
N ('a rltwd mlry 1, Ila,abY Iumililld
IJ Ccrlilicd Py Ii1c�p�Illphe lily in,pcµ ,, "I'll
Apphca,n_$._LL//p1Ciiy nt LYC
CERTIFICATE OF E,CGe1PFION FROM WORKERS'
('OhiTENSA' IIUN INSURANC!
(TIE, linut be culnplc LLd it Ihr
hundJ dlar,n l S I slo UUJ ur Ics.1 pennil i, IUr Une
re ol
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
PLG.COLIC. NQ PLG.
TOTAL
FIRE SPRINK ENERGY T.l4
Y ❑ N ❑ Y ❑ N❑
FLOOD TON[ A.LOC,
Y ❑ NY ❑ NE]
❑
CITY • MECHANICAL PERMIT
FEE
FEE SUMMARY
I cenily that in the parlimnann' ill the work tor whiuh this I)er.
mil i, meed, I ,hull Bnl awpiny :my Pcnul, a any moor,,, a, IB
hcculna .hjra In lha wl),N",('om@'Bealion Law, uicalilcarnia.
NO ft_
ICA......l
NUIICIi "I l) AI'I'IJI'AN'1It. ,leer making Ili, ('are ifcam cal T:x-
BUILDING
�• �O
ALTER OR ADD TO MECH. 5.00
...PUun, you \lmuld b.n,Iue ILIhj,.l IB the wurkan' C„IBp.m:'t1O1
provisions cal the labor Cuda, you InGD
u%I illwilh comply will
NTO vPl,,,ion, car uli, prn,dI ,hall he &,,Bled mvoka'd,
APPLIANCE 5.00
PLAN CH CK
`'FEE
/ . I
AIR HANDLING UNIT (TO 1MC.F.M.) 4,00
i
CONSTRUCT ION LENDING AGENCY
Ilcruby al lion Incl Iberc is a cunwuaion icurla" ag"', Ort
the "'Ou..nancc of the work lin which Ili, pennil i, i„m'd i s",
1097,cIr'C'1'
L.,Ider', Nems•
AIR HANDLING UNIT (OVER 10,000C.EM.) 6.00
SEISMIC
EE
T
EXHAUST HOOD (WITH DUCT) 5.00
: MIC I I_M
H EATING UNIT ITO 100,000 B.T.U.) 8.00
HEATING UNIT ( OVER 100,000 B. T. U.)9.50
ELECT IC
QO
Addre„
I crnily till,[ l till, "Id this applical ion mol ,lam Ilial thv ,boll
nl'm
onliun i, correct, I agrer to comply wiol all oily and am
t ly
)rdlUancn IDd ,tale law, miming u, building CUm,G,tjLB• and
un'by mull.., rirc re,,,G- lalives of Ihi, city 1u entor upuB Ihr
Ibuvrmeniio.,d propeOy lar iB,petlimt pugmsl',,
(we) agrtc lu save, indemnity and keep Imrn,le" the (� of
'u Pcrlino agxinsl Iiahilil ice, judgmm�le, u„I, and "pulse, which
Bar in : y w:ry accrue againM ,aiJ City in cun,an ucn,,. cal m1.
r nNn�•,a.y B'
VENTILATION FAN (SINGLE) 400
,
BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00
PLO GING
BOI LER-COMP lover 100,000 BTU) SEE FEE SCH.
ME
HANICAL
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
I
I
CO T. TAX
MECH. CONI. LIC NO.
gam, :I tN�!`,II`Z�IiTI{Ppht. Ill iJ,nl - t U.T
MOTAL
l
TOTAL
L ,3 SN
OFFICE COPY