11888 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
:NoAEu APPLICATION & PERMIT
Q -W L/t, p LV BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 11888
OWNER'S PLAN CHECK VALIDATION
T ""MEQTY. ELECTRIC PERMIT FEE
oil li7d6;L 0;L C�, PRONE
CONTRACTOR'S
AME OUTLETS-SWITCHES-RECEP 10.00/1.00
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NA �/ l
T fTI C�G54SO.0'EC CC/LIc.ND.38fJ19 1LIGHTING FIXTURES 10.0011.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
978.51. dALOI, PRONE V.5 IrL 3 1PANELS 10,00 PATE OF APPLICATION
ORtwracT - PANELS (OVER 200 AMP) 20.00 PLAN CHELK FEE P.C.NO.
OR
ENGINEER
UC.NO. SIGNS TRANS, 3.00
ARCH.OR ENO. SPECIALCIRCUIT 55,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION - I
< U U 1 hereby affirm that I am licensed under provisions of Chapter 9 j ISSUANCE DATE
G:z w (commencing with Section 7000)of Division 3 of the Business and /r
wW Professions Code n ylieeuse is in full fu me ff BLDG. ELECT. PLG. MECH.
z o m� License Class �- Lie Number ❑ ❑ ❑
Q u r w Dale Contruclorfi
LL Q L a n}((t�
¢ n ¢ < OWNER-BUILDER DECL-A'AATfO M Of CLC.. BUILDING PERMIT
F o a U MISC.- REFER TO ORD INFORMATION
F
; w I hereby affirm[hat 1 am exempt from the Contractor's License
u 0 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Q VALUATION S/FT.
- � � Code:Any city or countywhich requires a permit to construct,alter,
SE Q¢ 0 Improve,demolish,or repair any structure,prior to Its issuance,also ELEGT CONTR. LIC.NO.
p p ELEC. }
D S, requires the applicant for such permit to file a signed statement that I V I N,l�rf 5 0 3 d TOTgL 3 PERMIT TO
E
$ he is licensed pursuant to the provisions'of the Contractor's License
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