9346 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT 1 DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADO Es /�
L BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 9346
O NE PLAN CHECK VALIDATION
rM
QTY. ELECTRIC PERMIT FEE
ONE
c TOR'S UTLETS-SWITCHES-RECEP 10.00/1.00
N
LIc.No, LIGHTING FIXTURES 10.00/1.00
NT " OR's PPLIANCES-RESIDENTIAL 4.00
- E PANELS 10.00 GATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
EN
uc No. SIGNS TRANS. y 3.00
moo Ess ENc' SPECIAL CIRCUIT 5.00 f PERMIT VALIDATION
a eIr TEMP.METER OR POLE INS. 20.00 ^ ^
APPLICANT'E - MOTORS SEE FEE SCH.
ADDR E
SERVICE CHANGE 20.00 //fn��1 ,{[
woo ��)IfI? LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00 aa�
Qu e~i dere ay affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
int Q:y (c n mencing with Sec'un 7 0)of Division 3 of the Isine d BLDG. LECT. PLG. MECH.
H m z Professions Co mense is in full f +
z o m License Class Liv Number ❑ � ❑
9 w o Date Contractor
�r ;{ BUILDING PERMIT
ar M st N R-BUILDER DEC O
oae' MISC.- REFER TO ORD INFORMATION
w ; e-w I hereby.than that 1 am exempt from the Contractor's License VALUATION
LL 0 4 Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 $/FT.
tZ; Code:Anycity orcounty which requiresa permit to construct,alter,
ELEC.CONTR. LIC.NO.
ta ¢ 4 o improve,demolish,or repair any structure,prior to its issuance,also ELEC.
O a: requires cite applicant for such permit to file a signed statement that TOTAL PERMIT TO
E:
m he is licensed pursuant to the provisions of the Contractor's License
Hit Law(Chapter 9(commencing with Section 7000)of Division 3 of the '
- 4 Business and Professions Code)or that he if exempt therefrom and OTV. PLUMBING PERMIT FEE
r o the basis for the alleged exemption.Any violation of Section 7031.5 STMMIgS YPE CONSTR.
u 3 by any applicant for a permit subjects the applicant tua civil penalty
of not more than five hundred dollars(8500).): ALTER-DRAIN St VENT-WATER (EA.) 5.00
❑ I,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
property who bol Ids or improves thereon,and who does such work FIXTURES-PER TRAP 5.qw SO.FT,FLOORAREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintmWcdorofferedforsale.If,however,the building GAS-EA.SYSTEM-11 PIC.40UTLETS 0
or improvement is sold within one year of completion.the owner- GAS-EA.SYSTEM-O 4 (EA.) 2.00
builder will have the burden of proving that the did not build or im- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WAS ER. 30.00 RES IND cont Other
❑' 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
accused contractors to construct the prnjeel (SIC.7044,Business LAWN SPRIN ERSC 6 .6. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRIN E S-OVY5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANIT RV-ST MEA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-.B.&P.C.for this WATER HEATER W/ NT 6.00
reason
Owner ])life WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W'ORKF RS'COMPENSATION DECLARATION WATER TREA NG EQUIP, 5.00
1 hercby affum t t IT ve Hifi ' -ofc...Cut to self-insure, ZONING ENG.SITE NO.
Copy the
or a cent f en ti 1 s m , r " '•A
e
�j$� c.
Policy Nd.� ompany
O ❑ Certified ' hereby fount RE SPRINK ENERGYTI4
F 0 Cant
y is Ekd wit ^,i, division. MIS C REFER TO ORD. Y ❑ 'N❑ v❑ N❑
rnPE IT ISSUANCE 10.00 FLOOD ZONE A.L.UG.
� CC IC 1:of: :Nip ION 'ROM\1'(11 hi RS'
W 7 COA11'P $A'I' INSU RA NCB PLG.CONTR. LIC.NO. PLG. y❑ N❑ Y ❑ N❑
ZTh need ncompleted riot be if the permit is for one TOTAL
hundred fy that
($100)tiro ur Icsx.]
U O 1 certify that h the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 F Init is issued.I shall not rkers' 'any person in any manner so as to
U beaonm subject m the Workers'Compensation Laws o(Califomia. SD
d Dat° Apph°°nt BUILDING
L ALTER OR ADD TO MECH. 5
} y NOTICE 1'0 APPLICANT: If,after making Ihis Certificate of Ex.
2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most lo,thwitb Comply with FEE
CD such provisions or this permit shall be deemed revoked. AIR HANDLING UNI (T O=C . .) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING YNTUCpt,1 C.F.M.) 6.00 SEISMIC FEE
Thereby affirm that there is a cnnstr¢tion lending agency for EXHAUST H D T UCT) 5.00
the performance of tiro work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UN4T(Jel00,000 B.T.U.) 8.00
Lender's e
Lender's NAddre me
NamHEATI NG UN OV ER 100,000 B.T.U.)9.50 ELECTRIC 11,2
1 certify that I have read this application and stale that the above VENTIL ON AN (SINGLE) 4.00
information is correct, I agree to comply with all city and county PLUMBING
ordinances and stare laws mlating to building construction,.and BOIL -COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the B LER-COMP (Over 100.000 BTUI SEE FEE SCH. MECHANICAL
.hove-mentione roperty for inspection purposes.
(We) agr t indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cope It 0 ai abilities,jud s an I expert s which PERMIT ISSUANCE 10.00 CONST.TAX
may in accrue ab st sal n ronscapa a cd e
granting 1 pcnnit. MECH.CONT. LIC.NO. MECH.
7 TOTAL TOTALS
gn.tt o c t D e
INSPECTOR COPY ,
I