6360 APPLICANT TO FILL IN IN FOR TION WITHIN RED LINES - USE BA&POINT PEN ONLY
BUILDING PROJECT I DENTIFICATIW PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 6360
-.0 wrvER'S PLAN CHECK VALIDATION
rvAM QTY. ELECTRIC PERMIT FEE
DNE 2 r
NAME
CONTRACTORS ` UTLETS-SWITCHES-RECEP 5.00/1.00
Tic,NO LIGHTING FIXTURES 5.00/1.00
CONTRACTORS'
ADDRESSDRESSAPPLIANCES-RESIDENTIAL 4.00
age PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR '
ENGINEER
uc.No. SIGNS TRANS. 3.00
AARCH 04
DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00 ^ '�
APPLICANT rvS MOTORS SEE FEE SCH. (\!7/Y)/(
ADDRESS
SERVICE CHANGE 10.00 i/3/df4'
,00 LICENSED CONTRACTORS DECLARATION
a U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
v~i z m (Commencing with Section 7000)of Division 3 of the Business unit BLDG. ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
L z o w - License Class Lie,Number
04 - D Dmu Contractor _
: `a m E � BUILDING PERMIT
¢ ¢ w < OWNER-BUILDER DECLARATION
a o a U MISC.- REFER TO ORD INFORMATION
X
3 e- H I hereby affirm that I am exempt from tine Contractor's License VALUATION $/FT. CI
IHa0 J Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00
Code:Any city orcounty which mutinies a permit to construct,alter, / 0-0-0
Q'Q¢ 2 improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTE. LIC.NO. ELEC. `
',•W d OO M iequlres tine applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License
i