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HomeMy WebLinkAbout11758 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FI CATION PERMIT NUMBER BUILDINGC APPLICATION & PERMIT AoogEaa 11758 /•� e�. JIW S©/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME Gr�or y r (�P C QTY. ELECTRIC PERMIT FEE - � PHONE 5- ! NAME NcroRs t UTLETS-SWITCHES-RECEP 10.00/1.00 AME LIC.No. LIGHTING FIXTURES 10.00/1.00 ADDRESS oRD 's PPLIANCES-RESIDENTIAL 4.00 REss PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECTGINEER PANELS IOVER 200 AMP) 20.06 PLAN CHECK FEE P.C.NO. OR EN • LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 y�. ADDRESS MOTORS SEE FEE SCH. l:Q1I7"- AOORESS P q n " SERVICE CHANGE 20.00 Ir PPP ```///'''��'���,,, /G/l o o LICENSED CONTRACTORS DECLARATION C E'Cj .�. C� (�O� a o U I hereby affirm that I am licensed under provmonsaf ChaPler9 i7 f AS5 ANCYEQDATE . v, G n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. Professions Code,and my license is in full force and effect. z o License Class Lia Number- - _ Lit 1 I ui IeI F)r'IJ ❑ 9 m w Dale Comraelor a y f BUILDING PERMIT rtw OWNER-BUILDER DECLARATION INFORMATION K 3 LL _ I herebyaffirm that I am exempt from the Contractor's License MISC.- REFER TO ORD " P VALUATION $/FT. u0a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 l'-u -w-1 Cade:Any city or county which requires permit to construct,alter, l7 _D rt Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. -D ¢ requires the applicant for such permit to file a Signed statement that TOTAL PERMIT T `CMQ A w m he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the " Sr=O GbLK /aC.CEISO Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE ¢ro the basis for the alleged exemption.Any violation of Section 7031.5 STORIES YPECO STR. to dam _ by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ 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,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves tICICOn,and who dOCS such work FIXTURES-PER TRAP - 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- , mems are not intended or Offered for sale.1f,however,the building GAS-EA.SYSTEM-1 INC,4 OUTLETS 6.00 I i4t-ovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im" RES IND CON PB Other P forpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ El ElI,as owner of the property,am exclusively contracting with h sed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code The Contractor's License Law docs not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 . contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ 1aj2 pt Se - P.C.for this WATER HEATER W/VENT 6.00 reason .& � Owner. ' Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sell'-insure, ZONING ENG,SITE NO, or a certificate of Workers'Compensation Insurance,or u certified copy thereof(Sec.3800,Lab CA Policy No: Company 0 O Certified copy is hereby furnished FIRE SPRINK ENERGY T-24 Z Z ❑ 'Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. E] NE] Y ❑ N❑ CC CERTI17ICY'1'E O F F.XEMPTION F ROM WO R K Ii RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc. •p LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Q- 0 (This section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ Z) Z hundred dollars(5100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O W become subject to the Worker Compensation Laws of California. BUILDINGSZ Date Applicant ALTER OR ADD TO MECH. 5.00 } w NOTICE TO APPLICANT: If,after making this Certificate of Ex- ♦- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10900QF.M.) 6.00 SEISMIC FEE .fes 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM .3097,Civ.0). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - Lender's Name HEATING UNIT IO VER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 / information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building const action, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL i above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. C lino against liabilities;judgments,costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may to y way accrue against said City in consequence of the granting is efmit. MECH.CONT. LIC.NO. MECH. (} / ,mss TOTAL TOTAL S/ /(i/ igi nes[ reo Applicant/Contractor Dam OFFICE COPY