8312 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
BUILDING w
ADDRESS
Sp �� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 8312
OWNER'S
NAME V PLAN CHECK VALIDATION C , DTV. ELECTRIC PERMIT FEE
J J, �S GMONE� I� `
,V NAMERACTOns - UTLETS-SWITCHES-RECEP 10.00/1.00
uc.NO. LIGHTING FIXTURES 10.00/1.00 •�
CONTRACTOR s APPLIANCES-RESIDENTIAL 4.00
'PHONE PANELS 10.00 DATE OF APPLICATION
OgcHITEGT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.NO. SIGNS TRANS. 3.00
nooRRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
APPLICANT'S I' I _ E
ADDRESS MOTORS SEE FEE SCH. I `/ I (A'S
' SERVICE CHANGE - 20.00
o¢ i
F o o LICENSED CON'PRACTORS DECLARATION TEMP.POLE 30.00
a u I hereby affirm that I am licensed under provisions of Chapter 9
2 w ISSUANCE DATE
H ¢ 'm (Commencing with Section 700e)i in full
3 oftheBusiness and BLDG. ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect. ❑ 1:1
❑ ❑
O 5, m W License Class Lin.Number
m 1_ Date.Contractor
~ J BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION '^ry
w ;LL w 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u INFORMATION 1
O j Liov for tiro following reason.(Sec.7031 S.Basin ess and Professions i VALUATION SIFT.
- PERMIT ISSUANCE 10.00
,n 0 Code:Any city or County which reyuiresa permit to Cunstruq,alter, Ex 4/
¢O improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. - �f
ca O Mrequires the applicant for such permit to file a signed statement that TOTAL
n w ma. he is licensed Pursuant to the provisions of the Contractor's License PERMIT TO
_Fz ¢
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Anse
x O Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ 10. the basis for the alleged exemption.Any violation of Section 7031.$ STORIES vPEC R.
s. bymiyapplicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN (EA.) 5.00
of not marc than five IUlndrod dollars(5500).} -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.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 thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
pfovc fee Purpose ofsalc.l. INDUSTRIAL WASTE INTER. 30.00RES ElT❑ ❑N El 1:1❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 6.00 ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License Law does not apply V.B.
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 contactorts)licensed pursuant To
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.Creason f tld' WATER HEATER W/VENT 6.00
OwnerDate .WATER SYSTEM 5.00
Q/ ACC.DATE ACC.FILE NO.
pc
W RKIiN '(.OMPENSA1'10 DfiC1C4RA I( WATER TREATING EQUIP. 5.00 .
hereby affirm that I have a certifi air of consent to sell'-insure.
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy lhcreof(Sec.3800,Lab.CA
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRTNK ENERGY T T4
Z Z ❑ Certified copy is filed with the city inspection division.
F O Applicant MISC.- REFER TO ORD. v ❑ N❑ Y ❑ NE]
N CER'nFICAlEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.u.C.
LU > COMPI NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
C' D ('Phis section need not be completed if the permit is for one TOTAL Y[] N[_ Y❑ N�
Z) Z IT unit red dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ'any person in any manner so as to
become subject to the Workeri Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH5.00 BUILDING L/� e7
GO .J
} NOTICE 'f0 AITLICANT: If,after making this Certificate of Ex .
T
F Z eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE -
such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 6.00 SEISMIC FEE
I 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,Co.C.). HEATING UNIT(TO 100,000 B.T.U.1 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
® Ordinances d curmeL 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby uuthoriee representatives for ins of this coy to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, ijilbcmnifamd keep harmless the City of misc.- REFER TO ORD.
CuP ino against liabi les,/ rmts, costs and expenses which CONST.TAX
m any way ace e a st said City in consequence of the PERMIT ISSUANCE 10.00
MECH.CONT. LIC.NO. MECH.
p TOTAL TOTAL �f6
nature of'Apphcant/Contractor as� Date '
INSPECTOR COPY