C8699 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
I BU I LD ING PROJECT I DENTIFICATI ON PERMIT NUMBER
' BUILDING APPLICATION & PERMIT.
Al jiaj�)J
x ADUHESSO BUILDING -ELECTRICAL-PLUMBING-MECHANICA 8.699
c OWNER'$ PLAN CHECK VALIDATION
j •Is/
NAME OTY. ELECTRIC PERMIT FEE
PHONE
NA.EoR
Acrs OUTLETS-SWITCHES-RECEP 10.0011.00
•�'
_ 3 LIGHTING FIXTURES 10.00/1.00
I uc.No.
t CDNTRACToOa
ADDRESS PPLIANCES-RESIDENTIAL 4.00
1
Ifion
PHONE.2e ,IC PANELS 10.00 DATE OF APPUCATION
ITE°
A PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P,C.NO.
OR
ENGI
ua rvo. SIGNS TRANS. 3.00 01a- '
AD
5 E a SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP FTEMP.METER OR POLEINS. 20.00 P i
APPLICANTS AoonEss MOTORSPI SEE FEE SCH. 1 S
SERVICE CHANGE 20.00
0 BE 0 LICENSEDCON'PRACfORS DECLARATION TEMP.POLE 30.00
¢ L, I hereby affirm that I um licensed under provisions or Chapter 9 ISSUANCE DATE
B:
G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑
z o m - License Class r,ys Lic.Number 3fiet_t_i
o - ate��ly.-S.rc_Contractor C""�fNe.,�J
a y f BUILDING PERMIT
¢ ¢ ¢ OWNER-B UILDE R D ECLARATION
o o ° MISC.- REFER TO ORD INFORMATION
wS h 1 hureby alllnn Ilett 1 oat exempt from the Contractor's License `
.. o a Low for the following reason(Sec]031.5.Business and Professions PERMIT ISSUANCE 10.00 (lL ALUATIOry $/FT.
� - Code:Any city or county which mquiresa permit to construct.alter, _ G/•!�7 -
¢ ¢Q 40 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEQ ^
d W m¢ requires the apphe'JIII for such permit IO IIIc a)IgnC(I statement that TOTALcLI /S PERMIT TO
he is licensed pursuant to the provisions or tie Contractor's License
z a Law(Chapter 9(Commencing with Section 7000)oI'Division 3 ofthe
E D It and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H m the basis for the alleged exemption.Any violation of Sect ion 703 t.5 STORIES TYPE CONSTR.
by any applicant for o permit subjects the applicant to a civil penalty ALTER-DRAIN IEA.) $.00
of not mor,than five Imadred dollars(S500),):
❑ 1,as owner of lire property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the stnmturC is out
intended or offered for sale (Sec. 7044, Busmess and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:Tire Contractors License Law does not apply In an owner nl
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5,00 SO.FT,FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such int prove.
mre
meals anot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EA'.$YSTEM-OVER 4 IEA.) 200
builder will have the burden of proving that hd n
e Aiot h -uild or am. . BUILDING USE
prove for purpose out sale.)' INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Omer
❑ I,as owner of the property',am exclusively contracting will ❑ ❑ ❑ ❑ ❑
licensed 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 iia such proiects with"conlmeteds)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contmctois License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec._,B.&P.C.for this WATER HEATER W/VENT 6.00
reasml
} Owner Uma WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COM PENSAIION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insur,, ZONING
or a certificate of Workers'Compensation Insurance.or a Certified
`ENG.SITE NO.
copyI thereof(Sec.3800,Lab.C,),
PolicyNwyypeny_{T� Jp per_
Q ❑ Cetl10e o rc ler b}'fu oohed. FIRE SPRINK ENERGY T24
Z Z El C, if f ' 1J'Al Abyti"ity inspection division.
O Applicant MISC.- REFER TO ORD. ,Y E] N❑ I v ❑ N❑
c w 3R (ItCITP P ISXBhf PTION PROSI W'ORRIi Rs' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W CO IPENSATION INSURANCE PW.CONTR. LIC.NO. PLG,
CL O (This section need not be completed if the permit is for one TOTAL YE] N❑ Y❑ N❑
Z) Z hu frolics]do[]a,,(S 100)or less.) _
U 0 I certify that i the pvfurmunce of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F Init ix issues all not employ any person in any manner so as to
LL w become 1 tolhe Workers'Conlpensitiou Laws of California.
QL nate npMl°°nt - ALTER OR ADD TO MECH. 5.00 BUILDING s
>- In NOl'I , O APPLICANT: IC after making this Certificate of Ex-
♦- Z elnp Ion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith comply will 1 FEE S+1
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUC770N LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOO.F.M.) 6.00 SEISMIC FEE -•U
I hereby affirm that t ere is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance work for which Itis permit is issued(Sec. MICROFILM
3097,Civ,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 �>•�""-�~
LenAer's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's ns] s ELECTRIC.'
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. infonnalion is correct. 1 agree to comply with all city and county PLUMBING
Ordinances and state laws relating to building construction, and BOILER-COA4P(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) gree to save, iodenmif, a I l4yc,p harmless the City of MISC.- REFER TO ORD.
Cuper' a•aina liabilities,judgnt• s.A'osts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may 1 a 'ay a true a ainst Id -[Ily in consequence of the
gr t a MECH.CONT. LIG NO. MECH.
II TOTAL TOTAL 2
L C
'ig ata o u A pman / onlruclor IJatc a sL 9-
INSPECTOR COPY