16592 '(O FILL EIV INFORMATION WITFIIIV RED LINES - USE BALL POINT PEN ONLY
BUILDINGPROJECTIDENTI FICATION PERMIT NUMBER
KDILDING APPLICATION & PERMIT 16592
aapREss
0 7 I BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NANE 's ULAN CHECK VALIDATION
"AME 1 I ^ CITY. ELECTRIC PERMIT FEE
o\ GLA PHONE /���O ISA/
CONTRACTOR'S OUTLETS
6' -SWITCHES-RECEP 10.00/1.00
uc.rvo. LIGHTING FIXTURES 40.00/1.09
CONTRACTO 'SPPLIANCES-RESIDENTIAL 4.00
ADDRESS
a�pryk PANELS 10,00 DATE OF APPLICATION
AR HITECrpgNELS (OVER 20
K' ta �S' 0 AMP) 20.00 PLPN CHECK FEE P.C.NO.
Oil " �re. 4
�ENGINEER rVAr
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENO I 5.00
ADDRESS 14PERMIT VALIDATION
(k-
DID
CIRCUIT -
f-•t•- DID .METER OR POLE INS. ai�GO
APPLICANT MOTORS SEE FEE SCH.
ADDRESS
! SERVICE CHANGE 20.00 / r
o O
O LICH NSI(D CON'1'RACI'OHS DECLARATION
a u U I hereby union that I am been sed under pnwisiulu of Cha Pler 9 ISSUANCE DATE
N a IcommeacinN will,Section 7000)nl'Division 3 of Ibe Business upd PAP- BLDG. ELECT. PLG. MECH.
r m z I'micloan sCoJu.911 my licy'1x is in lull Ibrtt IylyfWet.�- F�--1 ❑ ❑
z o m- License Cl.m_ Lic.Nwnber__._. �J
Y E o Date- CPU 1� Cmametor_,QL♦��i* GS 11
¢ ¢ w¢ I OWNER-BUILDER 118CLARATIONJ V BUILDING PERMIT
O REFER TO ORD ' 0 INFORMATION
w ;
it- , 1 hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION
H u, o is Law tar lire l'ollnwiny reason.(See 7011.5,[rosiness and Prnlessinns PERMIT ISSUANCE
Code:Any city its county which iequilesu Penal loconxtnml.:dter.
� pao Iimpruv.•,Jemnlish.or....air:m y Rt,aa O•.Prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC. �[
O ¢ rcquinro the applic;l..I Ibr such pen..it la life a sign-[s1-1,aalaa dim TOTAL /a PERMIT TO
a w m" he is Iiccnscd pursu:uo to the pnwisi.nu it the ca nraclur's License .
H 2 i [.awl('IWpter`It,o�lmellelnAwill,Svoioa70000111aiwo,Oolllie ,E'LL-C-T
eu
a Ifuslnand Prolcuiuns Code)ur Ilett ha is lAcand therl4nnn and QTY. PLUMBING PERMIT FEE
¢ f D IIIC basis Int the i llegPd exelop1IOn.AIIY VmE,tio l oI Scetimn 7Ul I.5 STORIES TYPE CONSTR.
sg� by any applicant 101DPunpnlsohlacnthcappbeenlour sil Penalty ALTER-DRAIN BI VENT-WATER (EA.) 5.00
al not more than five honored dollars I SSOW.1:
❑ I,as owner of lira pmpeny,or my employees will,wuge5 as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will Jo the work,and the slructum is not
mtnaded or offered for sale (See. 7044, Business alit] 1'rol'essions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:Tire Contractor's License Law does not apply to an owner of
Properly who builds of improves Umrcun,and whod,.suet,work FIXTURES-PER TRAP 5.00 SO.FT.FLOORAREA TOTALACREAGE
hinue It or through his own employees.Provided that such initnue- GAS=EA.SVSTEM-11NC.40UTLETS 8.00
cornu are not intended ur alleivd lir sale.11'huwevur,the boi Wing
lir hnPmvcmcal is sold wilhin one yell ul'maple mm. the Owner-
ba
wner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 puIL00Jc USE
builder will have ill,burden at pruvinµIlett 1w dai lint build or int- RES IND CON PR Omar
prove lar Purpose•Of sale). INDUSTRIAL WASTE INTER. 30.00 11 1:1 1-1 1:1 1:1❑ I,as Owner al the property,am cx ClusivclY Contracting with
Iiccaucd contractors to construct the pmjeCl IS,,.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does nal apply
to an owner of property who builds or improves[hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Contracts for Such Projects will,a eonlruetorW lit'en.wd pursuant la
SEWER-SAN EA.200h/10.00 TRACT NO. PARCEL NO.
Bet Cammelat,License Law.
❑ lam exempt under Src. .Iffrlt('.Iia this WATER HEATER W/VENT 6.00
reason
Owner Dec WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WOKKI'.KS'('OMPI°.NSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby alliin that I have a certificate or consent to sell'-insure. 20NING ENG.SITE NO.
or a certificate of Workers'Compenulion Insurance,lir a cerlified
copy thereof(Set.11000,Lab.C.I.
PA -y No.IL4i_r'$•on Puny 5T E.. .t�
Q - Certified cn+y is etehyl FIRE SPRINK ENERGY T-74
Z Z ❑ Ccnilic N I- he city inspection Division. MISC.• REFER TO ORD.
O APPlicanl ,+ Y ❑ N❑ V ❑ N❑
H CI!It" A'rE of li%Ii MI'1'ION I'K(Ihl WOI(K GIGS' PERMIT ISSUANCE 10.00 FLooD zprvE A.L.0 c.
LU � COMPFNSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
CL Q TOTAL YE] N[3Y❑ N❑
(This ucl ion nceJ nal he mnRJrn•J it the Pcrwil is lar enc
=) Z hundred dollars(5100)lir less.[
U O 1 cerlily that in the perl'arnlance at tile work for whidh this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f mit is issued,I shall not employ any Vemm in any planner so as to
O W become subject to lire Warkcrs'(bmpcnsation Laws ar Crililortlia. BUILDING
lyase• ApplicantALTER OR ADD TO MECH. 5.00
} ran NONCE TO APPLICANT': If,after making[itis Ccrl,[',cute of Ifx-
F 2 empllan,you should became subject to the Workers'Catnpenmtion APPLIANCE 5.00 PLAN CHECK
provisions of the labor Cock, You must forthwith conn Ply will, FEE
U such provisions or Ibis permil Shall he deemed ,' akld AIR HANDLING UNIT(TO IOfXAC.F.M.I 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 100MC.F.M.) 6.00 SEISMIC FEE
1 hereby ul'I'irnn that Ibeiv is a construction Iemdiag agency lot EXHAUST HOOD (WITH DUCT) 5.00
the perlonnapce of the wall, lin which this permit is issued ISec. MICROFILM
3097,Cis.C.1. HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender,Name HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
Lender',Address' -�'
I certify thud l lnaterad thnSappli,mim,and flak[hal lire abuse VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply will,all city and county PLUMBING
m
BOILER-COMP(3 H.P.OF 100,000 B.T.U., 6.00
ordinances and stale laws relating to building cmulruclion, and
hereby millmno, representatives o1' this city to enter upon the BOILER-COMP to.,1tHlp00 BTU)SEE FEE SCH. MECHANICAL
adavcmenlianed property orinspectionp.rPoas.
(We) agree to save, Aemnify olid •p harmless Ibe City al' MISC.- REFER TO ORD. CONST.TAX
Cuperl ilia again' rix ,I ieS, p Inc casts and cxpeuscv which PERMIT ISSUANCE 10.00
may in an y clue II' , Cily in cons• ue' a ul the
'Datil Ilan pail. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
gaa,, pplicunllCo,_1r- r Dale
INSPECTOR COPY