2494 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALI. POINT PEN ONLY
BUILDING
BUILDING PROJECT I DENTI FICATION I APPLICATION & PERMIT PERMIT NUMBER
. -
5 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 2494
` T PLAN CHECK VALIDATION
...`ELECTRIC PERMIT � _ ,FEE .
...o. .5i HONE
NAME Acro s UTLETS-SWITCHES-RECEP 5.00/1.00
-er, UC.NO. 3 LIGHTING FIXTURES 5.0011.00
ADDRESS
s
APPLIANCES-RESIDENTIAL 4,00
OORE35
PANELS 5.00
P-ON
DATE OF APPLICATION
l ARCHITECT/ / SIGNS 6.00 PLAN CHECK FEE RC.�NJO../�
X OR 067 0
ENGINEER i 2 22,1
PT 11 Z/� SIGNS TRANS. 3.00
ARCH.OR EN . 4/t�lb SPECIAL CIRCUIT 5.00 PERMIT VALI DATION
x (tom ZIP TEMP.METER OR POLE INS. 15.00
kAODRE s
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
<u 1 hereby xffsrn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a (commencing with Section 7000)of Division 3 of the Business and SLOG. ELECT. PLG. MECH.
H D w Professions Cole d my lKi n t oin full force and effect. ❑ ❑ ❑
z o: Licen ass Lic.Numbe T Q
N H w Date Contmc
as x 7 7/ 1IY.s ;uBUIL!DING PERMIT
6 0 6 0 OWNER.BUILDER D A I y�,14,,*INFORMATION_-J4- ,..^.,�,{
x H I herebyaffirm that 1 am exempt from the Contractor icense MISC.— REFER TO ORD
w 3 u VI P VALUATION
S/FT.
Fu0 < Law for the following mason,(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE. 6.00
,A> Code:Any city or county which requires permit to canal me t,alter,
a ¢ < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 90 1
..
u DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
W $m he is licensed pursuant to the provisions of the Contractor's License _
Hi > Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe .I:r'Ze<�" 'T rrf''s+P.4*'I., aY'S§, ,$est,/--L± . t r�P
4 at Business and Professions Code)or that he is exempt therefrom andb€ft PLUMBING PERMIT v FEE:'
the basis for the alleged exemption.Any violation of Section 7031.5 m ri Y7 Y5 eI 4i'"'pil'+,fi ,?'4s,1.R'."? f/r.Y. iM*.u.'1E°l K`'.I4t`Sr STORIES T P'E/CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.. 0
of not more than five hundred dollars(S500)J: �TTII
Cl I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
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 4.00 ad FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- ^�
mems arc not intended oroffered forsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner-
build., -EA.SYSTEM-OVER 4 IEA.) 1.00 BUILOtNG USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Om.,
for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am exclusively contracting with ❑ 0 ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not applywho A�� _ as
to contracts
owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 Oi((
the Contractor's
Liceneclswithaconlmcmrls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec.—.BAP.C.for this WATER HEATER W/VENT 4,00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 4.00
I hereby affs(.of that or I have a ce Compensation
In consent to a certified ZONING ENG.SITE NO.
or a certificate of Workers'CompenMcate Insurance l a certified AA
NO-
copy ther feq_fS W800,Lab,CJ
Policy No
(J1,1(LO_Company
O ❑ Cerlfied copy' hereby fu niched. FIRE SPRINK ENERGYT'24
Z Z ❑ Cer ed, is filed with II city ' section division. MISC.- REFER TO ORD.
O Applican y❑ No y ❑
~ = PERMIT ISSUANCE 6.00
fL C IFI ATEONSATIOT FROM PL000 ZONE ^^
W COMPENSATION , Sd if the PLG.CONTR. LIC.NO. PLG. Y� Y^�
Z (This dollar, need not be completed i(the permit is for one TOTAL
hundreddertify that
IS[the pe lessm } E s� )_Fs� •+' _a 3 ra,RP t•-••+-
U O I certify that in the performance of the work for which this Per' QTY 4_,1 ."rA MECHANICAL PERMIT 4 kYFIE
� 51FEE SUMMARY., y '
LL {- mit is issued,I shall not employ any Person in any manner so as m } I ....r sa _51,i s `.Y.< s*s`yis.Crz Ie� r f..::ciefl
O W become subject to the Warkeri Compensation Laws of California.
n Date ApplicantALTER OR ADD TO MECH. q,OG BUILDING
} 0NOTICE TO APPLICANT: If,after making this Certificate of Ex.
I— ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
F) such ch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10AWC.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10,000CFM.) 5.GO SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the Performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read(his application and stale that the above VENTILATION FAN[SINGLE) 3.00
information is correct.I agree to comply with all city and county BOILER-COMP13 H.P.Or t00,0008.T.U.) 4.00 PLUMBING
hreby n and state laws relating to building construction. and
hereby authorize representatives this city to enter upon the
above-mentioned property for inspection purpurposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.• REFER TO ORD.
Vliabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
accrue against mid City in consequence of the
mit. MECH.CONT. LIC.NO. MECH. x'w _ '.,rc,�T*a'•'YF
TOTAL s=?TOTAL'
t?w
antlCnntracro Date es•°.;�:' j"A,�,y!
V
OFFICE COPY 7 — —