C7221 APPLICANT TO FILL IN INC`ORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT I DENTI F, ION PERMIT NUMBER
BIIILEING APPLICATION & PhKMIT
AD pSQ� 4jF44j0 �L BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 7221
OWwNNEER'S �j '�' ,' n: -. .r - - - •-r.. pPL.°wS PLAN CHECK VALIDATION
•� I�LJ N,�I G e 7;�0�.7 CTY: - ..ELECTRIC PERMIT =��•' it:�FEEA / �v ) /,LeR �r�fS
PHO E U Y
CONTFACTCRS UTL ETS-SWITCHES-RECEP 5.00/1.00
Lhe-rlm& Pov �Q LIGHTING FIXTURES 5.00/1.00
IfTRACTORS PPLIANCES-RESIDENTIAL 4.00
I • ON PANELS S.UD DATE OF APPLICATION
AR R SIGNS 6.00 PLAN CHECK FEE P.C.NO,
0
E uE
uc. SIGNS TRANS. 3.00
nFW0.E.G. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
DDRE� ZIP TEMP. METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
o&e _T,G AWIlb/N10
/O SERVICE CHANGE 10.00
Foo LICE.'Sh. CT ACTO S ECL ION (O
iv w hereby affirm thus 1 am licensed under provisions of Chapter 9 Iv'v ISSUANCE DATE
lmmmencmg d m 70001 of Di4DEARATION
iin 3 of the Bu iness a d B ELECT PLG. M CH.
Hi Professions W y license isAid eyj"p
o y License•C s �9d n
o Dale_ex s_�Ifon City 0 UO-( If10 . .
i ¢ a ILDI
OWNI:R--/BUILDER BiN�
U REFER TO ORO
3 a .- I hereby al0nn that I am exempt from the Contractor's License MISC. - '
'" .. o¢ Lewl'orthe following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE VALUATION S/FT.
Code:Any city m county which requires a permit to construct,alter. 6.00
� Q Q p improve.demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / I✓✓V I �` ^
O a, requires the applicant for such permit to file a signed statement that TOTAL � PERMIT TO Ir
x er he is licensed pursuant to the provisions of the Contractor's License
z a Law l Chapter 9 l commencing with Section 7000)of Division 3 of the
Nosiness and Professions Code)or Oul ht is exempt therefrom and QTY. PLUMBING PERMIT. 'FEE;
s $ the hasis for the alleged exemption.Any violation of Section 7031.5 - •t O STORIES TYPE CONSTR.
ate _ byy applicant for a permit subjects the applicant to a civil penaltrALTER-DRAIN&VENT-WATER (EA.) 4.00
ul not more than five hundred dollars 155001.1:
❑ I.as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 -bcc,GROUP RES.UNITS
their ole 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 SD.FT FLooR.RFA TOTAL ACREAGE
himself or through his own employees.provided that such improve-
Huntsarenotintendedurofferedforsale.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 4.00
or impnni mens is wid within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 0 0 0 0
❑ L as owner of the property,and exclusively contracting with
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL No.
to a,
Professions Code:pe The f,,Contractor's License Law does not apply
m un owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
coronets tier arch projects with a cotruetuns)licensed pursuant to
the Co II aemrs License Law. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT rvo. PARCEL NO,
❑ I um exempt under Sec. .BAP.C.for this WATER HEATER W/VE 4.00
reason
Owner Date WATER SYSTEM 4.00 Ace DATE ALC.FILE NO.
WORKERS COMPENSATION DECLARATION WATER TREATIN2aRRPJJ4.00
hereby ulfinn shut have a certificate of consent to sell'-insure. ZONING ENG.SITE NO.
or certificate of Workers'Compe t.l rly It,f it
aopy thereof(Sec. Co Lab.C�A1__ . n(t!r♦0
Policy No._Company
Q ❑ Cerlilicd copy uherchy lurni' eJ. FIRE SPRINK ENERGY T 24
Z Z ❑ Cer" d cop 'led wi the c ins 'tion ivision. MISC.- REFER TO ORD. YC] NE] Y ❑ NF
r 0 Applican a
y CERT FICAT'1!OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLooO ZONE A.L.u.c.
DO > COMPENSAT ION INSURANCE PLG.CONTR. uc.ND. Pte Y N Y� N
CL 0 (This section need not be completed if the permit is for one TOTAL
Z hundred dollars(S 100)or less.)
' U O 1 certify Out in the performance of the work for which this per. bTY -MECHANICAL'PERMIT FEET s .}' FEE�SUMMARY:
LL H nlit is issued.I shall not employ any person in any manner so as to -
0U hecomesuhject to the Workeri Compensation Lxwsof Califorma. BUILDING -
Date Applicant ALTER OR ADD TO MECH. 4.00
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emplion,you should become subject to the Workers'Compensation APPLIANCE 4.00 '� PLAN CHECK
provisions of me Labor Code. you must forthwith comply with AIR HANDLING UNIT ITO 10 GF.M) 3.00 FEE
U uch provisions ur this permit shall be deemed revoked. .�
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M) 5.00 SEISMIC FEE
. 4
I hereby affirm that there is a conut ctfon I ing agency for EXHAUST HOOD(WITH DUCT) 2.00 '
the pertlamance "the wo for wpKJ is pe K isuVd(Sec. MICROFILM
3097.Civ.C.l. !KU HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT OVER 100,000 B.T.U.)7.50 ELECTRIC
Lan er'ti Address
-
certify
Ler
enify That I have read this to comply
and stale that the above VENTILATION FAN (SINGLE) 3.00
17
information n correct I agree to comply with all city and county BOILER-DOW(3 FfPj%.109,000 B.T.U.) 4.00 PLUMBING
ordinances and vote laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP Miser 100.DDOBTUl SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. '
(We) agree to save, indemnify and keep harmless the City of MISC.- MAR 11 REFER TO ORD.
Cuper- ago' St liabilities,If encs, costs and expe s which CONST.TAX
may ny ay ccrue agar Bald Cit co ce ,,//////''' the PERMIT ISSUANCE 3.00
jr, ng of i p i�� i/ LH.CONT. n t' MECH.
i City df COc.r mo TOT
A
fj ;TOTAL l�
Signaru fApplicanl/Contractor Date
OFFICE COPY