15749 (2)'• APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT [�J /� (]
• AorREga \J r �{J
Er BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1
NAM 's S-8 GOO- r PLAN CHECK VAF'I�J ATION
rvAMIr-Fl 2�-/ QTY. ELECTRIC PERMIT FEE
PHONE 7/!-"�,'.
CONTRACTON$
rvnmE
�// .mow OUTLETS-SWITCHES-RECEP 10.0011.00
LIC.NO, LIGHTING FIXTURES 10.00/1 00
U/V�ND-N , :L
t
ADD -
RRACTON's
AOOREss PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00
ARCHITECT GATE OF APPLICATION
OR PANELS (OVER 200 AMP) 20.00palNCHECK FEE P.C.NO.
ENGINEER tII�I
LIC,No. SIGNS TRANS. 3.00 Qtr
ARCH.OR ENG.
ADDRESS SPECIALCIRCUIT 5.00 O. I HMITVALIOATION
:IP EMP. METER OR POLE INS. 20.00 N n�
APPLICANT
ADDRESS MOTORS SEE FEE SCH. �CI,�• 01(C�S- lr i•I
SERVICE CHANGE 20.00 M•
D¢ i
F o o LICIiNS1iU CON fknC`IORS UIiCL\R 'fIUN
Q U I hereby atinn till I and licensed under Io-,molts of Chapwr 9 Y ISSUANCE DATE l
Icomnu•n:ing with Se:lion 70001 of Division 3.1 the B.'iness and BLOC. ISSUANCE
PLG. MEC)T
0 i Professions Code,audio, license is If full for:r end:flea. n I I rs .S-I , ,C.`.1 T
o 0 H o Lisn a•Class Lic.Num he'r 1 I-HC. 6
w Date Contractor
a -F
¢ ¢w
OWNER-BUILDER Illi,-LA k,\"fIOK ner{7s,. BUILDING PERMIT
w ;`N I hereby aDilm Ihm I Bm eulnpf limn the Contractor's Liam". MISC.- REFER TO ORD Py'NP� INFORMATION
u0 J Law for We fDllOwillg reusun.IS,,.7031.$,B,,i n:ns and Prolenidu VALUATION
t - PERMIT ISSUANCE 40:00 ') s7Fr.
S w>E Code.Ally'ady or counly'which requires Permit w construct,alter,
u ¢ <O Improve,demolish,or repair any st Rlcture,prior to its issuance,also ELEC.COINER. LIC.NO,
D¢ requires the al,leant for such"'mil to tELEC.hen signed ft0lehnenl Iflat TOTAL I
the is licensed pursuant In the PR,Iniuns of Oil Contractor's License '�'�' J` PERMIT T
riQ Law(Chapter Hllonunlncing Willi Scelion 70001 set Dl,hnlou 3 of he �� •lU�
Business and I'm&ssiuns Code)or till Ile is nrnlpt Ihcrciroln and CITY. PLUMBING PERMIT FEE !/
ua¢f m the basis for if,,alleged'xenlptiun.Any viulxtiun of Section 7031.5 STORIES TYPE CONSTR.
fly any applicant for a pen uiI subjects file applicant I...ivil penally
.friALTER-DRAIN m nloa•dao tI"hundred dolluu 12500111'. (EA.) 5,00
❑ 1,as owner u1 ill,-p..... .ser my employees with A.",,, .DEVICE 4.00 BACK FLOW PROTECT
[]fell sole con4,rmalion,will do the x.rk,and ,be sltucl ore a not DCC.GROUP RES.UNITS
intended or offered fur sale (Sec. 7044, Bminrss ufid 1'r H,wns DRAINS-FLOOR, ROOF,AREA,COND. 5.00
Code:The Con tricot's License Law dors fill,apply to an owner of
Property who builds ser in4,rovas,hemun,unit who docs sucb wort FIXTURES-PER TRAP 5.00
himself or through]his own employees,pravidcd that such imprmo- so.Fr.Fwoe AREA TOTAL ACREAGE
• mems are n t intended ser-lured for sale 1,;however,tile'building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or imProvemun is sold within one year o(cmnpl'tion, tb'owner
builder will hove the burden of proving that he did nm build ser int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Prov for, urn" Isal'.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
I,a owner ul Ibe property.ctrl ioiccl(OilySe . 7044,ins will 11 ❑ D El ❑
II nn ro Contractor'od m construct tilewr pmjecl (Sec. 7094,It apply LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
and Professions Code:The C'ontruc,ur i License Low docs nal el'Pfy ASSESSORS PARCEL NO.
Io un owner of Property wlm builds seri ppru,e,dra......and wlm LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for Nuel Projects with a coin ria un+)licensed Punuan,Io
the C..Ua u ',License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am:seemPt under Sec. B.AII(1.Ibr Ibis
reason WATER HEATER W/VENT 6.00
Owner Uv11 WATER SYSTEM 5.00
wUk KlikS'Oon1PHNsnT'ION DI!cl.nenTION WATER TREATING EQUIP, 5.00 ACC.OATC ACC.FILE NO.
I hereby otirm IIla1 I have a cenif leap,of eunwnt to nrlpirl,arc,
or a certificate of Workers'Campensalion Insurance,or a 1111111111 ZONING ENG.SITE NO.
copy,herul(See 3800,LaRC.).
Policy No C'ompuny
. 0 ❑ Cenidied cup,is h creby lumished.
':Z 2 ❑ Certified copy is lilesl with the lily ilupletiou11ivisinll. FIRE SPRINK ENERGY T-24
O Applicant MISC.- REFER TO ORD. �
N CERTIFICATE 01;EXEFLOOD N� Y � No
W MPI ON FROM WORKERS' PERMIT ISSUANCE 10.00 YZONE A.L.U.C.
1 .
� COMPENSnPION INSURANCE PLGCONTR. LIC.NO, PLG.
-.� O (Alis section neral riot be coin feted it the TOTAL Y❑ N� Y ❑ N[D
C) P Pennlf is fur nor
O huficeddollen 151001 Pe les.i
I is issued,
that i ,he par ploynan of,he work for which this Per CITY.
L U blit is issued,I shall ria employ any person in any manner so m In MECHANICAL PERMIT FEE FEE SUMMARY
� ad b'eamlwbject,o the W'Iic,RH Compensofion Laws of Culllivniu. �y
°' Ila,. APPhum ALTER OR ADD TO MECH. 5.00 C BUILDING
f to NOTICE '1'0 API'LICAN'I': If,after making this Ccrtilicutc of 17 J
2 'In PHiml,You should bleonle Subject lu the Wurkel'i C'om Prnsu Go° APPLIANCE
Provisions of the Labor Code, you "Hill ki'lhwith conGhly All 5.00 PLAN CHECK
such Provisions or this Permit shall a dean'd revoked. AIR HANDLING UNIT ITO 10=C.F,M.) 4.00 FEE
I hereby affirm fit.,,
LENDING,ACI-NCY AIR HANDLING UNIT(OVER 10IOWC.EM.) 6.00 SEISMIC FEE ,_�
han tion is csl iun Inuring agency lin EXHAUST HOOD (WITH DUCT) 5.00 ,,,
Performance Ili the work furr wonhich thiThis permit is issued(Sec.
3097,Civ.C.), HEATING UNIT (TO 100EXHAUST
B.T.U.) 8.00 MICROFILM
Le Per
Lender's Name
Lender's Address HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I cerlil'y tlml l have read fills appivat R and stale Hill,IT,above VENTILATION FAN (SINGLEI 4.00
n formation is carred. I agree to comply with all city and county PLUMBING
ordi nmmes and state laws relating to building construniun, and BOILER-COI H.P.or 100,000 B.T.U.) 6.00
• hereby aullmri , rigsresenalivn bf Olis ciq' to cher upon IIIe BOILER-
. above-memioned properly for inspection purl'ums. COMP (Over 100.000 BTU,SEE FEE SCH. MECHANICAL
fwe) agree ,o save, Indcmnlfy and keep Imrndex the Cif. It MISC.- REFER TO ORD.
uP'dino agaim, liabilities,judgments:cuss :oldnxevspemes whi'll
nay in any way accrue agaimt wiJ Ciry in myuence of the PERMIT ISSUANCE ,1400 .(t: "CONST.TO
'
g•r' In
of thin pcnnll MECH.CONT.
�J LIC.NO. MECH.
TOTAL
Signutum OI APp l ,Irl Conlruc,Or pale - r� TOl•
OFFICE COPY