4087 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE• BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION , - - PERMITNUMBER
9DILDINc OGRESS "PG'"- rJD APPLICATION & PERMIT 408 O O
L EJ£ BUILDING=ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S . _ .. r_ ____.__
PLAN CHECK VALIDATIONNAME ! nnGy`�: DTV. ELECTRIC PERMIT FEE
0 '`- C 5'�o bOr�] .11aj)I PHONE 414'544-4 ..
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
2E uc.No. Oq• 7-1 LIGHTING FIXTURES 5.00/1.00
rRA
CoecroR's PPLIANCES-RESIDENTIAL• 4.00
APPLIANCES
11FDNE'2 p PANELS 5.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR. SIGNS 6.00'
ENGINEER - _
' I.C.No. ISIGNS TRANS_ 3.00 '
ADDR1ss END, PERMIT
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
'ZiP TEMP. METER OR POLE INS. 15.00 ^ '
nPPLICA TS -I ,a MOTORS," - SEE FEE SCH. ( ��
SERVICE CHANGE ' 10.00 0/yy/63
W ¢z y/
O'o LICENSED CONTRACTORS UECLARA'1'ION ^F"
.a d.0 I hereby affirm.that I am licensed under Provisions.(Chapter 9 ro IS UANCE DATE
y Wa (commencing with Suction 7000)of Division 3 of the Business, aLUG. ELECT. PLG. MECH.
V ° w I'rofessina'Codc,anA Iyy license is in full for¢.ILu fy I� ❑ ❑ ❑
zo 0 License Class `J•-Lie.Number`y E�`I 3c LI -
9 m- ° Ilmc_�=-i- 4J_C.m tactor-Dae ��IjI -
_r
a m a a - OWNER-BUILDER l 5 •� I BUILDING PERMIT
¢ BUILDER DECLARATION '
o d u INFORMATION
E
;LL H- I hereby ull'irm that I am exempt Gont.lhe Contractor's License MISC.- REFER TO ORD
Ho_ Law for the following reason.(Sec.7031:5,Businessand Professions PERMIT ISSUANCE 6.00 ��•{�svA1WATION $/FT.
¢ ,nom Code'.Any city or county whichrequiresa permit toconstruct,alter, ELEC.CONTR. LIC.NO. ' AIM
¢ ¢ p Improve,demolish,or repair any structure,prior to its issuunce,also • ELEC. -
°S, rcyuirei the applicant for such permit to file a signed-statement that _ TOTAL
Q�'1 PERMIT TO
'.ra
w $ he is licensed 9(cmpursuant to the provisions of the Contractor's License � Ol l $Ld
z < Lawless andr9(wnions ming Codewith Section is 00)exempt
Dtherefoofthe - � g,
E i° Business and Professions exemption,
or that he is exempt therefromand GTY. . PLUMBING PERMIT FE
¢ m the basis for the alleged exemption.Any violutiori of Section 703 L5 STORIES TYPE CONSTR.
a3 - by anyapplicant foruperrnil subjects the applicant In a civil penalty' ALTER-DRAIN&VENT-WATER (EA.) 4.00 I OT Li II
of not more than five hundred dollars($500)): - rIqu o "��F'
❑ I,as owner of the,property,or my employees with wages as BACK FLOW PROTECT. DEVICE 1 2,00 OCC.GROUP- RES.UNITS
(heir rule 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:'rhe Contractor's,License Law does not apply to an owner Of
properly who builds or improves thereon,and who docs such work FIXTURES--PER TRAP 4.00 SO.FT FLOOR AREA TOTAL ACREAGE
himselfor through his own employees,provided that such improve - -
ntemsora not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-) 1NC.4OUTLETS 4.00
or improvement is sold within one year or completion, the owner. GAS'-EA.SYSTEM-OVER 4 (EA.) :- 1.00 BUILDING USE
builder will haveThe burden of proving that he did not build or im- RES IND CDN PR Oma,
❑
prove for purpose of sale). INDUSTRIAL WASTE INTER ' 2000 -.
. I,as owner or the property,am exclusively'conrracling . .
with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sce.7044,Business - LAWN SPRINKLERS--1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. .
and Professions Code:The Contmetor's License Law does not apply'
to an owner of property who builds or improves thereon,and who LAWN'SPRINKLERS-'OVER 5(EA.) 1.00 _
contracts for such projects wish a contractors)licensed pursuant III - -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA. 200ft/8.00 • TRACT NO. PARCEL NO.
❑ air bexempt under Sea ,tl.&P,C.for Ihisreason WATER HEATER W/V,ENT 4.00 -
CI
Dale_ Owner WATER SYSTEM - 4.00 ACC.OATE ACC.FILENO,
woRKI:R- s'con71°IiNS,V'ION UeCLnknTION WATER TREATING EQUIP. 4.00
I hereby affirm.that I have a<erl ificale rif consent Io self-insure.
or a certificate of Workers Cnntpensaii.m Insurance,or it bertitied ZONING ENG.SITE NO,
rd
thereof(Sec.3500,Lah.C:). '
/ Nicy No lith _company 4n -
E O ❑ Certified copy is hereby furnished.( FIRE SPRINK ENERGYTP4
Z z% ❑ Certified copy is filed with rhe city .......conn division.
O Applicant- q MISC.- REFER TO ORD. y N Y N
�REEIS-Iord-C-co'Fr^T. ❑ ❑ ❑ ❑
~_N 4 PERMIT ISSUANCE- B.00
Lid
CER'I'IPICCOMOpIATIO1'ION PROMWORAIiRS FLOOD ZONE - A.LU c.
W � COMPENSATION INSURANCE PLG.CONTR. LIC NO.. PLG.
CL 0 (This scene. need not be;completed it It, permit ie I'o, m - TOTAL V❑ N❑ V ❑ IN El
0 Z hundred dollars(S 1001 or less.l
L) O 1 certify that in the perf.rman.e of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W F- mit k iesu ni. I shall not.nopLY any pa.Mdi in any nwnnul's.us to
O ED become subject to the Workers'Compensation Laws of Calll'ornin. '
Date-Applicant- BUILDING 403.00
aALTER OR ADD TO MECH. 4.00
} N NOTICemptio ,TO APPLIshould Acomia subject making this Certificate Compensation
Ex- _
Z emvisio,you>tireLbecoCode,byo lathe forthwith courply with gpPLIANCE 4.00 PLAN CHECK
provisions .f ten labor Code, you muss forthwith comply with
FEE
U' such provisions or this penult shall be dewned revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY- AIRHANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE 6..30.
I hereby affirm that then is it construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this,perntil G issued(Sec. - MICROFILM -
3097,Civ.C.L HEATING UNIT.(TO 100,000 B.T.U.) '4.00
Lenders Name
NHEATING UNIT(OVER 100,060 B.T.U.M50
Lender's Name ELECTRIC
I certify that I have read this application and- e th t the above VENTILATION FAN (SINGLE) 3,00
information ti correct:I,xgree to comply wit all city:md cowdy - BOILER-CCM
P(3 H.P.0r 100,000 B.T,U.) 4.00 PLUMBING
ordinances and stale laws rel Io.buil ng con mesion, and
Itb.,n.enth.riac rcperyl d' es of this ily'lu a Icr upwt.the BOL LER:COMP 10v..100,000BTU)SEEFEESCH. MECHANICAL
above-ntenti.ncd pmprrty I' ins cellon urposa:> - .
(W rec to save, in •moi nn keep ntless the City of MISC.- REFER TO.ORD. -
Cope ino gains[ liuhilili ju gn s, :mJ expenses which CONST.TAX
may in un way accnt age' sI s' try in consequence of the PERMIT ISSUANCE, 3.00 -
gm L tg.f his pemf MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 409.30
'$i re n Conlr or Date -
V. - -, •OFFICE COPY -