14327 (3) APpL1LEthd I i U PILL IN INFO10VW T ION VVI I FIlN HED LINES - USE FALL POINT PEN ONLY
F BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
conic yyyy APPLICATION & PERMIT 14327
AOONE55 a;'W'd YN•.
II�"'''�� Y� KJ .Y BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwrvEP'S /` PLAN CHECK VALIDATION
`_ f
. � Qqf-
NAME �S7'r DTV. ELECTRIC PERMIT FEE
PHONE l D J
CONTRACTORS
NAME
NAME y,, �/.��� /� OUTLETS-SINITCHES•RECEP 10.00/1.00
LA.f'tR.lit �" uc.NO. `TG .33 LIGHTING FIXTURES 10.00/1.00 3 '-
nooaessOR 1Sy-O �'�izJC�'AIZ 'Z 2i1 APPLIANCES-RESIDENTIAL 4.00
Y•�Ellk7 PHONEA PANELS 10.00 d -- DATE OF APPLICATION
AR rECT
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER� ^r
lr uc.Nu. 1pp0 SIGNS TRANS. 3.00
ARCH.OR ENG �-
ADDRESS '-72% i;7 rUAV r/; � cJ, `�f97Z I SPECIAL CIRCUIT 5.00 J-- PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00
APPLICANT'S ��U ` _ J'a
AOOPE55 '�A11�+-. vt+l •� MOTORS O, W'D SEE FEE SCH.
s• �r7� C — "� SERVICE CHANGE 20.00
o 0 z
ta o o LICENSED C'ON'I'ItnC'ORS DECLARATION
ri W I hereby arm, that I am livensed under pimisbus,n'Chapter 1) U NCE GATE
a e (commencing will Sectio.70001.I'Divisiun 3 uI'the IImr,,,s:uul
r y i Prolesxionl C.J"' ul my license is in full Iorec and elfcm PLC. MECH.
oi w G License Class_ _j__Lie.Nwnber-.TAf.'Ly-j
wit- Date_1 ��'-C'mllmelur_
Q y E
a a w a OWNER-BUILDER DECLARATION BUILDING PERMIT
w ;.°'y 1 hereby affirm that I am exempt from Thu('on[ractoh's Liecns'e MISC.- REFER TO INFORMATION
ORD
u O J Law for the following reason.(Sec.7031.5,limamessanJ professions PERMIT ISSUANCE VALUATION E/FT.
� w>E Code,prove,Any molish county whiny requitesa permit l.construct,
uance,also
10.00 p
ta Q a O IIIIprnVe,JCmDh]II,ll!rl'llalr any$1ln[Inm,prior 10111 Is]na11CC,also ELE0.CONTIL LIC.NO. �// "t
O IF requires the applicator for such permit to file a signed slarentELEC
Ilhul C ' TOTAL /7�
u w m w he is licensed pursuant to the provisions of tire r se Conlrac oLtcenu P L PERMIT TO
rz> Law(Chaplet 9(commencing with Section 7000).(Division 3 ollhe
z x o Business and PruI,.mns Cure)or that he is exempt HN,,roR1 and QTY. PLUMBING PERMIT FEE
s r o the basis 1'm'the alleguJ exculpliun.Any violar ion OI Sccl ion 7031.5 STORIES TYPE CONSTR.
u ;r^ by any applicant tot a permit subjectsIll'upphcxnl toa civil penalty o`
of or more than live hundred dollars($ ALTER-DRAIN&VENT-WATER (EA.) 5.00 Sj)J
❑ 1,as owner or Ili,pruperty,or my employees will wage as BACK FLOW PROTECT. DEVICE 4.00
their sole cmnpensatio), will Jo the work,and rhe hotel re is or OCC.GROUP RES.UNITS
intended or ol1'ered for sale(Sec. 7044, Business and Pir l'eWolu DRAINS-FLOOR,ROOF,AREA,COND. 5.00 /e- j
Code:The Conlruc[or's License Law does not apply to an owner of
property who buih his wne mplyeefeomanJ who rl such Ru work FIXTURES-PER TRAP 5.00 C,f 50.FT.FLOOR AREA TOTAL ACREAGE
himself or Through Ilio own employees',provided that such chiviie-
memsarenotinrendedoroll'ered for sale.l f,however,the building GAS-EA.SYSTEM•11NC.4 OUTLETS 6.00 j:Z,GQ�
Or improvement is sold within one year of completion,the owner-
builder will have the burden or proving that he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Prove fors Owner
.1 A,). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ L as owner of'lie property,ileh exclusively cont 4. Ing with ® ❑ ❑ ❑ ❑
licensed Contractors od la re Contct the none"t(Sec. 7044,of apply
LAWM-OVER
S- 1 INC 5 V.B. 6.00
and Pmfnsiunx Code:The CnnlmeT.i s License Law docs not applyASSESSORS PARCEL NO.
to an owner of property who hours or improves lhefcon,and who LAWS-OVER 5(EA.) 1.00 `�(06,.contracts forsuch Projectswith a ccrum,to,$)licensed Pursuant IoIheConucmr'sLicenseLaw. / SEWEY-STORM EA.2001t/10.00 UTRACT NO. PARCEL NO.
❑ I am exempt underSec. ,B,&ItC'.frt Tisonnin1 1 WATW/VENT 6.00OwnerDate / WAT5.00ACCGATE aCCFILE100WORKIiRs'cOhrPliNsn'rION DECLnRn7lON WATG EQUIP. 5.001 hereby affirm Thal I have a cerlilicuteofconsent❑h scll-irsur,,
or a cerlificulc of WorkenCompensatiml Imsurencc,ur a cetlilieJZONING ENG.SITE 100.
copy lhercol'(SL
'.31000,Lat,C') • T
1'00 ed copy Cu hereby f rmist oy1. N,ou3fg-
❑ Certified copy is hereby fwilishe�
Z Z ❑ Cerlil'icJ copy is Ii1cJ with Ih¢ city inepccli.n division. FIRE SPRINK ENERGY TZR
F O Applicant MISC.- REFER TO ORD. Y N[:] v C] N�
CI:RTIFICATR OF I'XRM PTION F ROM WOR R E.RS' PERMIT ISSUANCE 10.00 Q - FLOOD ZONE A.LU.C.
Lu > COMPI'NSA'1'ION INSURANCE PL .CGIS LICNO. PLG.
d 0 (Phis vection need nor he completed if lite permit is Our one . TOTAL V N Y N
Z Ili mdrud dullars(Sio0)or loss.)
U O I certify that in the performance of the work for which Ihil per-
L- 1- Init is issued,I shall not enpiuy auy perwn in any manner su uo 1. QTY' MECHANICAL PERMIT FEE FEE SUMMARY
O W become subject to the Workers'Compensation Laws of California.
Q. Daic-ApliNOI ICAN f:nl ALTER OR ADD TO MECH. 5.00 . BUILDING 710,S_-0
} 2 NO'ITCIi TO APPLICANT': II;viler making This Carl illcate ul'rix
F-. - emption,you should become subject to the Workers'C'onlpituatiun APPLIANCE 5.00 PLAN CHECK
provisions of rite Labor Code, you must forthwith comply will
U such provisions or this permit shall be deennod revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.EM.) 6.00 SEISMIC FEE ��C•J)'
1 hereby affirm that there is a Construction lending agency for /' EXHAUST HOOD(WITH DUCT) 5.
the peflornunec of the work I'or which[]its penmtl is issued(Sec.
3097,Civ.C.). HEATING UNIT ITO 100,000 B.T.U.) .00 MICROFILM f
Lender's Name
_ LendersAJJrns 'H EATING UNIT(OVER 100,000 B.T.U,)9.50 ELECTRIC J7
�\ 1 rmatio that I have real this upcomply and sluts thin the above VENTILATION FAN (SINGLE) 4.00 6 -�
information n cornet.1 sagree to comply with all city and county and PLUMBING
hereby as and sate laws relating to bucity' construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) .00
heath- authorize representatives of This rp to enter upon the
above-ntnmiuned Property I'or inspection pupnses. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL •7 C 0`10
(We) agree to save, indemnify and keep hunnless the Cit of MISC.- os -�
u erlino a Y REFER TO ORD.
p against liabilities,judgments, costs and expenses which CONST,TAX
rIltaY
gin any way accrue against sal 1 collseyuenee of rhe PERMIT ISSUANCE 10.00 1/0- ,G-
mnling of Ih'' en MECH.CONT, LIQ 100. MECH.
TOTAL 1� Ob TOTAL
LStgnurumol I locant/ConU:utur i-- me�--- CP�,O-• 4139 36 J
OFFICE COPY