7118 APPLICANT TO FILL IN'INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BDILUING APPLICATION & PERMIT
IhWAPhIV�J VA aooREs BUILDING-ELECTRICAL-PLUMBING-MECHANICAL l 71
OWPLAN CHECK VALIDATION
- ?NANiY ELECTRIC PERMIT FEE
PNONE
oNTr s OUTLETS-SWITCHES-RECEP 5.00/1.00
b�
N fIR 7 ILIGHTING FIXTURES 5.00/1.00
f.DNTR
ADORE PPLIANCES-RESIDENTIAL 4.00
A-
NE PANELS 5.00 DATE OF APPLICATION
ARCH EC SIGNS - g.00 PLAN CHECK FEE P.C.NO.
;6R
ENGINEER
Llc.Net SIGNS TRANS. 3.00
•ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
zlv TEMP.METER OR POLE INS. 15.00
'. Avvucarvrs MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE10.00 ��/�1,�
0 0 0 +_ LICENSED CON TRACTORS DECLARATION
2 o U' {(� I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
in a N 1co ioneacuhg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w at Professions Code,and my license is in full fur e ❑ ❑ 1:1
❑
z O m- License Cla' Lic.Number
O w Daze Contractor
F - J
a w'a W - LDER DECLAR 'T BUILDING PERMIT
a I MISC.- REFER TO ORD
INFORMATION
oA.�
w u- 1< -1 hereby of farm that I am exempt from tin Contractor's License VALUATION $/FT.
H .. 0¢ Lire for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
tt' Code:Any city orcounly which rnluiresa permit to construct,alter,
¢ 2 s- 1 ilnprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
e_ - 4s T roluires(lie applicant]or such permit to file a signed statement that TOTAL PERMIT TO
wm u he is licensed pursuant to the provisions id the Cmnrnctor's License
Law(Chapter 9(commencing w ith Suction 7000)of Division 3 of the
¢ uslness and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r o bbasis I'or the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
u > any applicant for a permit subjects the applicant to a civil penally
rilUtmore than five hundred dollars(55001.): ALTER
-DRAIN&VENT-WATER (EA.) 4.00
+ e - ❑ I,as owner of the property,or my employees with wages as
their sole temper, {Ion,will do the work,and the structure is not BACK FLOW PROTECT. DEVICE 2.00 DCC.GROUP RES.urvrt3
-' intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorof(eyed In,sale,if,however,the huilding GAS-EA.SYSTEM-1INC.4 OUTLETS 4.00
or improvement is sold 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 inl-
prove for ipurpose of sale). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB Orion
❑ I,as owner Of the pol"Crty,an,exclusively contracting w11I1 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
X' and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or inhproves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
v ,crud ado for such projects with a contmnolts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this - WATER HEATER W/VENT 4.00
reason
r Owner Dam WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
W'ORKERS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP, 4.00
'1 .aI hereby affirm that I have a certificate or consent to self-insure, ZONING ENG.SITE NO.
7dd.11..(SI00).lI,,sx)
f Workers'Co Ipcn- IDI I suranm,or certifad)p.
x' a FIRESPRINK ENERGYT24
cop de h M I ' s -et vin. MISC.- REFER TO ORD.O rx _ Y❑ N❑ Y ❑ N❑zr PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
IICATIi OF -A.MPI-ION PROM WORKIiRS'IL ' COMPflNSAIION INSURANCIi PLG.CONTR. LIC.NO. PLG..2 n need not be completed if the permit is for one TOTAL E Y❑ N❑ Y❑ N❑
'� Zrs(4100)or IessJ '
U O, 1 certify that in the performance of the work for which this per- FEE SUMMARY
yy f p ..lit is issued, 1 shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE
('1tzU become subject to the Workers'Compensation Laws of California.
}_qg 4 Uatc Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
" NW, NOI'ICI;TO APPLICANT': If,after making this Certificate of Iix-
Z' I c option,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you nmst forthwith comply with FEE
U' tC, such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 -
I, CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p0011F.M.) 5.00 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
n 7 Lender's Name
' Lender's Address HEATING UNIT IDV ER 100,000 B.T.U.17.50 ELECTRIC
I certify trot I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
ino illation is correct 1 agree to courtly with all city and county BOILER H.P.or 100,000 B.T.U) 4.00, PLUMBING t
ordinances and stale laws relating to building construction. and -
hereby authorize representatives nr this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE•FEESCH. MECHANICAL
it fro mentioned Prp tyforinspection purpo. s -
1 (w ) agree t demo ly and keep harmless the City of MISC.- REFER TO ORD.
r Cup rtm h abainm Int Milt Ls . ignicluts. hosts and cxpcnse3 whichCONST.TAX
nr y pp1 an way ac u b+int said (.'try in Ase encs of tin PERMIT ISSUANCE 3.00
9 tit lhg f this PC,mil H.CONT. LIC.NO. MECH. D
a TOTAL TOTAL
S4: re of A plic t m uc or IDate )
INSPECTOR COPY