HomeMy WebLinkAboutLAKESHORE DRIVE 16474_18-1250 CITY
LA K_E LS 111C)ICE
DREAM CxI'REME TM 130 South Main Street
4� APPLICA
APPLICATION FOR PERMIT
AP11 BY:
ELECTRICAL/PLUMBING/MECHANICAL
BUILDING ADDRESS
I hereby certify that I have read this applicaticm and state that the
above information is correct.I agrec to Comply with all city and county TRACT BLOCKMAGE LUIWARCEL
ordinances and state laws relating to building construction,and hereby
authorize rcprescnta c of this city to Coto upon the abovc•nrentioncd 0 NA n .
property for inspc ror pnrposc W
/t N MAII.IN
Y J-/ � E ADDRESS
U R .ITY
Signature of Applicant or Agent Date
I hereby aff
C witlr Section 7000)of Division 3 of the Business and Professions Code.and my
(circle one) O license is in full force and effect.
AGENT FOR: CONTRACTOR OWNER N LICENSE/t CITY BUSINESS
T AND CLASS TAX#
AGENT*S NAME_ R NAME
A
AGENTS ADDRESS _ C MAILING
suect city state rip T ADDRESS
O CITY STATr/ZIP PRONE
R
CONTRACTOR'S SIGNATURE
ELECTRICAL Quan PLUMBING Quin MECHANICAL Qus111
New Res. Multi Family/SQ. F"1'. fixture or Trap F.A.U.f Furnace/Ducts/Vents
New Rcs. Single Fancily/SQ. Fr. Building Sewer F_A.U.1 Furnace/Misc./> 100000
Pool Electric Systern, Private Rain Water System per Drain Floor Ftn race/Vent
Switches/ 1st 20 Private Septic Systcm Unit Heater/Wall I Icaier
Switches/Over 20 Water Heater/Vent Instill/Relocate!Replace Vent
Receptacle OUtlal/ Ist 20 Gas Piping Systcm I -4 Outlets lVentilating Fan
Receptacle Outlet/Over 20 Gas Piping 5 or More Outlets Evaporative Cooler
Lighting Fixtures/ Ist 20 Dishwasher Ventilating System
Lighting Fixtures/Over 20 Solar Tank Exaust Hood
Residential Fixed Appliance I Outict Solar Collector per Panel Fireplace
Non-Residential Appliance/Outlet Grease Trap/(Interceptor) Commercial Incinerator
100-200 Amp Service<600V Install,Alter or Repair Systcm Air Handler> 10000 CFM
200- 1000 Amp Set vice<600V Lawn Sprinkler System Air Handlcr< 10000 CFM
Misc. Apparatus,Conduits,Etc. Baekilow Device Smaller than 2" lFire Dampers
Signs Backflow Device Larger than 2" Registers
Sign Branch Circuit Floor Drail7 Compressor/I-Icatpump-3 H.P.
Busways/EA 100 FI' Floor Sink Compressor/Heatpurnp 3- 15 11.11-
Tctnporaiy Power Service Water Service Compressor/Heatpump 15-30 H.P.
Temporary Power Distribnlion Systcm Alter or Repair Drain or Vent Compressor/Hcitprrurp 30- 50 H.P.
Motors/Transformers fire Sprinklers per Building Repair/Alter Misc.IIVAC
Motors up to 1 FI.P. Swinuning Pool Compressor/Iicatpump Over 50 11.P.
Motors/Transformers t - 10 1I.P. Swimming Pool/Public
motors/Transformers It) . 50 I1.P. Swimming Pool/Private
Motors I Transformers 50- 100 H.P. Water Heater/Vent
Motors I TI ansformers> 100 H.P. Replace Piping
Replace Filter
Misc- Replace
Gas Piping
1.I am licensed under the provisions of Business and Professional Code Section 7000 et seq.and my license is in full force.
2. I,as owner of the property, or my employee w/wages as their sole compensation will do the work and the structure is not
intended or offered for sale.
3.I,as owner of the property,am exclusively contracting with licensed contractors to construct the project.
�> 4.1 have a certificate of consent to self-insure or a certificate of Workers Compensation Insurance or a certified copy thereof.
5 I shall not employ any person in any manner so as to become subject to Workers Compensation Laws in the performance
of the work for which this permit is issued.