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CITY OF SOUTH SAN FRANCISCO <br />BUILDING INSPECTION DIVISION <br />400 Grand Avenue, South San Francisco, CA 94080 Phone 877 -8545 <br />APPLICATION FOR ELECTRICAL PERMIT <br />Permit EA. — $15.00 Supplement $4.50 <br />See Table #313 Nat. Elec. Code for specific <br />details. - Ordinance No. 1072 -89 <br />SYSTEM FEE SCHEDULE <br />OT Y FEE Name l;, }9,= <br />z Address t r o . ��` -� ) <br />o City <br />Tel. No. <br />Name Ft- <br />cc Address/ ;, IAJ j� i� t <br />c City <br />z Tel. No. <br />e U <br />State License No. <br />City Bus. Lic. No. <br />WORKMAN'S COMPENSATION INFORMATION <br />In conformity with the provisions of Sec. 3800 of the Labor <br />_ Code of the state of Calif. each applicant shall file with <br />the Building Inspector the certificate designated in (1) below <br />or shall sign item (2) whichever is applicable. <br />(1) Certificate (or exact or duplicate copy) of Workmen's <br />Compensation Ins. issued by an admitted insurer. <br />(2) 1 certify that in the performance of the work for <br />which this permit is issued that I shall not employ any per - <br />son in anyanner so as to become subject to the <br />Workmen's Cori pensation Laws of Calif. <br />SIGNED :V ,, AAAA CA, <br />I hereby ac nowl'd'e that) ave read this application <br />and state that the a e is correct and agree to comply <br />with all City Ordinances and State Laws regulating building <br />construction. <br />Policy No. 9 <br />Expiration Date <br />O <br />v <br />v <br />New Residential: <br />New Multi family $0.03 per sq. ft. <br />M M <br />New Single Family $0.035 per sq. ft. <br />9 13. <br />Other types of residential occupancies & <br />alterations — Unit Fee Schedule <br />n! <br />Swimming Pools .. .........................$30.00 <br />z <br />Carnivals, Circuses, Expositions <br />Electrical Generators & Rides .......... <br />$15.00 ea. <br />lighting for rides ............... <br />$ 4.50 ea. <br />_ Display <br />System & Booth lighting ............... <br />$ 4.50 ea. <br />_ <br />Permanently installed rides etc. ea. <br />use Unit Fee Schedule <br />Temp Power ........................... <br />$15.00 ea. <br />Temp Lighting / Outlets .................... <br />$ 7.50 ea. <br />UNIT FEE SCHEDULE <br />Outlets — Plugs, Switches, Controllers <br />First 20 ...................... <br />$ .75 ea. <br />Additional .................... $ .45 ea. <br />(5 ft. or fraction of multi- outlet assy. is one <br />outlet) <br />Fixtures —First 20 ...................... <br />$ .75 ea. <br />Additional .................... <br />$ .45 ea. <br />Appliances Residential .................. <br />$ 3.00 ea. <br />Non Residential less than 1 hp. ......... <br />$ 3.00 ea. <br />less than 1 kw.......... <br />$ 2.00 ea. <br />less than 1 kva. ........ <br />$ 2.00 ea. <br />Power Apparatus: — (hp) (kw) (kva) (kvar) <br />Up to and including 9 ........... _ ..... <br />$ 3.00 ea. <br />10 to 50 ............................. <br />$15.00 ea. <br />51 to 100 ....................... <br />$30.00 ea. <br />100 + ............................... <br />$45.00 ea. <br />*Note: Multi -motor equipment - use sum of <br />combined rating. Fees include all related control <br />equipment. <br />Busways 100 ft. or fraction .............. <br />$ 4.50 ea. <br />Signs One circuit ....................... <br />$15.00 ea. <br />Additional circuits for same sign ........... <br />$ 100 ea. <br />Services <br />less than 600 V @ 200 amps max ....... <br />$18.50 ea. <br />less than 600 V @ 200 to 1000 amps .... <br />$37.50 ea. <br />more than 600 V or over 100 amps ...... <br />$75.00 ea. <br />Apparatus not listed herein ............... <br />$11.00 ea. <br />RECEIPT # <br />TOTAL PERMIT FEE <br />WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT. <br />WHITE — Bldg. YELLOW — Applicant PINK — Inspector's Copy <br />Apparatus: <br />This application is an Electric Permit when properly <br />filled out, signed and validated for the correct fee in <br />the validation space. Permission is therefore granted <br />to do such work as indicated in this application in ac- <br />cordance with and subject to all of the provisions of <br />the Electric Code of South San Francisco and all <br />related laws. Renew only once at full fee. <br />This permit becomes null and void if work is not com- <br />menced within 180 days from the date of issuance, or <br />if work is suspended at any time for more than 180 <br />days, or if any work is done in violation of any city or- <br />dinance or state law relating thereto. No materials may <br />be stored on the street or public property without an <br />encroachment permit from the City Engineer. <br />M M <br />9 13. <br />n! <br />z <br />A r <br />I <br />Approved � <br />By '. Date ;r <br />Building Inspector <br />Apparatus: <br />M M <br />9 13. <br />n! <br />z <br />A r <br />I <br />Apparatus: <br />