Fillable City of Rancho Palos Verdes (City of Rancho Palos Verdes)

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City of Rancho Palos Verdes (City of Rancho Palos Verdes)

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The City of Rancho Palos Verdes (City of Rancho Palos Verdes) form is 2 pages long and contains:

  • 2 signatures
  • 3 check-boxes
  • 91 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Rancho Palos Verdes

BROWSE CITY OF RANCHO PALOS VERDES (CA) FORMS

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City of Rancho Palos Verdes
Building and Safety Division
Permit / Plan Check Application
Job Address
Date of
Application
Print Applicant Name
Email
Applicant Signature
PERMIT #
Applicant’s Best Phone #
PROPERTY OWNER’S NAME:
Mailing address if different :
Phone Number:
Email
Commercial use only; Name of Business to occupy building:
Internal use Only:
Owner – Builder Declaration Required :  Yes see attached  No
ARCH / ENGINEER:
License # City Business License #
Address: City: Zip:
Phone Number: Email Address
Written Description of Work:
Square Footage
ICBO or ER # Valuation $
I hereby acknowledge that I have read this permit application and state that all information including any attached sheets
are correct. I agree to comply with all City ordinances, State and Federal laws regulating activities covered by this permit
for which I am applying. I authorize representatives of this city to enter upon above mentioned property for inspection
purposes. I will ensure that items requiring inspections will not be covered without an approval by the City Building
Inspector.
o Contractor with Worker’s Compensation or Contractor is Exempt
o Workers Comp. Policy ○ Exempt
No. ____________ Exp Date:_________
CONTRACTOR
PHONE #
Address: City: Zip:
Licensed Contractor’s Declaration
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and in effect.
Contractors Signature : Date:
Print Name : Email:
License Class
License #
Exp. Date
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Plumbing
Qty Item Fee Qty Item Fee
Single Trap Fixture Lawn Sprinklers
Water Heater
Solar Water Heating Vacuum Breaker or
Back Flow preventer
Water Service Piping Interceptors & Clarifiers
Water Treatment Storm Water Drain Inside
Whole System Re-pipe Residential Building Sewer
Swimming Pool Private Sewage System
Relocate Gas Meter Private Sewage
Abandonment or Repair
Gas Outlets up to 5 Fire Sprinkler Head to 5 units
Each Gas outlets over 5 Additional Sprinkler Heads
Miscellaneous Repairs Other
Mechanical
Qty Item Fee Qty Item Fee
Heating Appliance / FAU Single Flue or Vent for
Appliance
Comfort Cooling Unit / A-C Residential Exhaust Fan or Duct
Combo Heating & Cooling Unit Commercial Exhaust or Duct
Refrigeration Unit up to 25 HP Duct System per
1000 SF of Area
Refrigeration Unit over 25 HP Cooling unit with ducts
Pool Heater Fire Damper 1 – 10
Boiler Over 10 Dampers
Ventilation Unit Other Appliances or Equipment
Electrical
Qty Item Fee Qty Item Fee
Receptacles, Switches or Outlets
First 20
Residential Appliances
Each additional switch,
outlet or receptacle
Non Residential Appliance
Panel Upgrade 600V to 200 AMP Power Apparatus Rated in HP,
KW,KVA, or KVAR up to 1 ea
600V to Over 200 AMP
to 1000 AMP
Over 1 up to 10
Conversion from Overhead to
Underground Service
Over 10, up to 50
Temp Power Pole
Over 50 up to 100
Systems per SF for one or two
family dwellings
Over 100
Systems per SF for Multi Family
Bus ways, ea 100 FT to Fraction
Signs & Marquees
Misc. Apparatus Conduits,
Conductors & Circuits
Circuits to Manufactured Spa
Other Swimming Pool
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City of Rancho Palos Verdes (City of Rancho Palos Verdes)

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Completed 16 July 2020

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