Building Division Permit Type:

PLEASE EMAIL COMPLETED FORM TO [email protected]

Building Division
Plan Check/Building Permit Application
Building  Plumbing  Mechanical Electrical

Permit Type: _____________ Permit No. _______________

Applicant (Print Name)

Project Address

Date

/

/

Property Owner (If not same as above) Address (If not same as above)

Phone Number ( )

Cell Number

Driver’s License (When required)

Valuation of Project $

NOTE: This permit expires and becomes NULL AND VOID should work not be commenced within twelve (12) months from validation date or should authorized construction be suspended or abandoned for a period of 180 days after work has commenced.

For building permits issued in connection with an ongoing Code Enforcement matter, the permit expiration period referenced in the preceding paragraph relates only to the period in which the building permit remains valid and shall not change any time limit or deadline to correct the code violation as set forth in a citation or notice of violation issued by the City. Applicant/Owner Initials: ________

PLUMBING PERMIT 

Qty Type of Installation Code

Water Closet (Toilet)

P21

Lavatory (Wash Basin) P22

Bathtub

P23

Shower

P24

Kitchen Sink

P25

Garbage Disposal

P26

Dishwasher

P27

Laundry Tray

P28

Washer

P29

Water Heater

P30

Drinking Fountain

P32

Urinal

P31

Water Softener

P34

Slop Sink

P33

Gas Sys (1-4)

P5

Gas Sys (5 +)

P6

Waste Interceptor
Swimming Pool Piping and P-Trap
Lawn Sprinkler (Valves)
Repipe
Alteration to water or Draining piping
Solar Energy Inst.

P7 P35
P10
P36 P8/9
P13/ 14

Site Sewer / Additional P2 / 3

Sewage Disposal

P15

System

Miscellaneous Plumbing P1
fixtures

*

 Interior Installation  Exterior Installation

MECHANICAL PERMIT 

Qty

Type of Installation

Code

Forced Air Units (<100,000 BTU)

M1

Forced Air Units (> 100,000 BTU)

M2

Floor Furnaces

M3

Wall Heater

M4

Boilers or Compressors to & Inc 3

M7

HP or Absorption System

Boilers or Compressor over 3 HP &

M8

Include 15 HP or text

Boiler or Compressors over 15 HP & M9

Include 30 HP or text

“ 30 “ 50 “ 1,000 “ 1,750 “

M10

Boilers or Compressors >50 HP or

M11

Absorption Sys. over 1,750M BTU

Air Handling Units to & Include

M12

10,000 CFM

Air Handling Unit – > 10,000 CFM

M13

Ventilation System – single duct

M15

Ventilation System – Multiple duct

M16

Exhaust Hood

M17

Evaporative Cooler

M14

Repair, Alter. or Add. to Heating,

M6

cooling or ventilation equipment

Miscellaneous

M20

*

 Interior Installation  Exterior Installation

BUILDING  Description of Work:

ELECTRICAL PERMIT 

Qty

Type of Installation

Code

Amps Main & Distribution Switches/Meters

E1-E5

Branch Circuits, Outlets, Receptacles & Switches

E6-E9

Outlets to existing Circuits

E11-E12

Ranges or ovens

E35

Space Heaters

E36

Garbage Disposal

E37

Dryers

E38

Dishwashers

E39

Water Heaters

E40

Transformers KVA ea. & Welders KVA ea. To & Inc. 3 HP Over 3 HP to & Inc. 5 HP Over 6 HP to & Inc. 20 HP Over 21 HP to & Inc. 50 HP Over 51 HP to & Inc. 100 HP Over 100 HP to & Inc. 500 HP

E13-E18
E13 E14 E15 E16 E17 E18

Temporary Power Poles

E19

Signs

E22

Each Additional Temporary Power

E20

Pole

Each Additional Sign Circuit

E23

Swimming Pool Electrical

E25

*

 Interior Installation  Exterior Installation

Gross Square Footage ______________ New____ Legalization____ Both____

Type of Construction___________________ Occupancy Group__________

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LICENSED CONTRACTOR’S DECLARATION

I, hereby affirm under penalty of perjury that I am licensed under the 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 effect.

License Class

License No.

Exp. Date

Contractor Name

Signature: __________________________

Date

OWNER-BUILDER DECLARATION
I, hereby affirm under penalty of perjury that I am exempt from the Contractor’s License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also, requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor’s License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)):
 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7031.5, Business and Professions Code: Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions code: The Contractors’ License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors’ License Law).
 I am exempt from licensure under the Contractors State License Law for the following reason:_________________________________________________________________

By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an ownerbuilder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following website: http://leginfo.legislature.ca.gov/faces/codes.xhtml

Signature:

Date:

WORKERS’ COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
 I have and will maintain a certificate of consent to self-insure for workers’ compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No.________________________________________________
 I have and will maintain workers’ compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers’ compensation insurance carrier and policy number are:
Carrier_________________________________Policy Number_________________________Expiration Date___________
Name of Agent________________________________________________________Phone_________________________  I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any
manner so as to become subject to the workers’ compensation laws of California, and agree that, if I should become subject to the workers’ compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant ______________________________________________________ Date _________________________
WARNING: FAILURE TO SECURE WORKERS’ COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY’S FEES.

CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 8172, Civil Code).
Lender’s Name
Lender’s Address

Applicant: I certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. I (We) agree to save, indemnify and keep harmless the City of Pico Rivera against liabilities, judgements, costs and expenses which may accrue against said City in consequence of granting of this permit.
Signature of Applicant ________________________  Owner  Contractor  Authorized Agent Date ___________

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