HomeMy WebLinkAbout16146 �
_�.,�` CITY OF I7IAMOND BAR �
DEPARTMENT OF CC3MMUMTY&DEVELOPMENT SERVICES �,.� p�,
� : 21G60 E.Copley Drive Suite 19Q ���(���
(909)860-3195 Fax(9Q9)861-3117 (� PRESS
�����''� BUII.DING PERMTI'APPLICATICIN FIRMLY
'� JOBSITE /_ /_� �J �/ APPLICATION !(. i PERMIT � � P/C
� ADDRESS (!'(G C"�S� V1 f�� dATE � j"' �� NUMBER ���� � #
� APN �QT TFta` �-7Z f' ��SUE TYPE OCC
Y ����— DATE CONST. _ GROUP
Y OWNER � /�
,p ADDRESS ' r7 'l i ZONING SETBACKS
� CI�'�tll�1..'r _ ZIP��1� TEI. RE�ART RW ❑
APPIICANT _ 7EL.
� S{DE/SIQE STREET RW ❑
CONTRACT4R� � � SIDE U
ADDRE3S .-�- �����
� CITY Z!P TEI. PR�POSED USE � 1/'�
� ARCWENG/
QESt�NER ��
� ADDRESS� _�f_ti���� NO.DWEL. NO. NO.
tJNITS STORIES BEpROC7MS
� CITY� ZIP��77A�.-`'S'E�. �"
us � �� DESCRIPTI(JN SQ.FT. FACTOR PSF ADJ,AREANALUATION
� OWNER•BUILDER DECLARATICIN SFRtADDlREM
O
0 I FIERE9V AFFlRM UNDER PENALTY OF PERJIIRY THAT I qM EXEMPT FNOM THE CONTRACTORS LI- �df&48IC3ip0ti
W CEN5ELAWfOATNEFOII.�NVRlC1ftEA.50Nt`���70.��.5&/5NiE55ANDPF�ESS�NSCApE:ANYCITYOR {J)
� G'OUNTVNAiIpiflE9UIREBAPEFlMITTOCONSTRUCT,ALTEfl,kAPROYE,pEMOUSH,OfiREPAIRANYBTRUC• W {�a110/DBCk
TURE.PHIOR TO IT$ISSU/WCE,K50 REOUIRES THE APpLICANT FOfl 5UCH PERMIT TO i1LE A SIGNED W
S7AIEMENtT THA7 ttE Oft&F�IS ttCEN5f4 PURSUJ�tsT L4 lHE P{�VISIONS QF TNE CONTAAC70R5 ti�
CB15E UW(CHAPTER Y(COMMENC�NO WITH SECTION 7dloj OF DIVISN}N 3 OF THE BUSWESS ANp PRp- � POOUSp2
FESSqNSOCbEJOIiTHATHEOFlSHEISEXEMP7TNEfiEFR9MANDTH£9ASISFORTHEAI.LEGEDEX£MP� (�
TpN.ANYVIOIl�TNX70FSf:CTILN3Taif.68YANVAPPUCANTFORM1PEflM�TSUOJECTSTHEAPPLiGANTtU Z Re-Root
� A CINL VENAI.N OF NOT M�RE THAN FIVE HUNDRED DOLLARS(;500).): �
� ❑I,AStlYMEROFTH€�.PPXSPERTY,OHMYEMKQYEESWRHWAGESA57NEIRSOIE�MPENSATI�M. � COrtimetCid�
VALLOO THE W6AK,AND iHE STRUCtURE IS NOT INTENpED OH OFFEflEO FOR SALE(SEC.7044,BU51- J
� NESS AND VROFESSIONS C�DE:THE GONTMCTORS LICENSE 4AW DOES NO7 APPIY TO AN OWNER Of
PlbP£RTYYftqBUp950H16iPRfWESiMERERN,ANDWtiOD�ESSUCtiV�C1RKHihiSElF4RHEFiSElFOR �
[� MROUOFi HIB OR HER O`MI EMPLOYEES,PHqVIDED THAT 5UCN IMPRCIVEMENTSAqE NOi INTENpED OP m
QOFFEqEDFQRSILE.IF,H0IMEYERINEBUILDINQORIMPAOVEMENCIS54LDWITNINONEYEAROFCOMALE ^. .....
a TION.7NE OWNER$UItDEti Y111t NAYE lHE 8UF3DEN OF CR6YIN6 THAT tiE pR SNE D1D NDT BUtLD QR
� IMVRpVEWRTHEPURPp:;EOF5ALE).
(y� OI,IISOYM5f40FTHE�PA4pERN,AMEXCLUSIV6LYWN7RACT;N43WITHlIGENSEDCONiAAGTORS �
� TO CONSTRt1CT THE PpCULCT(3EC.1o�s,OUSMESS ANO PROFESSIONS COpE:THE CANTiiACTpRS LI• V81U0fi0f1 ___ �AADJ,AREA
GENSE UW pOES NOTAOPLY T4AN OWNER OF A pROPERTY NMO BUILDS Ofl IMPqfJVES THEflEON,AND
NR7�GUNTRACTSfORSUt7.iPliOJECTSWi1}tACOMTR+4C'TOR{Sj410ENSE6PUHSUtNTTOTHECON7RAG (,j(JA1�j71TY DESCRiPTiON FE�
� '}TSRS IJCENSE LAW.). — � �
❑i Md£XEtdP7 tMiDEfl SEC, B.b PC.FOA iHiS REaSON Q
U
t� __ �
DA7E OWNER,.� �_"' �
� �N�ENSED CONTRAGTqRS DECLARATiON w i.
J
� i HERE6YAfKWA UNDER Pf'NACTY OF PERJURY THAi{q},{�,�CENSED XtNDEfl PF�VISIONSCiF CHAP7ER �
� Y(COMMENGMIO NATH SECTKKJ 7000)(7F OIVIS�ON 3 OF THE BUSINESS AND PROFESSIONS t',ODE.AND Z
}C MY LICENSE IS M FULL FOWi:EM,/7�p EFFEC7. �^-' +7 �
� LICENSE SS j�! LIG.NO. ��� � j v
� �
� DATE. !�"�J�_ CpNTRAGTOR .,,,_ d
W
� WCtRKERS'COMI'ENSAT�QN DECLARATION -�
Q
� i HER Y AFFiRAi WiOER PENAtJY 6F PERJttRY tk7E OF THE FOLIOWING DECtAPATKNJS: Z
C] �IHAVEINGW�LiMMMAiNACSRttf"tCATLOFCAN3EMTT05£LfdN6UREFOHYi(7RKER5' _
�� COMP'ENSATfON,AS PROYIOEp BY SECTION;fTDo OF TME LABOR CDDE,FOR THE PERFORMANCE W
� OF TME WORK FOR IVMICH TMIS PERMI7151SSUE0. �
QW �I HAYE AND WILL MAIMAIN WORKERS'CAMPENSATION INSUqANCE,A9 REOUIRED 6Y SECTION jy��///�
3700 C�TN£LABOR COQE,fOft 7HE PERFOf1AdANC£4F FHE W9RK FOR WHICti THIS PERMIT tS , �-----��� �,,,,. -.._—.^
�.� ISSUED.MYWOR 5'COMPErNSAT�ONINSU 'EC�HRI /�OP�OU�.CjYNUMBERAR� CONS7RUCTI(JN
}4. CAPoiIER����1' t'� +/7 fL��_�/��� PLAN REViEW __ .. . . ..
T--
G1 POLICY NUMBEfl__ p �L ELECTfiIC ,_ _
.��, D �
p fTMuSS[ctoh�NtaiNor9Ea�ErFC�oc�aEanxrswaar�ei�N�Ecooi,u�asryiaoloa�EsSA PLUMBING . .. •'��:
� I CERTIFV TNAT IN TF�E PERFORMANGE OF TNE WpFiK FOfl WHICH THIS PERMIT IS ISSUED,I MECHANICAL _
(�,f SHALLNOTEMPLOV,WYPERSCININANVMANNEflSOA9TOBECOMESUBJECTTOTNE
� 14KtftK£RS'CqMPEN2iATKN1UWSOFCM.iFORNiA,ANOAGREETHATIFiSHOUIDeECOM6 �NSPECTIONFEE __,
� SU&IECT TO THE W6fiNERS'CbMGENSATION PROVISIONS OF SECTION 3�ao pF THE LABOP
� cooE,isHa.tFoqritwir�+can+v�vwin+TNo aaovrs�oNs. ISSUANCE _._. __._ , �-1--+
O j �j
p OATE:��}^��JAPPLIGANT. �- _ SMIP __ ... . ._...�._
� ENERGY P/C _
WAFNMG.FAILURE TO SECUF7E WOflKERS'COMPENSATION CAVEflAGE IS UNLAWFUL.,ANO SHALL BE
yy. SUBJECT PN EMPLOVER TO CPIMINAL PENALTIES PNU CtVll FMES IJP T60NE NUNDFED THQUSAMQ ENERGY PERMI7
OGCURS{SiDQ,0007,lNAD07tiONTOTHECASTOFCOAIGENSATiON,OAMAGE5A5PROVt�EDFOAiN —� -�--� �����---
� SECTIqN 370p OF THE LA60P CdDE.IN7EREST AND ATTORNEYS FEES. RETENTIC?N FEE:
__'
d CONSTRUCTION LENDING AGENGY PRE-ALT FEE:
4 -
� I HER£8Y AFFiRM UNDER i EFIKTY OF PENURY T THERE 3S ACbFiSTR tiON IENDtNG AGENCY
FOR TME PERFORMANCE QF'fHE WORK FOR WNI 'HIS ERMI IS ISSUED SEC.3067,CIV.C.�. 'J"—" '—
� i.ENOER'SNAME�_�jjL�f� ,,,��C--
i_- GEN6ERSADbRESS__
� TUTAL FEES �^ e� 1� .�� �
� I GEATiFY TMAT i HAVE READ�(HIS APPt.ICA7iON AND STATE TNAT TNE A8(')VE INKOR6tA7qN IS CORflECT. �.µ � � �t /��� l /` f�'
� I qGHEE TO CpMPIY WITH ALI.CITY AND CAUNTV ORDINANC:ES ANO STATF UWS RELATING TO BUII,DING t �' ! ��h'
� CONSTRUCTION,PNO HEAEB'f AUTHOHlZE REPRESENT0.TNE5 oF THlS CRUNiY TO ENTER UPOH TME
ABOYE�MENT70NED FROPE.'�lY FOR iNSpEC N PVpPOSES.
COMMENTS
a ���� ��
� PERMITfEEN E(PAfNT)
Q , � _�� --
� �, �--
�,ry SIGNATU Mi E . DATE
� �^ � RECPT.NO. PAID BY �,,,, t� VALIpAT10`�
~ WH77E-OepartmeM Cflpy.YE�LOW--Finance Capy,PINK-Assessor Copy,GCiL6ENROp--File Capy,GREEtV-App�icanPs Copy
���� �� �������� ���
1 ����°�"���� ��;,����
„ � � � . � � . � r . . � �
: �; x „r�„� ! �I F������� .�
__ � ___,______�__ --. __ e.�_ __ — —.,. � . _�� _..__._ __ _
_ f z ,�, � _ r a �"�..'�r� i ���
� � _ � _ _ . _.. . _ _
� _ � _. . _ , _� __, . _,__ - _ ,
b-
� ::,,.� -ti• �.[�f\( .� ; . .._ �is ;a� t�.ia '� �� � � i.
. .. .., .___._u. . .__. �.._..,._. . ,.___....._.__..—_ . ... _ ._ ., .. ......_.. _._ . . ..._ ._.. .. _ . ... .
a
,., ., .�. . �
� � � , �� .
� t-=� . � <:� � � - " 'I 4``„_'ri i.^ � ; �
, .
_._ � � __ _ _.
_ . ��...__.� _ + ___ __ _.. _.,._ _, _
�_. __,. _,. _._� -
� _, _� w . .F �, t ;t�;,, �
E '> �. ,�..i._4t*:e'.. r'�i ._0��� ..r� , �--Ji F -
. _. .._ ._._ .__ _._... ._ w..._. _..�.._.._._�...._.._... ...— . ... ._ _ _ - ..
' -�. _i,�, ra s'? ` .^-e-! - Fs'�� 'a-� a ..
:v vs . �. _. ., } .. �
_ .. .. �.._ _ �._ ._ ..,._ ._.. .._ . _...._ _ _._...,.. ,.._ . . . w .- _._ . _.. .. .._�_ ,
. 'fi; r i-%�=.. �x� �-- �� �¢ � r a _
�, - • _ . _ _
t_ . __., _ _ w_. _. _-- .. ._ _ . _ — -
, ,., , y ,,�� ; � '" �� �"`l;'r
� ,
, .�� ..� ��. 2 � �
� ,� , ��
�.i '. ; __ .
__ __... . __.. _.._ ,._ � __ _ _ —__ _ _
_ , , ,
�~x 6.- r.°; , � � � ��� �r- �
a � ��
� � .���,�_ .,. _ n�.
_ �___ __ �. _._.__ a ._ _.
_ __ ___�_� _
� :�r t ,
� � �w __ _._ _ ___ _. ___ __.�_ _ __ �. ,..� � .. ___ _ __ _. _._. _ .. .._..�... __
_ ,.
; aa� ` ,� �.'s ���° : �� � '" vs :•����t�" �
, .
. d,M _.
�___ _. __ __��_. _._,; ___.. _�.___._ . _ �____ __.�_�.. w_ __ __ _ _.._� ___s._�.__� _ _�,.__ __._� � __ .
;'��`�,���, � ,��#a , , �•�,, � �*;
_ ° _ _._. _ _ . _ . _
,a � � �r..a����i&��, �.. ! Y:; ��Q .
3
,._._._... ._._.. .., �...„.,... ..__ ,._ .,,._ . . E.._. . ._.._ ........ ['.�_ _....w............ .... L. ... . .. .. .. ._ . . .._ . .
,... . �.��. e__� ..-a.. �i i k . 1` ..�1""1
��v �
,�:`, , `, �- vl a3 ,"-' i ' z✓ , �
. ..._... _ _._.. ..... �,,,..._. _ ._.__ .__._,....—. _..__.a.._ ... ..,._. __.,.._. _., __ _.__ '_ ___ ...__ ._.
_..�
. &n, � . '"t_ vr.,.�i�E'. �1 ��.
. ._..,.. _ ____. ._ �...� _..�.... ....�. .._.._ . .__..� _ .._ . . . .._ ___._..... __.._ _.,.�_ .._. _. ,
�" ` `'�' � o.e'.; : . : .';'S!�`N i �.
r, _ ,
.. _ _.. , .._.. , .,,__. :._�..._._ ._ __..,.........__.-fr-"-_... , . . _.._.._.... , ..__ �. . . . � ..___.�. ..._..___...�, ... .. ,.
....... ___ .
, . � � , . 3"� . �
' _ . ..._._ _ ., ._.... _.,..-..� _..,... _ < �—. __. . _._ -.. ._.. ...... .._.. .
..
:.
... . _ ..._.. . � .. � . .�. ?�..}3�. �
... ..... . _ ._.... .. ...__.. ......._. ._._._ _. .....,. .. . . .. ,_.... ,_ ..... _.. .___. .. _ .
w �.
. �'.. ; ' ' '#y :- ' �. .v . ,..
_ .. , . ., . . � -¢, _ .. �._ .
___ , _._. „_... _.... . .. ...—.. , __. ..._.. ��� . . .. ...
� �t��� r� �%�,"�+"'�A��.` �.-$"�i a� .��y y. . _. .,
_,.-. , ,__ . _""__ __.. ,-.�_._ .__ �,._, ,.. ...._k,�...e'°.�+#�i+�t,4�t`:s�BS� , �n.., . ,�. ._ _ , .
',._.. . ._... ..__. , _._.. ._._ ....._... _..__ -__., _ .._.. .. ..._.. , ...,.__ _ _ . _...._. ..._. .._.. .._.. ._._.. ......... ... �
._..._ _..... _._.. .._... _... ....... _ .___. ......_ ...... ... ..... .. ,_.__ ....... ..... .._.. . ..,.. . ..__ ... .._ .. ..... -
f . _ .._.. _... . .... ...... . .._.. .._.. .... .... .. . .
._.._ ..... .. .__.... , ._._ ._.. ..., .._... . .__. ..._.. ,__.....__ .... _ ..... . .. .... ....._ _..... ....... ..,__.. ....... . ... ...
iP .. . ., ...�. ..
' ; �^y'..-. C'p�wtt E�# -;'r'�r'�*�i,�e'i" '"s . . ...... ...... ._.. . ..._. .._... .... ...._ ..... . ... ... ........ .... . .�
t 4 Y �4�R� __ . _.._. _ .
� ��,�
E � �"�. • � � � . .... . ...... ...... .... ....... _. ... .... .. ��.
y �
i1
,' Y4 .a '. .: .. �. , ......_. . . ,...,..., ..... .. .... ..... ......... . .._.. ..... . _... ._... ....... .......... .. .
41
� �)�'r��;�� �.
; '. „� ��, ..
i .^ � � �� ._... ..., . .. .....
� .._... ...._ ... .. ... .._. ..... ...... ....... .... .... ... .. .. .... :
k-. �
i . .... . ..�
I
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS
FIRMLY
ADDRESS
APN LOT TRA S7Z ra
OWNER F� 32� 7
ADDRESS c r7 r
CIT1L�{/%d."ZIP'?2617-TEL Z97 Wt
APPLICANT TEL.
CONTRACTOR a
ADDRESS .r
CITY ZIP TEL.
ARCWENG/
6
1-
DESIGNER
DESIGNER
77
ADDRESS�
CITY' �S N JV"'/r/ZIPg77-EL
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE,DEMOLISH,OR REPAIR ANY STRUC-
TURE,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 CONTRACTORS LI-
CENSE LAW(CHAPTER 0(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP.
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).):
^ 1,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. 7044,BUSI-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OFI 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 OFCOMPLE-
TON,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
^ I,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON.AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS INCENSE LAW.).
^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
0 (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE D EFFECT.
LICENSE CL-ASS LIC. N0.
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I HER Y AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
- 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
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 WOR
S'C
OMPEN
SATION INSURA,E CARRI 7D POLICY N
UMBER AR'
r
CO
NS
NU
CARRIER G
I�7
)�
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED OF THE PERMT 6 FOR ONE FLECRED DOLLARS($100)OR LESS}
I CERTIFY THAT IN TFE 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'COMPENSATON PROVISIONS OF SECTlON 3700 OF THE LABOR
CODE,I SHALL FORTHWITH COMPLY WITH THO PROVISIONS.
T
P
0
L
L(CANT��-
DA
E:
AP
WARNING'. FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE
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 3700 OF THE LABOP CODE. INTEREST,AND ATTORNEYS FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY TH THERE IS A CONSTR TION LENDING AGENCY
FOR THE PERFORMANCE OF'THE WORK FOR WHI THIS ERMI I" .,E_SEC. 3007,CIV.C.).
LENDER'S NAME
LENDERS ADDRESS
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 COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPEC N PURPOSES
PERMITTEE N E(PRINT)
441
SIGNATU MI E DATE
APPLICATION PERMIT I J"I P/C
DATE NUMBER VVVV)Y' #
ISSUE TYPE OCC
DATE CONST.GROUP
ZONING SETBACKS
FRONT RW^
REAR^
SIDE/SIDE STREET RW^
SIDE^
PROPOSED USE c y"
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
Garage/Carport
W Patio/Deck
IL Pool/Spa
0
Re-Root
Z
Commercial
m
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
UU
N
U
U.1
-J
w
0
Z
CL.
Q
Z
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING A-
MECHANICAL
INSPECTION FEE
ISSUANCE VJ
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
;I
I
mz
I
TOTAL FEES F E B 20" 2001 .
COMMENTS
RECPT. N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy