HomeMy WebLinkAbout15581 CITY OF DIAMOND BAR EXP►RED
--��-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190 MAY �9 ?003 pRESS
�������W BUQ.DING PERMIT APPLICATION FIRMLY
o� JOBSITE �"��--�T_��� 1 Q� h I j1�'� DATEICATION � � G�� NU BER �`��I #1C �U ��
ADDRESS t"7 «
� ISSUE /� � TYPE OCC
APN LOT TRACT DATE ` V CONST. GROUP
°C OWNER —�--.� `�
o ADDRE$S •��� � �I\�� i ZONING SETBACKS
Z CITY ��'ZIP 3 TEL R�RT RW �
� APPLI ANT ' TEL. SIDFJSIDE STREET RW ❑
� CONTRACTOR_T•� L � �+ � SIDE ❑
� ADORESS � +' ��- �' �`' '��.+=�
� CITY � ��,,.,.�- ZIP TEL. �— PROPOSED USE � �
w ARCWI�����`tl` -�/- ��
Z DESIGNER f,�?.� r+t,� L� J�
� ADDRESS r'-'� � NO.DWEL. NO. NO.
UNITS STORIE � BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
¢ OWNER-BUILDEF DECLARATION SFR/ADD/REM
O
� I HEREBY AFFlRM 11N0ER PENALTY OF PERtt1RY TH�T I AM EXEMPT FROM THE CONTMCTORS ll� Gdf898/C8/POff
W CENSEUWFOR7HEFOLLOWINGRFAfiON(SEC.703158USMESSMlDPROFESSIONSCODE:ANVCITYOR (n
U COUMVWHICHREOUIRESAPERMITTOCONSTPUCT,ALTER.IAIPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8I10/DBCk
w NRE,PRIOR TO ITS ISSUANCE,/�LSO REW IRES THE APPIICANT f-0R SUCH PERMIT TO FILE A SIGNED W
STATEMENT MAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll�
� CENSE UW(CM/�FTER i(IXMIMENCINO WITM SECTION 7000)OF D�VISION 3 Of THE BUSINESS AND PRO� LL' POOVSP2
FESSIONSCOOE)OflTH�THEORSHEISE%EMPTTHEREfROMANDTMEBA515FORTHEALLEGE�EXEMP� (�
TION.ANYVIOLATIONOFSECTION7031.5BVANYAPVLICRNTFORAPERMITSUBJEGTSTHEAPPLICANTTO Z Re-Roof
� ACML PEN�LTY OF NO7 MORE THAN FNE HUNORED DOLURS(S50o).):
,„ � ❑I,ASONMEROF7HEPROPERTV.ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENS/TION, � CommefCial
MALL DO THE WORK,AND THE STRUCTl1RE IS NO7 MTENDED OR OFFERED FOR SALE(SEC.7041,BUSI� J
� NESS AND P/Y�FESSIONS pJDE:THE CONTRACTOPS LICENSE UW DOES NOT APPLV TO AN OWNER Of ? � „
PROPERiV WF/O BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELFOR HERSELF OR
Q TNi1IXlOM HIS OR HEfl OMM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENOED OR m
QOFFEAEDFORSALEIF,HOWEVER,TiEBULDINGOFIMPROVEMENTI550LDWITHINONEVEAROFCOMPIE�
Z TpN,THE OWNER-BUIIDEF WILL H�VE THE BURDEN OF PROVIN6 THAT HE Oft SHE DID N01 BUILD Ofl -
� IMPROYE FOfl TME PURP05:=OF SALE).
w OI.ASOMMEROFTHEPROPERIV,AMEXCLUSIVEIYCANTRACTINGWITHIICENSEDCONTMCTORS
� TO CONSTRUCT hIE PROJECT(SEC.7046,BUSINESS AND PFOFESSIONS COUE:7HE CANTRACTORS LI- V81U0110l1 / ADJ.AREA
W CENSELAWOOESNOUPPLY70ANOWNEROFAPROPER7VWHOBUILDSORIMPROVESTMEREON,AND
� WFIOCONTRACTSFORSl1CNPRQIECTSWI7NACONiRACTOR(S�LICENSEDPURSUANTTOTHECONTfiAG QUA DESCRIPTION FEE
TORSLICENSELAW.).
� ❑I AM EXEMPT UNDEFI SEC._ B.8 P.G FOR THIS REASON Q � � �
O U _.
3 - �
LL' DATE OWNER ~
W
� LICENSED CONTRACTORS DECLARATION W '�
� 1 HEREBV AFFIRY UNDER PE:NALN OF PERRIRY TH�T I MI UCENSE�UNDER PROVISIONS OF CHAPTER �
p„ a(COMMENCINO WITM SECi'pN]000)OF DNiSION�OF THE Bl1SINESS ANO PROFESSIONS CADE.AND Z
X MV LICENSE IS IN FULL FQFCE AND EFFECT. �,. � �, �
l!J � j � _y / f m f' , �„ t
� LICENSE CUSS ��{ (� _ LIC.NO. � v'� ! + �� �� _ � �
~ DATE ; � 1 CONTRACTOR � , - ��
W �_:� � _
� WDRKEflS'COMPENSATION DECLARATIO � ]I�
� 1 HEREBV AFFIRM UNDER PI=NAL7V OF VERIUFY ONE OF THE FOILOWING DEC . '�
� ; Z
O IHAVEANOWILLM/11NTAIN�CERTIFICATEOFGONSENTTOSELF-INSURE ' 2
� COMPENSATION.�5 PROVIDED BV SECTION 3�oa OF THE UBDfl CODE,FOR THE PERfOHM CE W
, OFT}IF WORK FOR W411CH THIS GERAl1T IS ISSUED. �
0 { /)
W yl�I HAYE AND WILL M�iINTAIN WOflNERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION
Q � 37000F THE LABOfI CODE,FOR THE PERPoRMRNCE OF THE WORK FOR Wl�1f.H THIS PERMI715 �s C��
J ISSUED.MYWORKLRS'OQ�APFNSATIDNINSU,qTeurc CARRIERAND��PpLICY/NUMBERARE: �CONST—RUC�TION
¢ _f. �% �j.�-{,v�L..(.�.�,6 PLAN EVIEW' .'' -
� CARRIER �'L`'3—--- � �f�
ZPOIICY NUMBER__ ��- - � ELyC;T�IC _ __
Q Lr * r l/
0 (fYi55Ecrnr�NE�NOTBE DOF'7HEPEro.rrlSr-0iioNEwFDaE (S or1 y PLU BING --
W �
Z I CERTIFY THAT IN 1'HE PERFOPMANCE OF fHE WORK FOR WHICH THI PERMIT I51 S M C AL '} ' �``t� _
(} SHALL NOT EMPLOY M!V 7ERSON IN ANY MANNER SO AS TO BECOME UBJEC?TO T . '
uJ WORKERS'COMVENSATION LAWS DF CALIFORNIA.AND AGREE THAT IF ULD BE OME SPECTION FEE v�
SUBJECT TO THE NIORKERS'COMPENSATION PqOVISIONS OF SECTION 37
Q 9E �RHWITHCOMPLVWITHTHOSFPROVISIO 5. � / ISSUANGE -
��� , �, ! J f- ,PM
' IL - SMIP °�� � ''
O WARN�ING�FAIWRE"OSEC� APPLICANT '�` � " L �.. . � .�.� —-."
� AJRE WORKEflS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C ��
J SU&IECT AN EMPLOYERTO CRIMINAL PENALTIES ANO CNIL FWES t1P TOONE HUNDRED THOUSAND
� DOIURS�0100,000),INADOITION�OTHECOSTOFCDMPENSATION,DAMAGESASPROVIDEDFORIN ENERGVPERMIT �
� SEGTION 3]080F THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. RETENTION FEE: ��
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER F'ENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV __
� FOR THE VER�ORMANCE OF THE WOPK FOR WHICH THIS VERIAIT IS ISSUED�SEC.3087.CIV.CJ.
Z
w
� LEN�Ei7S NAME .__._-
h= LENDERSADDRE53_ �
¢ I CERTIGV THAT I HAVE REnO THIS APPLICATION AND STATE THAT THE ABOVE MFORMATqN I5 CARRECT. TOTAL FE ES ,�' �� �
W 1 AGREE TO CAMPLY WITH ALL CIN AND CAUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING -.
� CONSTRUCTION,AND HEREBY AUTFIORRE REGRESENTATNES OF THIS COl1NN TO ENTER UPON THE
� ABOVE�MENTIONED PROPERTV FOil INSPFCTION VURGOSES- CO ENTS
o </ l �� �.'
J
m PERMITTEE NAMF��(VRINT) '��/� /
Q � r.�. . � � . `, ,
� - � n '
� SIGNATU EOF � I_ '- ATE ,
_ -� RECPT.NO. PAID BY VALIDATION
~ WHITE—Oeparlment Copy,YELLOW—Finance Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
��T� �� �� �3�� �
�P������`��?� ������
� � _ � - � r . � .
� ��T��, �i � ' t��� �,���,
� _ ___. . .� _ — -- _ _ _ _ _ _ _ ._-- _- -- -�� �
�"i , ��` "P�� "?l=� ��� ��� �� �' �` �� �
_ _ �
� _ _ ` � — -. . �_ _ _ _ __ __
� r �; � t�rg ;_ , , ' �� s r,-,�- - �
s — _�it����� � - _ �
� _, , t •. _� - � ��r� r , ; ,
�
�- ,-� -.
�_ _ ____� __ ___ �_..._ __ _. __. -----, . ___
` t=it..',_ _ �;�'• '� '� �"�.��,� .;3,' i r3 �.,A.� ._..... _, ..
`-- -. __.. __..., __.. _ . ._..._ __,._ . �,.__ . __ ..._. . _. ........ .._.._. _ ._..._ _ _.__ ._... .. . .
°'�_�1 C (';t, �: c ''n P_;�i��i , s�
,
� .�_ � _, _ �_, _____ __..___.____�_ _ _ _ ______ , - -_ __ --
�,_`� � `^-'�- # ;i_ �,� _� �_
m�,�.�3� .�_, ; , � �..1,;�_ , ; �
;� ___..._. - ___�__ _—__�._ ._ ______—____ ,
_ _._. � ._. �.__ . . _._. __. _ __—. _ _
� �z��c.� �,� �, �`'��� � � r '3"'���`iF�ts',°�
� ` � ;�
,, �t . ,
� -_ _._ __ _ ____ _____..._.__� , , ___._. . _ ___ _.__ _.. __ _
9 :�� �,A;.'•" �� 3tt. � , t'; R�=��,�° ��
r,_r
,_ _. _ ___�,. . — ,—_- ___ _�.. . __ _ ______ _ _. _
.
� ,
�� -�g �� � �:�.� `,�_d,�, Tv,`; �
� '_�__ . _ �...: ---_____. � -
�, � � — ��- 1 j e ,� _ __. _. _ _ _ _ ._ _
_ . ___...� _. � _. �____ __�_�_ _ _ _ ___
�������'� t; _.� -� ; '�������, ._ � � r i � c�A'}��;� � __ _� _ _
_ _ __ --- - _ _. _ -- -
s�t: ,�._iw� _ ; � ,
� ,, --. �.__ __ _ ___._ . - _ _________ _ _ _ -- --- - , -- _
' :" `°',i �� i�,� �t �-��.
.
. : . � _�L �� �
�. — _ _.__� _�._.___._.______ . __ � I�;,.._. _� ___ _____.____ __ __ ___
.. � . .�.. _ �r r r ��..
. .. . . . . _ ___ ..�.._. w_ _- __...__._. _ _ � _._ . �_ — .__ _......
. ,�, .t .. .. ��.i , r 5 3"�°.i,�+�..� �� ��
, �,� .� � ,a, s�.
, � , F
. . .� . — _e...._..� .._.. —.__. _.._.....r. —, — - -- . __ __ _ �..�.__.,.. __..____� _ __.. .. .
. _ ,. . e . � .. . ._. , ��._. �.
. � _._..� . .__. ___......_�._ .. _.r . � . ... �— . .__ ..._. __.. _._ ..
_ __..
. .-_ , -_ . � . _ � ai. ' i , � :�„:._}.A:`.` . ...�.
s= ..
_.
'"__ '_"_ _�_. . ........�__...... __ � . > ... i
... ., _.._. __ .. .__.. _ __.___._........ . __... t -_
.... ,.._..
, ,_..� . . : .�..., . .— .... --� .
� —_� f_..__� �.___' ,. .—�._ ,. , �
_ "_'___ __.._y
,"".. . ...... ;.._ ,. .:3 ... .__ _....._... ...._. .._.. .......... .. .
• _ . . . ." .. -. . .... ''`" S„� . ��.
� e
_......,. , . . �_.._..._ ._ .....,...._.w ..—...... ..�1_.,___._ . .
._—._._......._.._� . __ � .___ �_—' _._.._ _...........�_._.
� � i r? , — _ 'i�T�_......— .... ... .
. _.. _.. ' _ ., ,.3 e „ �� .
. _ ' '._'_ ...._., _ .e..___—..._�._.._.__ ._ __.__,_.... �..�...F. ._. ..__ ....__._._.___ �_"_—__... __.. ..... .
." .« _ __.._ , .. ._.
.. ... . ,.�. . , ,_ �.__ �.
,. __ ._.___,.. . '�.'—_—_'_ _,.._._._ __.. .._..__.4—, . ,. ... ._ ..._ .._. _._. .__. _ ._.... ...... ..... .
. ..,- ._. ,.r� -�
. . , 'F,�.�_ �. . _ ._. , .._ �. . �
, _ . ._ . ..._ .._�....__ ___..__ .�.._.._ _'.__ '_,._ . �, ._ _. _ ._... _ ___ _."_ ..... _. "_. . . _ ... ._. . .
��. . :': t.' .
.. . _ . ... . ...... .. ___ ......_ ._ _... . ___ � �„y... . �� __ .._.. __.. ._._ _... . .. . .... .
�'?s".�� �$ �• ..� . . ,,. .
....... ., ..._ .. .... .... .,.__ _ _.. ..._... ,. ., _.. __ ,..__.'_"'_W. , w�:. . .� . , . .... ._.. . ...._ ....... .._. .
'x'� ,. ��2`�-�>.___�_'P_��.��?,� ¢s�ut`�._...r,� �!!�M4�� _�' . __.__.� ____ _
. � .��n � �
�
�
��__.__ __ _, . �-- — _..___. ___,_ _ _ --__. ___ __ __ _ _,__.. _
� ____ _ _ __ — __ __ �
�______ ___, _. _ __— -- _ ____ _ ____ _ _.___._ _ _ _. __ _. ___ — _ _ �������
;
�
, __ _ _ __. _ _ __ _ _
;
�
�____ _ �_._._ , _� _ —_.__ .__....._ ____ __� ._.__ ____ . _ . __._____ __ ___ ..___ ._.__ . _._ __ —..._._. ____ �
� �
;
__ __ _ _ _ _._ . _ -- _ -- — _ _ __ _ _ _ �
�---
�
, _ _ . _ __ _ __ _ _ _ __ _ _ . _
° ��E ,t .E_,= sr" � . _ '
f �-�� ��_� ��_ _..._ _ _ _ _ _
tv�_ ,
`� �p,,.. Y,r+13F � ' o ._.... ..._ ��.
f ' �� .a... .—. � .__. __. ._ ._ ..__ ._... _._ _.. ...... ..
a ._ �4'¢�I�b '.." . . _
9 y
E
� _ ......_._..., . ...... .....,. . ...... ...... ...... .._.. _..... . .. ... ...... ... .... ..... ..
!j __ . ...,-...__...... .._,_._ .,_.... „._ .._. _ _ —_ _ .,_v.._.._, _._ ....... ._... .__ ....._ .,..._.. .�.
9
S ,.. .,,__..—....� .�._...._.,. >. _ _� . _. _.__ _ ...__ ...,.. __� ...,. _ .._ _.. .. .... .. .. _. .. �
1
q .,..,..... _�._�. ., m...,..._._.,. . "___ _... .__._ _._ ..._. ._.._ _....._ ._.... _.. ... __.. . .. .
�
X
� . . .:-� .: .N ...... . ...... ..... ....... ..... ..... ...... .... .. ........ .. .
� _ __" ___ '_. .
�. ...«�,......e,...,_.._....�.-e....w.w..n... . .........�._...:,.....��.....,,.�...,.,_..._....« ...w.� ..e.�aa.. ,_._.......«�.....�.........�,,...,. ...:,. ........... .
DLtMOND BART
I a•rslt=,R
JOBSITE
ADDRESS
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMTT APPLICATION
APN LOT TRACT
OWNER
ADDRESS• 3s
CITY-ZIP TEL.
APPLICANT TEL.
CONTRACTOR._
ADDRESS
t
' rN
CITY ZI� TEL.th " '
f^o�
ARCFU
DESIGNER
ADDRESS,
CITY
ZIP
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 REQUIRESA PERMITTO 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 Y(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 CML 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. 7044, BUSI.
NESS AND PROFESSIONS CODE:THE 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 COMPLE-
TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
0 I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCTTHE 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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
^ I AM EXEMPT UNDEFI 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
Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE WAD EFFECT.
LICENSE CLASS LIC. N0.t['_
DATE CONTRACTOR I-�
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEC
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE
COMPENSATION.AS PROVIDED BY SECTlON 3700 OF THE LABOR CODE,FOR THE PERFORMANCE
jl��//f,r OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
r I HAVEAND WILL MAINTAINWORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
rT rT 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
Y NUMBER ARE:
E CARRIER AND POLIC
ISSUED
MY WORKERS' .IPENSATIOON INSU
I
C
{
/
POLICY NUMBER
Jr
1
TEL.
(THIS SECTION NEED NOT BE CX vA-ErED OF THE PERMIT IS FOR ONE HUPDRE
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THI
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME
WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTlON 3
COgE,I SH FOFITHWITH COMPLY WITH THOSE PROVISIO S.
I
DATE:J, mi L APPLICANT:
WARNING: FAILURE'0 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(2100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
CONSTRUCTlON 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(SEC. 3087,CIV.C.).
LENDER'S NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
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 INSPECTION PURPOSES.
EXPIRED
MAY 0 9 2000 PRESS
FIRMLY
APPLICATION PERMIT I
P/C 00��
15-96/
DATE NUMBER
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ^
REAR ^
SIDE/SIDE STREET RW ^
SIDE I If 1, ^
PROPOSED USE
N0. DWEL. N0. N0.
UNITS STORIE BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION
SFRJADD/REM
CI) Garage/Carport
LU Patio/Deck
LU
LL Pool/Spa
Z Re-Roof
Commercial
I�w
m
Valuation AD I AREA
OUA DESCRIPTION FEE
15 'Eiazl
U -
W
U
LU
J
W
Z
2
W
o-u
-CONSTRUCT
ION
PLAN II IEVJ�
ELfdCT IC
EING
PLU BING
AL
MC
SPECTION FEE
ISSUANCE UANCE
SMIP 's7
ENERGY P/C '
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES O1
CO ENTS
n
RECPT N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy