HomeMy WebLinkAbout18999 r�
1� CITY OF DIAMOND BAIt
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
(909)860-3145 Fax(909)861-3117 PRESS
��"A�' BiJILDING PERMIT APPLICATION FIRMLY
o� JOBSITE �a sk line APPLICATION ��! {r�'�'�pERMIT ��� P/C �� �
ADDRESS DATE �•� NUMBER #
1 ��L.'PE OCC
� APN LOT TRACT pq EE 1 � � lr CONST. GROUP
p OWNER �QJ�'P�
o ADDRESS�atf}e ZONING SETBACKS
gCITY ZIP TEL. FRONT RW ❑
APPLICANT TEL.S'D�X� REAR �
� SIDElSIDE STREET Ryy r,�
CONTRACTOR L �1/ L.l.� �Cf1 j9 SIDE
� CITY WAIhL1 �ZIP�II7� TEL d PROPOSED USE � 'P d
o ARCHlENG/
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWMER-BUt�DER DECLARATION
p SFR/AOD/REM
Q I HFAEBY AFFIRM UNDER VENALTY OF 7FRJURV THAT I PM EXEMPT FROM THE CONTRACTORS LI- � Garage/Carport
W CENSEUWfORiHEFOIIOWMGREA50N(SEC7031.SBUSINESSANDppOFE5510N5CODE.ANYCI7VOR (n
� COUN7YWHICNREWIRESAPERMITTOCONSTRUCT,ALTEFi,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- ijJ Pg110/DBCk �'�
TUflE.PRIOR TO ITS ISSl1ANCE,Al.SO RE�UIqES THE APPLICPNT FOR SUCH PEqMIT TO FILE A SIGNED W
� STATEMENT THAT HE Oq SHE IS LICENSED PUqSUANT TO THE PROVISIONS oF TME CANTRACTORS LI-
� CENSE UW(GHAPTER e(COMMENCINO WIiH SEC710N 7000)OF�IVISIDN 3 OF THE BUSINESS AND PRO� � POOUSpB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (!�
TION.ANVVIOLATKKJOFSECTION7o3768VANYAPPLICANTFORAPERMITSU&IECTSTNEAPPLICANTTO Z qe-Aoof
F, ACML VEWLLTY OF NOT MORE THAN FIVE HUNDRED�OLLARS(5500)).
� ❑I,ASOWNENOFTHEPPOPERTV.ORMVEMPLOVEESWITNWAGESAS7HEIRSOLECOMPENSATION, Cpmm0fC12I
WILL DO 7HE WORK,AND THE STRUCiURE IS NOT INTENDED OR OFF�qED FOR SALE(SEC�044,BU51- �
� NESSAND PROFESSIONS COOE.7ME CONTRAC70RS LICENSE UW DOES NOT APPLY TO AN OWNER OF .�/
PROPEFiTYWF108U1LOSORIMPROVESTHEREON,ANDWNODOESSUCHWONKHIMSELFORHEqSELFOR � (. � ��$
wTHROUIiNHISORHEROWNEMPLOYEES,PHOVIDEDTHAT3UCHIMPROVEMENTSARENOTINTENOEDOR m
Q OFFEREDFOpSALEIFViOWEVERIMEBUILDINGORIMPROVEMEMIS50LDWITHINONEVEAfiOFfAA1%_E
Z TION,TH�OWNE(iAUIIDER WILL HAVE THE BURDEN OF PqOVINa THq7 HE OR SHE DID NOT 6UILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,ASOWNEflUFTHEPROPEFi�Y,AMEXCLUSIVELYCANTRqC71NpWITHUCENSEDCONTpACTOqS
� TO CONSTRUCT THE PqOJECT(SEC 70a{,BUSINESS AND PflOFESSIONS CODE•THE CONTRACTORS LI- V8IU8I10l1 G'O qDJ.AREA
W CENSELAWDOESNOTMPLYTOANOWNEROFAPROPERTYWHOBUILOSOflIMPROyESTHEREON,AND
� V+Y7000NTRACTSFORSUCMPR0.IECTSWITMRCONTMCTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
� TORSLICENSEUW) FEE
0 ❑I AM EXEMPT UNUER SEC ___ B.8 P.0 FOR 7HIS qEA50N Q
3 �
� DA7E OWNER F
2 U
� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDfR PENALTV OF PERJURY 7HAT I AM LICENSEO UNOER PROVISIONS OF CMAPTER �
p� Y(COMM�NCINO WITH SECTKNJ 7000)DF DIYISION 3 OF THE BUSINESSAMD PROFESSIONS CADE,AND Z
�X W LICENSE IS IN FULL FORCE AND EFFECT m
� LICENSE CL4SS LIC NO. �
V D0.TE CONTflACTOR d
W
� WORKSRS'COMPENSATION DECLApATION ¢
� 1 HEFE6Y AFFIqM UNDFR PENALN Of PERJURY ONE OF THE FOLLO WING 6ECLARATIONS. Z
�Z _IHAVEANDWIILMAINTAINACERTIFICATEOFCANSENTTOSELFdNSUREf-0RWORKERS' a
Q
COMPENS�710N,AS PROVIDEO BY SECTION 37ao OF THE LABOR CADE,FOR THE PERFOqMANCE U
Q UFTHE WORK FOR 1VHICH THIS PERMIT IS ISSUEO. �
QW _IHAVEANDWILLMAINTAINWOPoCERS'COMPENSATIONINSVRANCE,ASREpUIREDeYSECTION (�
3700OFTHEI.qBORCADE,FORTHEP�RFORMANCEOFTHEWORKFORWIiICHiM15PERMITIS '2t ' ►'
� ISSUED.MV WOflKERS'CO PENSATION INSURANC CARRIER AND POLICV NUMBER ARE CONSTRUCTION V__j_��Yi
� CARRIER s N _ __ PLAN REVIEW �
— - �l'�
Z POLICY NUMBER__...'�Q��_�. ELECTPoC _ �V
Q
p (fFdSSECiX]VNE�I�qiBEIX:M�EfEDOFR,EPERW�SFORCIVEHUWREDdJliN1S(f�oo)ORLESSJ PLUMBING
� i CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PEpMIT IS ISSUED,I MECHANICAL
(� SHALLNOTEMPIOVPNYPER50NINANYMANNEqSOASTOBfCOMESUBJECTTOTHE
(n WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETMATIFISHOUL�BECAME INSPECTIONFEE
� Sc/BJECT iO TNE WORKEFS'COMPENSATION PR6VISIONS OF SECTION 3)0o OF iHE LABOR
� CODE,i S4ALL FOflfHWITH COMPLY WITN h105E PROVISIONS. ISSUANCE �
�
p OATE. APPLICANT SMIP
W
J WARNINCr FAILURE TO SECUFE WURKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C __
� SU&IECTpNEMPLOYERTOCRIMINAIPENALTiESANDCIVILFINE5UP700NEMUNDFEDTHOU3pND ENERGYPERMIT
OOLLAR3(f100.000),IN P➢DITION TO THE COST OF COMPENSATION.DAMRGES AS PNOVIDE�Wq IN
� SECTION370BOFTiELABORCO�E,iNTEREST,ANDATTORNENSFEES qETENTIONFEE. �
OCONSTRl1CTION LENDING AGENCY PREALT FEE. _
� I HEREBY AFFIRM UNDER PENALTV OF PERJ�RY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C.). Y
Z
W
� LEN�ER'S NAME _
F� LENDER'S AODRESS
� TOTAL FEES ��
� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOpA1ATqNISCOqqECT
� I AGPEE i0 COMPIY WITH ALL qTV ANO CAUN7Y ORDINANCESAND STATE L1WS RELATING TO BUIL�iNG ��� �
� CONSTRUCTION,ANO HEREBY AUTHORIZE REPRESFNTATryES OF THIS COUN�`/Tp ENTEP UPON THE
z PBOVE�MENTIONED PROPEflTY FOF INSPECTION PURPOSES
COMMENTS
o '/1 �-� -
m PERMITT N �P
a l��'' p
v� � ' > > n
Vj SIONAT RE DATE �g �
= RECPT.NO. -l \ PAID BY _ _ _ _ VALIDATION
~ WHI7E—De artment Co YELLOW—Fme+roe C
p py, opy,PINK—Assessor Copy,GOLDEMAO�File Copy,GREEN—Applicant's Copy
�.:�'� ��' �P=����r.��� ����
�t����.��";��� �:��a�h"�,'
+,��` - _ - � - _ _ �-_-- _ -_ -- -_= � -t=--,= , ,_.. -_Y�_. _-_-=,=�=f�, - w�-��;,�-_
�`�� �s3j�-_ -�� . = _ � __-__ _ -__ - _ _ s-���5 F�'_` _ 1. �I�p�� �,T_,.-�.'y_� �"_ _ - _— � - ' ' -
�;-4 - '!�"*r""', ,�,_ � ..
,.._.,_ -.,.. ._. —.,�r, , ��--�-a�f:. -___ -���c�`r., _._ �, __ _ __ r =_,- ,-a-.,:��.-, �_- _._-, _ _
. ..=iYt�';. 4 ' �r`r'G ' 1 � _��t.;f�'` ', . , .. ,
r• , ., �, � �� � � , � , ; ;r
`, ::...i:::..iF '.:€•;"��.::aL. � j ' ' �eF��,:` f� -__�i:;.. �iilr;i' ' ,v
�_-- - ' �. �''-�� '
r ;s_�_ / �
.;.s-.__. ,'"'-'�' - � - ._.'_- - - --"- ------------"_ -"�' ...... i) , �' �`. . �a�: C`�.w,�,�-• �l � '��'>✓ „f'r�� '�
t;.,i�� ;6;.3n • "� �;:��'' '.t�,��.-. „•ia � �� �•�
` ' -'- . � ---- � ---- -�- —_ _--- --.__..._.._- - - ---------- -� - - - - ' '-- ._ .___._. _' '-
_. . ,. .�,.',:: _' ". ; e,-�.m �
: . ,;v- ..,; ,__ _ . . .
. .. . 4 ... i'^.C" .
_ ,
. �' ',.� i..��°,t�`ry�':�
i
_� ._ _ _'_ . _ ,_._ �.. .-_ _ ,.._.... __�.1_. ___.�_ _______._."'_'__'_. .�_Y__._. .—__ _
i ., .-,-._.. ,.,,.,._
. ...-..._�.:r-"„t " . ;J;r '-- - �-
.
, .. ..._. . �. ..,.,. � y i
� -
.f
� ,
:'
, . . . _.. _...__ _ _.. .. _ -...__,__�.. _.. .�_ .. ...__,__" _ ' _. _... ._.. . ._ _''_ ___ __ _. _ "_"� . _"' _
"'"_�_ Z+) a J�
��.�-'. ^",��..,�.�.k" �`.'-� � ! � �?' 3 .�c)!\1i.�r`''���tti I - .
,_�r: rn�r. •r�,: .. ,.riFt'`•+�. , --- - --- �____ , - j�6�4 �'1,f'r?:v_.:,i��=�- --- -- -- , _—�__. . . . -
{
_.. . . - — ----_. _. . �______ _---...- -
— - -- � - _—_ .
_ , .. ( ' �.'F-c v.'�:4�iiii���fij , , '
+ e_.' d
�._ . "' " "__ ' ..._...'�__ _'__. _.__ .. _..._—'_` ' _'__ . _._. ._. .... . _._.." ' _ ' ""' "_..." »_...,_
t :;,:sr... ; ',"r�k.!-. � g�P^G-
. . .'..�. . .�e. i " " .
� ' �2w _ �;i 3:rv i
. _ , _. ... ..�...._ ""' _ '_'_.... .....__"_ .._.___.....,.. ._ ... , _. '._"_ . . _�. . .� _ ... ,__.... "__.` .'_. ._ _ ...... _
. 4'Se"'.i i+. "��✓ ( ' �� $�t'11::1'"!� �.�:hi�` . � '
.. .. _,�. ...
.__ " `"' ' `" ""�" ' _�_.._._' w' '_" _._._ �_ ___ .._ .._ _"' '_ '_ __.. . . "' "_" ".�__�..__. .. _... .. '_""
.. .. . , i�,.3�i`, � , {�_ '°+�I.-'-i ��`�JE.'.J�" ,
.. ,
..
;;: ,�.<. .. .a� . �. _ . .. __ �--- --- ---_ _ _. - - _-- � -- _ - —.._�_— _.�-_ _ - ------__. .. .. _
..
,�.'
.:- ��;
— -- . . _ __-- -- ---- _�.. .' --- _. .._..�._...� ._�_.. _ -- — - ---
��� r- r � r
:� , . .. � :„�t,tF. ; i �NC�£;i �=�;t;�:,,,��:, � _
_ . . __,_ . __ ..._. �___ .___. __ . ._�._ ' ' _._... __,____._ A - ---- , ---, .__ ____-_ -- ---- --- - -- .
, .•:.:. . ..,,- .. .. .
. , ,. , : r,,. : .n. : ��,� ,
---- ' Cx _.t�,�n�
_ - ,- _ - . —._. .___ . _.._��..- --__ .._.___}_,_.__ _`_ .
. ., .,.. . . . ,., ..<. -- — — ---- - _ _--- . _......_ _---- —
, . , .. , . .� ,,,, '
____---_� __.___ _._I_� ` _ _ �
.,...,_
_�F`� "�� - :-�� ".�
� -•_�. �. , . ,... , ' - - - i - --_.. . - I :C.'Y.- ,. . ..itz'� ---- - - �- --- -' - _ .
'_ _ ._ . _ _ _ _ _ `__. �_ _ __�_..,._'_ .__._..__ __>.:..____'_ _____.____...___._.._ _,_. ,._,___"'_.... ,_ .'__ . .
_.. . "_
. _ . �. '"' __... .
� ., � , '.��eti.. ;...[.�.".
� , .a
_._. .. .. _._ ....._ ._ ,....'""....._.�. .�..,.- _�..._ ..�.__.�-__ _. , . __ ._.... . _"' " _ ' � ' .. . .�.
"_' ' ..�
. , . .S.' ` " y ,
_.�.., .r
,, i ' r ... . •-,�fr},r
' ____"" "' ..." ".`"_"..._'_..,._�_..� � _.«...�_..__..._.�..._,�.....____".__.� __...... ...� -- ._�....
.._ . ...... ' ( w. � . . .st 1:��... ' -.—.. . ._ ....""'r' ."'___'"_.� ._.. ._
. . .
' ' _ _-' ___. ..,_�___.._.. __..... ._�_. . . �._. ....._ ....._-b-.-
._._ _..._ "_"_.,. ..�.'.' .�__..._.��______'`____.,__�__'_ _
. '.d?..' ..it ., a. . __ _ ___' __ _
_.. y.,.. .'"_ ' "'_�."" _ _,�,[ `_ '._. _ .. . """" " _" •... . _"_ "'_ ' "_ -. . .__
, ..a a,.,:.;;J"'_ ��/�/7�r (//1�i�' , ,=f
3 .'- ..a: . . . ,--�����.�' """���rpl�_ ._.�...� '-- '- -- ___ _-_ �'_�s-' .... ; - -� .- . . - -_
..._.. ,:..._
_ " -' _ . -- -- -' --- - -. . ._ . __' .- �. - - - -- - � . --._. _._ ..
., .. - . , i ' , :"�'_,,. --. .. " � ,.
g` _" .. ...... . . . . .�_�.`. _"�.'
• f'
_••_ .� ��� "_` _ . _ "_ _ . ... . ___....._._'. . ". _.' " _
, . .., n , r , . "_
:'.•..• .,,-'C,°, . . ._. _ . _ .. _.._ _.._. .
,k± . S . . . _"' _" " " '
... .;v N, • , . .....,...__."_.._ _" '" ' " - . .
!r:Yt.�:' .. '" " p ... _._�._.. .�. . . � _... . . _._ _ . . - " '_
d,J,g;.:rA+Y: , , . • • . � , _
.., ' .. A , ...... _ �__" - , - ._. . . . _
� � �� .t�a ,. . �.. ... . . .. . ... .. . _.._.._. _ _ _ ' '_
. e+Y"�.',...Ner'�. .. .. �. � ' � ' ' ' .
PIAMOND BALI i
PRESS FIRML
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
JOBSDRESSIT E 650 sk tine
AD
APN LOT TRACT
OWNER S+ r. ke ..S
ADDRESS X ARO/e
CITY ZIP TEL.
APPLICANT_att4/,...1.:4TELI0 7.57 r 54.5/r
,,.. t_ 'y'0, L. c
CONTRACTOR ti s ci^ '4
ADDR ES o.2 I' -47 gks-e C./te)
cm, 1.)I ZIP 9 il 7 TEL. 90%.9qg's.45 K
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PEFUURY THAT I AM EXEMPT FROM THE CONTRACTORs LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESS AND PROFESSK)Ns CODE.ANY CITY OR
CC(JNTY WHICH REQUIRESA 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 UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER 9(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 VIOLATKM OF SECTION 7031 6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLIcANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(Ssoo)).
O1,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 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 C.ONTRAC-
TORS LICENSE LAW)
0 I AM EXEMPT UNDER SEC B.a P.0 FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PEFUURY THAT I AM LICENSED UNDER PROVISIONS OF CHARTER
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 LIC NO
DATE CONTRACTOR
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'
COMpENSATK)N,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 WORKERS'PENSATION INSURANCI CARRIEFI AND pOLICY NUMBER ARE
CARRIER st" rwi ci
„Pt.
POLICY NUMBER I ii O1 "W.&
(THSSECTIONNEEDNOTBECCANPLETEDOFTHE PERMITIS FORONE H)RED COLLARS(S/03)OR LESS)
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 S4ALL FOR THWITH COMPLY WITH THOSE pRoVISIONS.
DATE. APPLICANT
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($loopoo),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTION 3708 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(SEC 3097,CR/C.),
LENDER'S NAME
LENDERS ADDRESS
I CERTIFy THAT 1 HAvE READ THis APPLIcATIoN AND sTATE THAT THE ABoyE iNFoRmAnoN 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 INSPECTION PURPOSES
�I �
PERMITI- : NP
1/4� •Ik 4*. it-11-0-z-
SIONATAiri r, •V' i^J/'1 DATE
P. N
APPLICATION
DATE
IA_rs.-4-0)..... PERMIT 1 I(. GI P/C a '..---LfSCD
NUMBER IS I #
ISSUE
DATE
' 1�, ('Ic 111M3E OCC
'CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
0
SIDE/SIDE STREET RW 0
PROPOSED
N0.
UNITS
USE
DWEL. toNA)6V\^A--P•0
N0. N0.
STORIES BEDROOMS
(.0
W
w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION
u-
0
z
SFR/ADD/REM
'Garage/Carport
Patio/Deck 1".Pjr 1 , 0
PooVSpa
Re-Roof
CD Commercial
5 5 uoi rov-ws i2-V
co
Valuation $,4j2._?_C_VPADJ.AREA
QUANTITY LiMIRIA DESCRIPTION FEE
47001.-rq,
—I
0
Ec-
1—
0
to
W .
0
Z
m
m
m
a.
c..)
-2
a
Li,
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE.
PRE-ALT FEE. 31. lo
Lio,So
• L)I 00
ft est--
III
-X•
ACC1
\\\
)\
i:7)
TOTAL FEES �All.) 1"' -.1Z-1 r)2.a
COMMENTS --&:
RECPT. N0. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
C.',ON OF DIAWkoND BAR INSPECTION Rii7CORP