HomeMy WebLinkAboutPOTTERY WY 409_18-1771C I -ry C-) f-
LAJ<E
DREAM
1 0 a
31411 N 03 WHO W "0111140y Me
VALUATION CALCULATIONS
ist FLOOR SF
2nd FLOOR
3rd FLOOR
GARAGE
STORAGE
DECK & BALCONIES
OTHER:
VALUATION:
FEES
BUILDING PERMIT $
PLAN CHECK
PLAN REVIEW
SEISMIC
PLAN RETENTION
_SF
SF
SF
SF
SF
SF
0 1 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 Insp-
tion purpo-*04,
Signature of Applicant or Agent Date
gent for E:1 contractor 0 owner
gents Name [�Zid.6&'
Agents Address
Street city state Zip
130 South Main Street
MMOMN - / 7 7/
APPLICA,�N RECEIVE
DATE
AP #3�
BY
SUIE51140
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TRACT BLOCK/PAGE f LUI/f-ARCr.L
NAME'g
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AILIN
M DOR G PHUNt--
ADDRESS
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I hereby affirm a am Icense un er provisions of chapter 9 (co-r-n-me-n-cTn—q
with section 7000) of division 3 of the business and professions code,and
my license is In full force and effect.
LICENSE * CITY BUSINESS
AND CLASS TAX#
T
R
NAME _k iE _,So jti_
A
C
MAILING
ADDRESS G LAI, si 4&0
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0
(ATILM4 &_j4'k�STATE�r �Nyo
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CW�'SSIGNATU -DAIL
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NAME LICENSE #
*
*
MAILING
ADDRESS
H
CITY STATF-1zIP PHONE
0 NEW
OCC GRP, CONST.
DIVISION: TYPE:
0 ADDITION
1:3 ALTERATION
NUMBER OF NUMBER OF
STORIES: BEDROOMS:
0 OTHER
[31 SINGLE FAMILY
0 APARTMENTS
ZONE:
13 CONDOMINIUM
HAZARD YES
AREA? NO
0 TOWN HOMES
0 COMMERCIAL
SPRINKLERS YES
REQUIRED ? NO
0 INDUSTRIAL
[3 REPAIR
PROPOSED USE OF BLDG:
PRESENT USE OF BLDG:
0 DEMOLISH
JOB DESCRIPTION
wi V u P,4, 4.:
W10L 141 am licensed under the provisions of Business and Professional Code Section 7000 et seq. and my license is in full force.
2. 1, as owner of the property, or my employee wtwages as their sole compensation will do the work and the structure is not
intended or offered for sale.
3. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project.
*-I have a certificate of consent to self -insure or a certificate of Workers Compensation Insurance or a certified copy thereof.
5. 1 shall not employ any person in any manner so as to become subject to Workers Compensation Laws in the performance
of the work for which this permit is issued.