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130 South Main Street
�PPLICATION NQ.— n'w
APPLICATION FOR W
APPLIGA,/I N RL- elyF-D
IBU I LDING PC, RMIT DATI=-
AP V
VALUATION CALCULATIONS
guCul REP�i
I at FLOOR SF II L-A UBIN 924530
TMAZ LO
2nd FLOOR SF TJ
3rd FLOOR _SF 0
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GARAGE SF N ADDRE. S1141-11s 41+1. 0001
E (A
STORAGE SF A
I howhy of trill
DECK&BALCONIES with section 7000)of division 3 of the business and professions code,and
C Y license Is In full force and effect
OTHER: SF CITY BUSINESS
�N :LASS TAX#
VALUATION: R
A MAILING
0 ADDRESS
FEES T (;Ily S IXI C72113 PHONE
0
BUILDING PERMIT R At Utip
PLAN CHECK NAM LICEN51Z OY
A
PLAN REVIEW R MAIEFKTC;�—
C ADDRESS
SEISMIC H '.Ty
PLAN RETENTION 10 NEW OCC GRP, —66NST
M ADDITION DIVISION: TYPE
0 ALTERATION iZiiBiER OF NUMBER or
M OTHUR STOWLS:
d:qINGLE FAMILY ZONE'
0 APARTMENTS
I certify that I have mad this application and stale that tho C3 CONDOMINIUMS HAZARD YES
above Informstiort is correct.I Agree to COMPOY With all City 1;2 TOWN HOMES AREA 40
and county ordinances and state laws relating to building 0 COMMERCIAL SPRINKLE-FtS YES
construction, and horoby authorlz^representatives of this 0 IN13USTRIAL ItEQUIRED? NO
city to enter upon the above-rnentloncd property for Insp- 171 REPAIR PR0l'06I;-'0 USE OF BLDG.
00A purposes. t7 DEMOLISH PRESLIN-f USE OF BLDG:
JOB DESCRIPTION
q_'U tit_
Signature of Applicant or gent Date
Agent for E] contractor L1 owner
Agents Narrie_-- N
Agents AddIress-..,
19EM IN
Stroot city State Zip
1.1 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 w/wages 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.
4,1 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 lit the performance
of the work for which this permit is issued.