HomeMy WebLinkAbout638 17TH ST - Building Permitsvn�.�n Lril 5ltlxurr 11,cV 5 reulvl a�n�il •
JOB ADDRESS 638, w. 17th Street BUILDING PERMIT N0. 2�
AP No.
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s�._ —
ROUGH PLUMBING
PROP. SWN. LINE
SPRINKLING SV51
ROUGH HEATING �NO �IR CONOITIONING
TEMPOR4RV SERVICE OR POLE
lINOERGROUND � POWER �
ROUGH WIPING
TRENCHES FORMS STEEL REINF.
FLOOR SVSTEM
fRAME ANO FLRSHING
LATHING - IN n OUT n
PL�SiER.BROWN COI.T
$T'UCTURAL FINRL
NG, VENT., REFHIG. ANO �.f., FIN�L
PL�MBING. FIN4L ANO GAS TEST n
ELECTRIG. FINAL
BUILDING, FINAL
SPECIaL REpUIPEMENTS
SUBCONTRACTOR
EIecV ical CD
7ract eiock �ot BUILDING PERMIT NO. ��mit rao. l-�93/�� c
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ql� Stroet u �v O V PermH NO. �
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Owner �j O G p— TYVe ol Aolect: ❑ New ❑ Altar �ACEilion �
AtlGress sv /"{4• ❑ Repalr ❑ Convert ❑Demo ❑ OccuoancyGmt.
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cier ��q �S � zioyz66ano�� y y A.V. 5 sD. A'rea/
Architnct/ Zone SD�. Pmt. No.
Desiqncr L�cenze No.
$etbackt P/L Froni C/L Sl. Slreel Witlth
Atltlress
YarCs Leit 9h ear
CItY ZIO PhOn¢
ave o�. e �9 • �
En9lnear Ucenu No.
C Parkinq SPaces eqwr0 ovi t OVNe
2 ACtlIciS
ry C" Z' Pnone Snuct No. 01 No. of
a Y P Helqnt Storfes Family
� LICENSED CONTRACTOR'S DECLARATION aark Fees ves Fee
� Reauiretl No C.T. 0.eceipt
n I hero0y atfirm i�at 1 em licensetl untler provisions ot ChaDter 9
� Icommencinq with Saction 7000 07 D�vision 3 of t�e Bvsiness antl Zp���9 q0��ovetl By: Date
Proimsions Cotle, antl my license is in tull tOrce antl eHectl.
y License Cles License N�m�er
T Date ConVactor Misc.
E nea�o::
Propoietl 115G
� ol5trutture
y CityantlZip Phone
H CONSTRUCTION LENDING AGENCV
� 1 heraby atfirm that there is a consir�ction lentlin9 agency tor the
L performance oi the work for w�ich [his permit is issvetl (Sec. 309], ���' TyPe Coae
Civ. C.1. Clazs Const. �'ear
y Lendar's Name USE/OCCUPANCY SIZE S�. FT.
C Lender's AOOross
� OWNER�BUILDER DECIARATION
: I �araby affirm thex 1 em eaempt lrom t�e CoMranor's Licansa Law ��
� tar tha fol�owinB reeson:
� � I, es Owner of t�e prOperty, or my amploYaes with waBes as t�eir 2.
� sole componsation, wlll tlo tha work, entl [he nruct�re is not
� intentlotl or oHaretl tar sala.
3.
- ❑ I, es owner of tho property, am azclusively cOntrectinp wit�
� IiCBnsBd COnSIaCtOI{ �O cOnSilUCL the prOjBtt.
v ❑ I em exempt untlar Sea �&P t .[�is r 4�
a oata 6`Z � �l/ Owner � �/«
E WORKERS' COMPENSATION DECLAR pN Total Vaivation
I �aroby atfirm that I �eve e certificata of conuni �o seM�ins�re,
or e certifica2e o� Workori Compensation Insuronce, or e cenifietl Encroacnment Farmtl ReqWreE ❑�'es ❑ No
C�p coOY theraol. Grading Pmt Gratling
y Policy No Compeny ReOUi!!d ❑�'�5 ❑ NO PTt. N0.
❑ Certifiotl coDY �s �aroDy t�rnis�atl.
a Rough GraEinq �
s� Ce.xitiaE eo y la tiletl wii� Ora e Cov A. m
_ � � • Approvetl Gy: Ddtt
Det• APPlicen[ 3
��CERTIFICA E OF EXEMPTIO
FROM WORKERS COMPENSATION INSURANCE 2
(T�is soction nea0 not be como�atetl il permit is for $100 0� lessl. �
I cmtity �hat in iho porformanca oi tha work lor which this parmit is Q
issuetl, I t�all not emplOy any person in any menner ao as to becomo is
subject to the Workori Compensation Lews ot Celifornia. PERMIT FEES
Daia Appliceni
NOTICE TO APPLIGANT: H, d�er ma4inq ihis Cmtificete o1 SVutturdl S PoanUeCk S
Exampilon, you sho�ltl Gecome subject to 2he Workers' Campensetion
provislons oi t�a Lebo. Cotle, you mesi fon�with comply wit� fuch E�a�t���� Soecial
prOvisions or tAif Oermit thall bo tleemetl revoketl. f ���eil. s
I CERTIFY TMAT I HAVE READ THIS APPLICATION AND STATE p�um�Ing S
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL COUNTV ORDINANCES AND STATE LAWS
HELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH- MethaniWl f
ORIZE FEPRESENTATIVES OF TNIS COUNTV TO ENTER VPON
THE ABOV M NTIO d PROPERTV FOR WSPECTION PVR- pro-GraOe -
POSE . /_ z`_ _ c/ �nsoection 5 .
6 6 � Ro-Gratle Pormit
5' ature ot Applice x r Apant Dete qec. No. s Issue s
LEo S�� o FF
Prim Applicam's/ABenYf Name
All specas within this box musl be tompleted to prortss P�an Iss�ance
Cneck ey: Aoo�ovea:
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