HomeMy WebLinkAboutPermit Historyil,i
j:
CITY OF SAN LUIS OBI$PO
PERMIT for COI/STRUCTION of
DFIIVEWAE SIDEWALK, CURB AND GUTTER
LOCATION OF WORK:Da,t9 ----
Street Address -Owner
St. betrveen
N1
Address ---t*-----
Contractor
Phonc
trinal Survey by
Cut Shcct by -------
Orvner Notified by
Ii'orm Inspection by
N. S. E.
tD+St. and -
-- Block
DESCRIPTION O[' WORK:-"-Z""ffi;
concr.ate Driveway widur-.--l b-: =Length--l 12: -
Constluct Concrete Siclcrvall< Width---*
Constluct Concrctc Cur.b and Gntter - - tength
---- - -To Ilcpai
RtrNIARIG:
trinal fnspection by ---.-___
AGREEMENT: t\ll work Tterfo,rmed yndey this perntit sltall be hr accordance. uith the Stnrtrlot'd Plmts nrttl Sltccif icatiorts ,
Concretc Driveway, Sidewttlk, Curb uul Guttcr in th.e City of San Luis Obispo and the Genersl Provisiops in tlie rcversc
-NO CONCRETE IS TO ]]E PQURED UNTIL FOR\,UNSPECTION IS-N,{ADE AND APPIIOVE]
DEPARTMENT OF BUILDING
Cruv or SeN Lurs OsrsPo Permit to Erect Sign varuation: n )bQ,-A-
N9
Date ----
(1/z of t%)
1 903
Fee: $-\,-6D-
(Minimum fee $1.00)
Neon
Other
Fluorescent Plastic-------;;;)S-- wood X
DESCRIPTION OF SIGN
Metal
Other
Single face
Double f.ace -
Other
Length
Thickness
Weight
1!#Er:Amperage
Wattage
U. L. No.
Shop No.
LOCATION INFORMATION
or, Lot --- --Blk*----Subilv
.D,
F---
L
Date granted--Variance requested
N,.lry7bsteet-Lb:W
Contractor
Address
INSTALLATION INFORMATION
Flag length
Roof
Wall
Structure
Other
Use permit required---- Date granted---
Owner
Address
Center mount
Base mount ----------
Susp'd mount
Flush mount
b
the to
srgn,
regarding
permit
the
Luis
at any time upon viola-
Inspectar of Building
Owner
AGREEMENT: In consideration of the issue and delivery to me.by the Inspector of Buildings.
posed work in accordance with the description set forth above and accordrng to th,e Plovlsrons or
f"* rr.i"J by me and contained in the above permit are true as therein_ stated'- I also agree
;;;;ii;;r;;e d;;F which may accrue froin the use or occupancy of the sidewalk, srreet
the Pro-
thethat
harmless
By
DEPARTMENT OF BUILDING
Cmv or SeN Lurs Osrspo Permit to Erect Sign Valuation: $
N9
Date
(1/z ot t%
(Minimum fee $1.00
LOCATION
*,WT.b-- street-
or, Lot-----Blk----*Subdv
roN
---- Date granted-Variance requested
Contractor
Address
INSTALLATION INFORMATION
Susp'd mount Structure
Flush mount Other
Use permit required---- Date granted-
Owner --
Address -
Wall
Pole
Roof
Flag length
Center mount
Base mount ----------
DESCRIPTION OF SIGN
Fluorescent Plastic-------
Painted X- Wood
Neon ---- Metal
Weight
Other Other
Len$h -la2L _{_:l_t_'__--Amperage
WattageHeight--
Thickness U. L. No.
Single face
Double face ---
Other
ALAg?
Shop No.
copy reads -&-Ws Hz-UA*-1JiX -
lnqteetor of Building
Owner
I
AGREEMENT: In consideration of the issue and delivery to me.by the Inspector of Buildings.
Bosed work in accordance with the description set forth above and accordrng to tne Provrsrons or
f".r, ,r"t"a by me and contained in thi above permit are true as therein stated._ I also agree
i;;; ;iil;'""d d;;;g;;.hi"h *"y accrue froin the use or occuPancy of the sidewalk' srreet
the pro-
that the
harmless
By
(
/
,/
CITY OF SAN LUIS OBISPO Business License tr
PLUMBING PERMIT ilH'.rfi:.,,,,[..,.,r,
This oermit is issued with the undersisned applicant's asreement and acknowledsement that all work will U'dirutti""l6td#"3 v u re a
with bity C)rdinances, including a"y slecial iequirementi and other applicable lails. This permit becomes invalid if work is not
started ;irhin 60 days. This peimit do'es not inilude permission to -i[* any structural altirations or install electrical, sewage or
sidewalk facilities.
fiit'?,?'il 4zoileI l] *"1'li';
N o
D - Piri0
FEE
3736
' -':r |', i',
$47,N
Fixtures
- Bathtubs
-'4---Showers
-fi--L^vatofies
---l---Water Closets
------Kitchen Sink
------Floor Drain
------Laundry Tray
--1---urirr"l'
------Water Softener
------Clothes Washer
------Dish Washer
------Disposal
------Grease Trap
--l---Dri'k F,.,.I
---L--Slop Sink
------Other
------Other
------Other
------Other
----------City Clerk.
fn accordance with the requirements of Section 3800 of the California Labor Code, I, the
undersigned, hereby state with regard to Chapter 9, Division 3 of the Business and Pro-
'fessions Code:' 1. I have a valid California State Contractor's License in full force and effect with
lnspecnr of BuiV'ls.
-COVERAGE-Check appropriate box (one must be checked, Sec.
3800 Calif. Labor Code).
ty'C"*iti"rte of workmen's comDensation insurance, copy thereof or certificateq of consent to self-insure from Director of Industrial Relations, has been
filed with the City and is still in effect.
n The permit sought is for one hundred dollars or less.
the following classification and license 4pmber:. Classification ________ ___-_{q1__,a__I____________ License No. ________
2. I am exempt from these prolVon; by Jeason of the following:a. I am the owner of the property described in this permit application and I am' building or improving slruitur-es thereon for my own occupancy and not to be
offered for sale.b. The work involved is of a casual, minor or inconsequential nature and will not
exceed One Hundred Dollars ($100.00) for all labor, materials and other items.
c. Exemption is based on the following section of the State Contractors' License
Special Requirements
/lt
Owner
Occupancy
Contractor
Address --
Fees
$_____ 2.00
-15-'-st
---E-,-&-
--Ian-
--/'--.*-
on&7.
_^_
_Q1_r0n
Items
------Gas Heating
-*----Water Heater
--1--G", o.rtl"t
--l--Water Piping
------Drainage Pipe
--J---f^*nsprinkler
------Fire Sprinlcler
TOTAL
-Fixtures
l--Permit
Conn.
Gos Applionces
------Water Heater
------Space Heater
------Furnace
------Wall Heater
------Gas Dryer
------Register
------Flues
Law: Section
fl
l'J:'?.?:15 It aloeE DCTii*
CITY OF SAN LUIS OBISPO
Heofing ond Cooling Permit
This permit is issued with the undersigned applicant's agreement and acknowledgemerlt that all work will be done in accordance
with bity Ordinances, including any slecial iequiremenii and other applicable laws. This permit becomes invalid if worh is not
started #ithin 60 days. This iermit ioes notlnclude permission to-install electrical, plumbing, sewage or sidewalk facilities.
Business License
Permit Card
s"ffFEZ-?5 Faoo?5 Ng ^,,, 1()s3
FEE;,&7' N
'!, ,',t!
$,; ; .,i-) -l
Number SCHEDULE
Heoter: Suspended - Wsll - Floor
Combustion Products Vent ----.---
Repoir, Alrerotion or Addrtion
Boiler, Comp. or Absorb. Unit: -.---------- H.P. BTU's. ------
Air Hondling Unit: CFM .--"-....
Evoporotive Cooler
lncinerotor, Commerciol
?l-1 t,./ .#T.l @: l.a:afl- ;iu ; A - ;;il; : ;;;;.
Do
Owner
r,"JSIs:
g*
----,.r---. Gos Pipins/@ $.30 per outlet. Mi:h other j4z UUtzt,a-a-c_---.
Vent System: Single Duct - Multi. Ducts - Greose Hood -----------------
Loco
Occuponcy
Controctor
*-lD,^^
Address
Speciol Requirements
!!*^**
ru-!"
of Buil"dir
nimum $l.50
-----CitY Cletk.
fn accordance with the requirements of Section 3800 of the Califo-rnia Labor Code,.I, the
i"j""-r"iglilia,iJ"66v .i"t"-*itti regard to Chapter 9, Division 3 of the Business and Pro-
fessions Code:
1. I have a valid Catifornia State Contractor's License in full force and effect with
the foUowing classification and license numper:
Classification ------ -- Vl --l--- ------ License No' --------
2. I am exempt from these provisions bf reason of'the following:
i"iidiition i-iip";"*t Jtru^cturi,s thereon for my dwn occupancy and not to be
offered for sale.
3800
appropriate box (one must be checked, Sec.
{C.*rti"^te of workmen's compensation insurance, cop!' tlrepeot or certificate
;i;-"".;ni to self-insure froir Direetor of Industrial Relations, has been
filed with the City and is still in effect.
for which this permit is issued,
so as to become subject to the
I understand that failure to
FeesEoch
oatr:i
7': ot.'.A;7rA '
&.'..R...
...8.t..R..
';"ii4-:5; *a
TOTAL
E
laws shall cause revocation
CITY OF SAN LUIS OBISPO
ELEGTRICAL PERMIT
Business License {
Permit Card n
Street File tr
Ne 4024
D * [.LE '-:'i 'Sl]
FEE $3-l :N -
This lcrmit is.issued wjth the undersigned Jpplicant's agreement and acknowledgement that all :"#:lHgfriffffitf5pwith bity Ordinances, including any slpecial ieq,:ire*enii and other ap-plicable laws, This permit I
.,".i"Jii*r* Ao a"yi This peimit'do'es not inilude permission to maie any structural alterations or install plumbing, sewage or
sidewaik facilities.
0?5
Items
-. - --. New single-family residence with ----- square feet'
| -- Space Heater
I Ternporary Sen'ice Pole
Service Size
l1v-s
t*-er.WkP4Circuits & Feeders
- Switches
- L,ighting outlets
-..- .. -.--Recept. outlets
- Fixtrrres
.--.- ---Range & Oven
n --Dryer
6P-.-\Yater Heater
,,. - 'l'ransformers
--- Signs
.. Other
c)wner Q^ -
noo,"l|-L5-
DA
Contractor
--*--- - --- City Clerk.
CONDUCTORswtTcHCONDU IT
Motors
FEEH.PNO
.<
Special Requirements
- Inspectn of Buil?1S.\_
CE COVERAGE-Check appropriate box (one must be checked, Sec'
3800 Calif. Labor Code).
t/*rrrrr"^be of workmen's compeLsation insurance, gopy tl"lr",o.{ or certificate
;i ";;;;l io ief-insure troir Oirector of Indu3trial Relations, has been
filed with the City and is still in effect.
tr The permit sought is for one hundred dollars or less'
Address {-t=-.--G.+=cP------
ryp" Brds.S-t;-- Fire zone -
In accordance with the requirements of Section 3800 of the California Labor Code, I, the
undersiened, hereby state'with regard to Chapter 9, Division 3 of the Business and Pro-
fessions Code:
l. I have a vali<i California State Contractor's License in full force and effect with
: the following classification and license 4umber:
Classification 4 ---lr-- - License No' ---.-----
. ,'2. I am exempt from these provifions by r:eason of the following:
a. I am tfre owner of the property described in this permit application and I am
n.iitaine or improving siru-"tur"es thereon for my own occupancy and not to be
' offered for sale.b. f[" *orf ln"olved is of a casual, minor or inconsequential nature and will not
exceed One Hundred Dollars ($100.00) for all labor, materials and other items'
c. n""*pti"" is based on the foiiowing section of the State Contractors' License
Fees
\
---l--Permit --- ---
J ---ru"* Bwett -
---*--Circuits --,---
------Outlets ------
------Fixtures ------
J,--S"rui.e
------Appliances ---
.------Transformer --
- ---,-- N{otors .-*.----*
-------Alteration ----
s-3-7-'--@TOTAL -
tr
CITY OF SAN LUIS OBISPO
BUILDING PERMIT
frlt'7,7-1, ttzoo?7 h *]il llg "-ssz7
Business License tr
Permit Card n
Sneet File n Plan Check Fee
Other Fees
L975
Permit Fee $---?99'-5-0---
d.-7 ; ,'''r\.1
This permit is issued with the undersigned _applicant's agreement and ackn-owledgement that all work will be done in accordance
with bitv Ordinances, including any Secialrequir€ment-sandother applicable-laws. This permit becomes invalid if work is not
.irir"J #irfri" 60 days. This fermit toes not include permission to-install electrical, plumbing, sewage or sidewalk facilities.
$------------
293,50TOTAL $--
DESCRIPTION OF STRUCTURE OR WORK
use --------------- -9IEIAE- -------
Estimated value --------1-6t7-tQQ-0-'- Unis----:-----
New &(Addition D Alteration D Repairs E Move tr Demolish D
width--q9l--- Icngtb--991--- H"igrt-19j5-1 Qe^-:- 1
Foundation-l-lga---Exteriorwatt--$99-c-o--Roof --99SP-IL1
How heatedBas--furn-- Type----V-- GLup--------
Garage fl Carport tl ------X------ Attached tr Detached tr
--City Clerk.lnsp ectnr of Buildings.
COVERAGE-Cheek appropriate box (one must be checked !.In accordance with the requirements of Section 3800 of the Califo-rn-ia Labor Code'.I, the
irJ"-"i-ig""a, tt;ibt;tat" *ith regard to Chapter 9, Division 3 of the Business and Pro-
fessions Code:
1. I have a valid California State Contractor's License in full force and dfect with
[he f ollowine classif ication and-license number:
Classification F-:1-------- License No' --------
3800 Calif. Labor Code).
n Certificate of workmen's compensation insurance, copy
of consent to self-insure from Director of Industrial
filed with the City and is still in effect.
tr The permit sought is for one hundred dollars or less.
thereof or certificate
Relations, has been
laws shall cause revocation
2. I am exempt from these provisions b-y rea-son of the following: -.;.-l "t" ifie owner of th'e property described in this permit application and I am
i"iiiiiir o"'i-ri,iproving slru'"tur-es thereon for my o-wn occupancy and not to be
offered for sale.
b. ilf;;;"k i"""l"ed is of a casual, minor- or inc-onsequential. nature and will not
;;;";d bngHundred Dollars (9100.00) for all lab-or, materials and other items.
c. E;;;;ti,il i. Uas"a o" the foiiowing iection of the State Contractors' License
for which this permit is issued,
so as to become subject to theI understand that failure to
owner ---419e-!elqgds-
910 Santa Ynez Ave. \
Address ---Ba;aood-Jark--CL---- ----
Arch. or Eng. --&r-$-Ltrbl- -&-Jr- -Ee-lCeee-
Owner
Address
Builder
Address
u* -o"-B-:fti." "oo"-l--. r,ot tio--199r-13-9-
rro't ya. -1,6-
r-&15-t side yds. - - 29-'- - - - t -
uRear yd. Nearest bldg.-----------
Permit ls aubJect to the acceptance-by the
-s-f--Ebe-Jlsel--ceb-d!v1-s-1s4-.$apr--Ns-s-Leb-s--o-r-
f^r
Street--I€9--O-s-99--V-g!-l-ey--$dillr
19
Parcel No.
City Councll
_f_o_e9_hss__slcl-1
thebygrantedftverwaiaunlessteepEancaccIrhto
ing1dBuiThis
LOCATION INFORMATION
No.--159-5----
Bbc#- - subdivisonlE:- -3-?1-
53-102-t 9
da
$iri'tu[q,ppl$po BUILDING PERMIT
AlUAddition - Commercial
BLDG-1583-2017
I ssuance Date: 8/25 120 17Building & Safety Division . 919 Palm Street. San Luis Obispo, CA 93401-3218
ProjectAddress: 1400 Madonna Rd
Unit or Suite(s):
Project Description: INSTALL NEW CAN LIGHTS. STUCCO
REPLACEMENT
Owner: NEAL FAMILY TRUST (TR 1)
Assessor's Parcel Number: 053-102-031
Legal Description
Fire Sprinklers: Not Provided Stories 1.00
Census:
Occupancy: Business, professional offices (B)
Code Year: 2016 Dwelling Units:Motel Rooms:
Construction Type:V-B
Dimensions Valuation
Category:SQFT Group Type Sq. Ft Factor Valuation
Fees Payments
Fee Name Fee Amount Date Receipt #Amount
New/Altered Circuits - 15 or 20 amp - BLDG $s3.04
$12.12
$403.92
$1.00
$345.12
$457.00
$0.50
8125117 12,845-08-25-2017
Total Paid
$1,272.70
$1,r?z?olT Surcharge
Stucco/Siding - BLDG
Green Building Fee
Code Enforcement Fee
Special lnvestigation Fee
SMIP (Commercial)
Total Fees $1,272.70
Contact Name
Plan Gheck Account Payment by Contact
Account Name Status Total Credits Total Debits Account Balance
Total Account Balance
Balance Due $0.00
ctuy or"S o tsJo
Assessot's Parcel
Project Description AC FOR S
Legal Description CY SLO PM 19.17 PAR B
Permlt Type
Property Owner
Mailing Address
City/StateZip
Contractor
Mailing Address
City/Statezip
Project Manager
Lender Name
C.B.C. Group
Census
5175 RANC OAKS RD
Building X Mechanicat
NEAL JACK E
Electrical. _ Plumbing Sign _DemolitionOccupanvBusiness Name NEAL-TRU ESDnf_f tt tSURnruCe
Grading
sLo cA,93401€1s4
ArchitecVEngineer
License #
Conkactor's Phone No.PLUMBING 54+5118
60 ZACA LANE Contractor's State Lic. No.373936slo cA 93401
Project Manager's Phone No.
Lender Address
B C.B.C. Type V-B Stories 0
Dwelling UTii-O
Codes: CBC13 CEC13
Motel Rooms 0
Building Permit Fees
Plumbing+Electrical+Mechanical Permit
Grading Permit
s.M.r.P.
Green Building Fee
Demolition Permit
Sign Permit
MiscCharge/Credit g.ggAdministrativepermit
Archival Fee
Subtotat 219.00
lnvestigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 0.00
Development Review Fee
Fire Safety Surcharge
Fire Systems
Fire Sur/Sys Subtotal 0.00
Construction Unit Tax
Water lmpact 0.00 Area -
Water Meter lnstallation
Wastewater lmpact 0.00 Area -
Traffic lmpact 0.00 Area -
Affordable Housing
Public Art
Code Enforcement
Park lmprovement Area _
Engineering Development Review Fee
Open Space ln-lieu Fee
Total Fees
Balance Due
Valuation
Total Building Value $0.00
-Legal
Declarations
2a - CALIFORNIA LICENSED CoNTRACTOR.S DECLARATToN
I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9
commencing with Section 7000 of Division 3 of the Business and professions code, and my
license is in full force and effect
Contractor: KNECHT'S PLUMBING Chss: C4.14.16.20.36. License #: 373936
3a(2) - WORKERS' COMPENSATION DECLARATTON - I have and wiil 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 compensation insurance carrier and policy number are:
Carier:NATIONALLIABILITY poticy#:010001507805,t Expires 10/01t14
Fee Exemptions:
Comments:
0.00
51.00
0.00
0.00
0.00
0.00
0.00
't68.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
219.00
0.00
Payment #1 219.00
ts
Date
o6t'tot14
Receipt
65590
Paymen
Amount
Total Paid 219.00
Application Number 140483 Permit Number 28171
Application Date OGl10/14 lssuance Date 06/10/i4
/Address File
Signature or
cttyco oF t; san Lurs oBrspoi-
NSTRUCTION PERMIT A aar*
Department of Community Development,990 Palm Street/Post Off ice Box 9A0han Lu is obi spo, clM1trSfu+&0s&&$9s
TYPE (lF
PERMIT
B0ombination -Building n Remodel n Electrical ! Plumbing tr Mechanical tr Solar n Grading
tr Retaining Wall D Parking Lot n Demolition I Moving tr 0ther
projectAddress 1450 lladorrna R'oad UseZone C
Lot Number 19 Fl lnn lz Tract 393 Assessor's Number 53-102-19
0wner NeaL-Truesdale 3400 }tadonna SLO CA Day Phone 549-7430
Contracto
or Builder
t ifheeler Construct,ion 4661sss 843 I'ia Estebao, SLOrCAphsns 543-7204
Architect
oi Designer Reeves Associat,es Address 417 So.ElLl-
"
Los Angeles . cA (213)
Phone .^^ ^^^^ Lic. No.UO\J-JZJV
1sn2ni Gibralter Savinss Address Day Phone
OCCUPANCY & GROUP PROJECT INFORMATION
Type ol Project:
Proposed Use;
TENA,T\T IISR0VEMENTS
TYPE OF CONSTRUCTION v-N 0fflce
FOUNDATI0N: fl Wood n Concrete E stan n Piers/Caissons
FRAME: n Wood Stud I trletat ! Timber n Masonry
Floor
Carport Covered Porch-Dcck Storage-
Setbacks: Front- Sides- Rear-
EXTERI0R WALL: [J Wood Siding ! Stucco n Masonry Veneer
! Masonry ! gricx n Concrete Block E tvtetat
R00F: n auilrup n Metat n Composition Shingle E tile
! Wood Shingle/Shake
HEATING: n Electric n Gas Furnace E Gas Wall E Solar
STATE REOUIREMENTS: ! Energy n Sound n Handicapped
LEGAL DECLARATIONS
LICENSED CONTRACTORS DECLARATION:
I am licensed under the provisions of Chapter I (commencing with Section 7000) of Division 3 ol the
Business and Prolessions Code, and my license is in lull lorce and effect.
B-1 232534
License Class License Number-
Wheeler Construction 3lLe186llrlc
OWN ER BUILDER DECLARATION:
I am exempt lrom the contractor's License Law lor the following reason:
! l, as owner of the property, or my employees with wages as their sole compensation will d0 the
work and the structure is not intended or otfered lor sale.
n I, as owner ol the property, am exclusively contracting with licensed contractors 10 construct the
project.
n I am exempt under Sec.
No. Bedrooms- No. Bathrooms- No. Stories-
Building Height
Retaining Wall lnformation
Material
Mobile/Modular Home lnformation: Manulacturer-
Year- Serial No D.0.H. No.-
D.M.V. Lic. No. State No. Bedrooms-
M0vingBuildinglnl0rmation:PresentLocation
Locality- Presenl
this reason
Date- Applicant
Proposed I lcc Tot. Lin. Ft. ol Fdtn
Grading lntormation: Tot.Yds.;
Tot. Fill_Cu. Yds.; Area ol Disturbance-
TOTALVALUATION......S ,. nnn.
Plan Check No.
Combination Permit
Building Permit
Electrical Permit
Plumbing Permit
Mechanical Permit
s
s 6? nn
$
s
$
s
Other:
Other:
s
s
TOTAL PERMIT FEES
Contractor-
Date-
B. & P.C. lor
employ any
CaliJornia.
! Construction Unit Tax
TOTAL FEES
c_
s 62,44WORKERS COMPENSATION DECLARATION
I hereby atfirm that I have a certiticate ol consenl lo self-insure, or 'a certificate 0f Workers'
Compensation lnsurance, or a certitied copy hereof (Sec. 3800, Lab. C).
CertiJied copy is hereby
Certilied copy is liled with the
3- t4-
REQUIREMENTSI water Fees to be Paid
E Fire Hydrants for Const. n Sewer Fees to be Paid
E City Business License fl C/G/S Permit Reg'd.
E State Contractor's Lic. ! Encroachment Permit
D 0ther
X SPECIAL CONDITIONSCERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE
I certily that in the perlormance ol the work l0r which this permit is issued' I shall not
person in any manner s0 as 10 become subiect t0 the W0rker's Compensation Laws ol
NOTICE OF APPLICANT:
ll, after making this Certilicate ol Exemption, you should become subiect to the l{brker's
compensation provisions ol the Labor code, you must comply with such provisi0ns or this permit shall
be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby atlirm that there is a construction lending agency for the perlormance ol the work lor which
this permit is issued (Sec. 3097, Civ. C.)
Lender's
Lender's Address
I certify that I have read this application and slate that the above inlormation is correct. I agree t0
comply with all county ordinances and state laws relating to building construction, and hereby
authoiize represenlatives of lhis county to enter upon the above-mentioned property tor inspection
purp0ses.
NOTICE
Unless noted this becomes null and void il work or c0nstruction
authorized is orfrork is suspended or aband0ned l0r a
of 180 days any time is
ol Contractor or
Signature ol owner (ll owner Builder)
VALIDATION
John L. I(ellernan/ve 3/re/86
Authorized Department Representative
SEQ DATEWHITE - Applicant YELLOW - File PINK - Assessor GOLD - Counter
Date