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• AMCATION FOR PERM T
IUNJHM
MIUM" HIP"TWOM CCTV Of PALM WOW"
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dal Vi1ut of Work {�� �`•} '� "
ERMR NOtf�t : PERM
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IDUNL1CATt p ,.
AMtICA,noN 10 DO
L PLUMBING•
IIJADIMG DEPAXIMEW, CM OF PALM i1'R"S
J46 77
lb P%mk6mr
__Amf'r rate
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MIT No. ►EAMIT FEE!$--1_.w_...._"-''T
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DUK1CAri
APPLICATION FOR MMIT .�
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- 6YILSIM0 9tttARTM M►. CIIT OP PAM WMIWi
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Description of Work to Be Done —Remarks and Rtferemm tiO
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cl■dl■p fP
or
Tofal Value of Work [ILA t wfft• �I wrl.*
Cfl
�pfRM1T NO._ G PERMIT FEE'j
Owner OR Contract
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4&71
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BULMNi 101PANVINT, CiTT OP IAtM sl'sIlli�'`.► '
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4 VICE ENTRANCE: �S'�rh7;► %r �.
Fuse flees__._ a....:.....� _ _.....�..�_
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_ Temporary Service ..»...-..._..r.�.»�. __ ._.....:.
Outs e h
Rstures
Heaters + » @
,.'...� Ranges
Trandorercrs In NCO" Signs
Onc to Four 1.04
r
• i(Treaiy•fire Cenh fat Each Additional)
ECTRIC MOTORS:
I , s
!en than HoAs
-----. IJi to 2 Harsepowat �, •*;�� .50„.. '.` t:
_ 51h to iS Harsepowa (c 1.25.'_..`'
151h to 5o . Horsapor+u
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....t' so to !!10 cHempowarg r �z•�t1 tsotq :-t--�
milk" Qeer 1100 Hcrstpo+rer ': - '��Qp�;t��
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', ,,, ` '±r •; , ��3 °JOB CARD
;�� =rr,,.n,�• Bui 1ding, & safety.�ts s
CITY OF PALM SPRINGSR
. r f
weer Bruno ;
• + �t,r
`gate 21171,
acation ry. ----._
I DING I SP CTI -. •- ,;6,xitlL
_.
P':,Po e
Gas Pres.
�.j�P�� usbing �{
Firep ace Ftgs
Ooting5. ,•, ...,.`
i rep
ace
f:. • aSQnry wa t 5
L ;.�.1
•
tside wrap g
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Masonry fe
sonr� Zia
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li. eat erstripp
UE ect • � f-. q!
ati
ti,•,: Security.
Y=i ,
Y.Wa
Panning Re ease 1
oer•. S etc on Reverse ,t a
�} ire c ease �
ng• :Re cast �• yr
Ina bIlls
ROOFING INSPECTIONS'
'
Patch, Flash T�„jM►hF�'
7!.. Roof Final
i'r 6onrling, Setbacks
aground Piping L cct '.."'"..—�;r�:
. Pr es- -Housing,
�,
ff ..s.1O• ••• • . • , . ,• . ♦ ♦• • • • • •1
•� . • • \.: ,mac; r.i
ri;7l{IS CARD SHALL BE POSTED ON ;THE JOB
T11'�A mum
TO.
PL L -Ab I N-2
lin
rl ),of
Oe
TOTAL OF y4w.,
_rEC�iAN ICA L A iLkiiii fw
7 TETl —sT
ViEcSUREWS VALIDAU�jrl
Fes
TOTAL-FFF�LL9TPirtAltr
i
SLY.EW
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2 Ospaulllnitlteut:zi
M-W I
OwigWa7,1-
shir
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Oki" Fouolj:n
"0 �bf palm Spr pp gi *I, ap� y.jg tk.i p-m-.1t andmot, imt I Rh� wMNflr.vlth all rectOgerrin% el I'm
kii;v41suw th'three. rooAt "'mm-be WrV�Jled OrLOT-fD Cnal'im fwl i At no M
necupomcybrhly U. thm requil"-nh-ft Will. I
flat I t tha f I MOYE 7rYrf 4N., ONIKI. try
r 82�
2- -e--)
ql Q�
20 -T h i
-i THs fiffrit Will r�' vowk [I not caned 11 120 ebis, or lf.i
it a Fluit:Imq PFFIY:7 trkj I M E F
Nirmll *fm:m'PrQp.1f%v files out, trjqA "Val
• DfaARTME�+T Of' #tIII.Ib[N6 AJKD � ����'! �•'`ti r 'r".` �:• ''- i���,' . � 1CAT
� k �
CJ�iIOR"
T T `
y.'.j y�l9�t},,:Cfirpter1301 �.5ecti0 19826:'ot';eheJilq t /nd�3a a t }� res-the.�ex�'eir=^'"-T_�
RA
-' tlt,r, of thi fa�liNr1{i1_appj{tehle.dec�arbki ' � hiap�;to: tht�t3sUiii�r'"- {bgldiP �� t:� leaib'sl�;� `�-
r-tat orntrPe�:lklil14+�;b�law.
L[CEN'ED (ON
I h:er26p affirm that I am 11Cen.ec ai�dar rovis 9 Gel. fcaM"'WCin +rith•.Saeti 17d0p)'of.�?r
D'•sision 3 sf the Putireis and Professionss 1 if °R`k_ar.:t�
+, Cede'Arid;ill! 1 erase .is In :F�'ll fa Ce and:effect,
L'censr lralssq_.`?, 1 onse'�I�:cL-,�`7� }.
�:. Cate—dL
OW1tEPo•! :LCEN DJ RA IM-
t 4- ire r rh r - at ; ,. 4 •` r
,�- y aft rm that t rt earmpt f the Cdrl raetmr"" •lcerrsr` Ease fo- the folToraffg rims
1 ❑ 1. as orate of :the pre er.y, nr nj employees ,+1t.h wages as thrJ r Sp a: CarpCflt`L Oft 11 b IV."
�' da the -work, #lid the structure is rat intended ar a[Ierfd.'Or3ajeF$tf 1 sell'Ylifir� �
ytar of compTatlon, 1 .Ipldarstand I will hove tr-e burdrn'nf i k,f 'tad d rive blltld`0
.d R n4
r ' imPT YI? fur the purpOSe of sale`{Se:. 7031.5. E.Ep.C.},. `_ ;
e . F -
as miner of -the prafrty, am CyCluslvely ctntractiruj with `,iGensF c�ntractcrs t7
'construct the project ;Sec, 3044, S.6P,C,}; i r F. _
'� ❑� f am exempt under Scctijr" 9.11P.C. for. 1f is ,reasol?;
Date
U+r�e r
a 10E1'DfCklWATi -
t1DRfiERS" CDMR T a Dori a-w--
] hereby aff'r:n that ' r:aye a rertlficatp. of conslalt.4#o,'S0; . or ¢tort; !catt Of.�arkers'
Co"Pensaticr. Insurance, or a certified copy,ltJheSeuf-; a 3XV, b, Code};
Fa. icy Na. �Insurirj,ea�f1'�:C
- i F --_— -
' ,r Q Certified aopy;l/hereby r„rnl��•i , �� � ' .
+ s ,Ccrtiffeill pyalf?;Yiled r4tr [r:r, cou my a! Riner3�dfe ?G! ltrnent pf08 ;:ding and afety.
t'- - Date ,t % applicant � �►r�'i 'err -_
CCAT]FICATC CF E]IE11PT1011 F,#CM lIG 'y IOFr E!151iP,A'I.E
7hrs setltan need �l'F';LwF tS�i�P
r• � _ rat do tucv]cla•i 1F VIM tlxiYtON, fo_r. f11U0.ou or less,;, '
1 �ertlfp tMal+fn Etla performance -of the wcrl: +fir WMI;fi: 'iiS't I#; S iistred, . L. shall
a� person in f A. employ:.
p "acsnner so as to bRcome:subJec- to ttiefilo.niters',�oapansativn 1a�s_Q.;C/llfiorrsia:'
vrther undrrs'&nd'thAt if after maki Ithit CertIf.Icite:p�' pd' I should ti s rig f71 p ,;_., IbbjectK, I,
th+ WPrkers' torpentatlon provislflrs,af: thi -labor coQe; [•must fb tkiwu
or this, perm t thal •,be detmeil reuoked;};Date b.rApvl I tn+.
1
r1. cant . ti
• c „ „ :� •• CQAS4kTION LENh'f�G
• 1 hereby affirm tAat. there -is?:i '
- wlyich,lnli.PeTIt;.1,� 1sS;►ed�Se
lrndfir's Not '':L>».} L'T''--- r
r ndr ' Add `�
nStrr,rtian Terdit►g';1panCy,Tpr the , rrFanrStlC�
309% C1v. Coee).
r 'Z' - i.0 r'"',fir„�J'C ,'�,,•
e. r s ress '
DIVISION ISF• INDUSTRkAt SAFETY PtW T E.ERTJf[CATIt''
r 16reby;e*rtify thi,.hb•ext/vatipo five (5);' r vane 'tit ` 1n.depth into-Whicti a ok—Son Is rit V• WrCO to=descend: i+ikl.be We In cGnnectlhr,wl±h work /Utharized.by Sims perarit, .s� that na .
bullding,'.5tructure,;sc5ffolding, falsewcrs, or dcealilfan e,r diSmanL1}''q #hereof, w,11 bC
„ore.'than•thirty-sin (3da: feet high, -(Crap 3.2. 5rp,?�'A'rt �;13�s 341,; flt`e 9, f.A.C.T
[.]. AS cwaer-.6ilder, 1 *I -IT not art,loy,.anyanr to'do � ork Which i+osild rrqul1 e z permit fran tie
;th ', is+an of Induttria•1'Safr-tr,,as noted•4�cv_e� unless such, erson has a' ptrmit_ to do Such -orl
'pt("A that dlYliinit.
.'"r"""D+visio��f.•:dgduttC7��SAfc•f Paro'It Mn. � ` 4 °. °� - �, ,
Doke "� Ap¢llc/nt
CERTIMATE 0 CCHP4IAKE AIIA AU7HMI3Ail0tl, dF. WRY
�:• .• ,� • 1 certify I:,.ave l-*ad RAis applTafion aid'3"£bth'that:�thr�nfeT+dtffl7ie'�"#feira�cR-r'trt._. 1 agree to
tonply with all State liws and county ordlrtanceS .relating'.to bUild1fig'iciitr.uetion, and aut"rize a
repre%entatIve df• tbe•Covnty pf Hwerside,.dr1.partment of. 9aillding.'and;bli# Iy'ta ert=r Lipari the ;:ro-
pKrty.fer w ICh 1 ha a 1 d for t s pe it�for he'purpose af.nek�np yvs cticns.
9n+ re &f 0114plirjnt gent D-dt�e.
rp Qent /too _ e
i.. -.. � '{�' r - • .. - _ . ....�A�:��-�vi "r�Sn�� �vr. , �_�:_!':..�-w'1.�•'�edbL}r"riit•iti.'•i:�r .3r�
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