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Pe <br />Specific jobsite location <br />Nearest major cross street <br />City <br />County <br />Name and title of jobsite supervisor <br />Field phone <br />Office phone <br />No. of employees <br />Starting date <br />Anticipated completion date <br />High Voltage lines in Proximity ® No ® Yes <br />TYPE OF JOB <br />INSTRUCTIONS: THE APPROPRIATE ITEdIs1 must be completed and signed by a person knowledgeable about the project, for each jobsite to be covered by a permit. Please fill <br />in or Cnecx off blanks wnere appropriate. <br />Construction of: Building Structure Type: Steel Frame Tiered ' Concrete <br />Tilt -up Wood frame Liftslab Precast Slip Form Depth No. of Stories <br />Description <br />Scaffolding Height Metal Wood Metal over 125 ft. <br />Wood over 60 ft. (require design by California Registered Civil Engineer, plans at site.) (CS01643.1644(c)(7)) <br />job aescriotion <br />FalsB /Yartical Shoring Maximum Haight Maximum Span Material <br />Job description - <br />Tower Crane Erection/Dismantling <br />Maximum Radius Capacity Make and model of crane <br />Foundation and/or supoorttsl for crane on this site designed/constructed by (see Section 1584(x), -CSO): <br />Will crane be stepped or jumped as construction proceeds (see CSO Section 1584.1) Yes _No <br />Name of crane certifier <br />Demolition of: Building Structure Type: <br />Steel frame Wood frame Concrete <br />Loader/tractors Other <br />Helgnt No. of Ston <br />Demolition Ball Clam Explosives <br />CSO Article 31 - Demolition ....... <br />Excavations/Trenches - Depth rang min max) 5 ° Width rang (min max.) 6 ° <br />Ground Protection Method: Shoring Sloping tit Shield . . <br />Project description: - <br />Total Length <br />Olvition use Only f hm# antfr tba to the bat d m/ kneafodge, the tbm laferiattoe : -•sunlit us trill and cel and that <br />Uthe 40100 hm Mattel® Qe d will wit ail! tfflN <br />Fail <br />Ptid <br />i dent. -- Diner _•, _ _ - _• _. _ - - - <br />.._:r...e. _.:•>.r<-'.,_.•w.-14�. .: �., •s.,.,'.+"- .,�...... a .. w.+... J,.^: .-._.... _....:_ ..r•_._s.wa�'rc"�w?.� -Mi.x r•ve <br />g � , .. _ ,.,y'• _. .:: •^air !.•. ,,,,,,, w... -•f. Ys.- .. <br />a. <br />3 <br />i. <br />