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HomeMy WebLinkAbout0174A (4) � WORKER$ CO(v1PEN5ATiON tlEC�'AiFATl�d+�l �'� �� Y V .� epp ((ye "{"'"��"�" ..;'�"` � �-� ��:���-� I berebv dtfKm that T�ha e a certificote of conse t to self 6 ^• • �ev^�o� ��/������h " '- - insure,or a�ce I f cate of Worke s'Compensotion Insorance' �� � """'µD� '�"�'����3��4��J���«��� � �-or a terfified copy ihereof(Sec 3800,Lab.�C.� �6A364c��� ��� :� HEAT7NG.-�VEN'C��,7C�('1�-�Y��q.,�.�. � � � � � � � ce=e;s��Ev.,o�es7 � - � . .P�olicy No �fbmpany �_ ,� u,.._ . �.�+,. � ... - .� .�_.,,_-� — ��<�- Cerr�fled copy is hereby furnished. COUNTIi OF LO E S BUILDING df�0$Af�TY"'Lu _ -- �.,_ ,_ _ �_�� Cernfied copy is filed w'fh tF�e couniy build�g mspec- �-PQR�{PPLI�A T�� N - � AUito�rlG' � �., /✓�c[..L_, fiondeparimenf._ - .. _"._�p ,T E LY ._ .- .� .. ""'..` , ._ _ . (PRIN � .Date . _ _..APPfiwnt _ - _, _� . .:o Y _ � .<.>_ ��� -s-:s�: NO. TYPEOF'A`qPIIAT�P�.'�`�R 1 T- . E ... . �.. "`""" _._,..�a.. � - CERTfffC'7+'T�""O� ' M -^ -� - '-- �" - �� NEa.RE57. . -,n �� a � � �COMPENS`�if'�61�NSUkA�ICE,.-•- �. ... �,. Ceo55 57 . ,iv• , rycsv.� ..._.._.,._ �- , � ABSORPTIpN UNIi gTU -'�- J157RICT NO.- ! � - PROCESSEO Br (Th s section need no+ba completed i the work Involved by --- � - the parmit ts for one hundrod doflars(S10D)or-less.) � -.- •-°� � 1-certif`y rhat in rhe performanre of the work for wh<h this A�R HaNDONG U171T',�CFM �� -- �� Q'7 �'� �:pgrmrt is issued,4 shall�not employ any p: bn i�n any mo��ner"�'�' - --� �'� - �'� J . �-" ' '"' - io os to become subjaci to the Wo ker �mpens ' ��ows��. BO�IEA.BTU� _ -_ ,aPVROva�S DATE iNSFECTOrt"SSIGNATi1QE�`� . ....._....� . � �' -� COMPRF550R 6TU, _- <�.: ROUGH --�Date � ,:... A ImaM - � :-:- ' . . . . . ���'—. �6wIfJT ,. _.PP ..., , -., . -`. .-. NOTICE fiO��APPIICANTi-IT, oFter -king ihis-Ce �ficate o4 vENTItA7idN SYSTEti1�� �� FlNAi�� . ,�Z3'�0 • . . . . _.,.......�.,_.. ._ - . Ezemption, you should. be<ome su6�ed ta--ihe 1Mockers' _ � - - :��"`� '- . �- - --- - �-------- � �____..: -. �Com ensation� rovisions of ihe Labor Code,you musf forih- � '� ""�"��� �//4�ID14TI�N - -- � - P P EVA9pRATIVF LD2512k.���y,��� `with comply with suth provisions�"a7 this pe�mit.sholl be � �-� ---- ---�- --�� `` -' � � -deemedrevoked. - _,,,,,,;,-. �� �.�:�..xry-w=��+� FLOORCE FAU��BTU GRAVIiY - . �. LICENSED CDF1Ti2ACfi0a5�ECL'Xk�T?�J` � � - ..,_.W_�.... .. �f here6y affirm that I am licensed under-provisions ot Chapter 9 HEATER: SUSPEND�O �� UN�T� - (commencing with SedSon 7000)of--6ivi.sion 3 d#ihe Business �P« - ' and Profeuions Code,and my license rs m foll 4orce ond effed.--. -� �. - �.�-� � OC> a � - L cense Number �::_:Lic Class.. ..-.--.-.. . � "� . ► �G� 7,[�� �. .. .�.-.. � - _,.�.. --< . ._ � _.__ _ , .,. . � Contractor _ _-».:,�ate -_,:. �;°«m o_e a g � ❑ I am exe+npt under Sec. � [m�2�Q Q � Plon check fee �-B.&P.0 fo this�eoson - � � � � PERMIT(3SUt►SG��S4 l t/`1� . ,�2�,��` c�13 .. Date. .,a_. . . - - � � .�.._�. �,� �., .... .., ._ . TOTAL FEE ` Signature � . - . -_.' _�'.� , . . t Q-� Q'-' . . ... . .. -, .x �_ OWNER-BUIL�ER DEQRRdTION . PLAN CHECK APPLYCANT � � I hereby affirm fhot I om,exempi from fhe ConiraUor's License - -� , - Lpw for the following�teoson(Section 7031.5,-Bosness and - NAME . - -P�fessions�Code1: . . -� - .. . .. _ �� - . ���::� .. ADDRESS I, as oavner of fhe property,�or my employees with �,. ' . ..wages as fheir sole mmpensof on,wfll do ihe work and . C77Y � JEL.NO �- ihe siructure is-noiintended o�offered forsale(Se<tion - - - -.��, -� - - � -70A4,�B siness and Professlons Code). . � OWNER � � � � - ❑ I,as owner of�he property,am exciusively conirac�inq � � `� . �_--"� . . . -� � � � - ..��- MAIt --- � - . . with iicensed coni aciqrs b cons+ruct ihe project(Sec- qODRE55.__ � - hon 7044 gusiness�and Proiessions Code) � -��`"" � ��� CONST�UCTION LENDING AGENCY Ciry 7EC NO �� 1 hereby affirm thaf�here s o consiru tion lending agency fo� _ ...., �: ' � , - ihe performo ce of fhe work for which this permrt is ssued CON7RACT07Y -��� ��� � (Sec.309T,�Crv.C.). - .._. . _ .. ..-- - . . . . . . .. . . . . - ADDRE$S .. .... . . -.> _... - . . _ ..��Lender'sName�. . ,_:,.:-.,, �.:,�:�_.�._�.-._.. ._..._.- _�..,._, --�. ._ .:., � .. .- : . � � . . . � � . � . � CITY TEL NO ...... _.:...� . . . . �Lender'SAddress - ..-... ......;., ,�-.. -.. . .-.- - '«.. ` ... . . � � - � � S7ATE UC � - - I cerli4y ihpi I�have read this app��ca�ian and state thai ihe � LICENSENO _..,_ �_,�.„,:�.,,u,M.,,,sR. CLA55 �,�,-:u. � -��,o;..,�:-. '- . � � �� above information is corred.I agree to comply wifRa�l County . � . � � . - �- - � - . . . . � � ordinan es-and Sfate la s elating to building co struction, _ . _ . . - . . .. . � and by authorize re resen.dtive of iNis Count ta enter - '"'"`""-'����� � P Y . -� . . �-�s._`�+�v�aa-a�- .w�r�-s=.�r.w.�TM.�zr-o--.�,�v.<� u t ab v . e Ioned perty for fnspedion purposes. SEE REVkRS$FC)R�y A AGE . �, . ...�, " 5 nature of Appl or Ag r por ,� ;�. � ^�'�+� "�"'" , F;s �:-��". r :,z.�c�`'� �;^x,�".�:'�.r�:.��� `s"��-�� � �'���,.��s�r�������,�"`�'..�..._� _. _ _ _' ' °'' . ' ` T INSPEC'FOR'S NO7ES � . OWNER-BUILDERLDECLARATfON _ �,v..._� r : .�:-; : s„ . .; ..�,_ ._. �, .,, , . .,..._ .y;' , �e:_ , �}.'- ` ��� I hereby od�rm-tho .a�r+"'exemp+from�'he Conractor's�--- "��� ..;::'�.� .�.,• .., .":. '• . � . ... -. .. lkense law for tn={ollqwing .:: -. .-- �� .----�--- rea�nn ;Secfion 703I:5, ...... :..... . ..... ...... ."._.. .... -_.. .._�'t. . :�...;t . _",_° . . ... - � BusinessondProfc . ��s Codel:Any city cr counly�which . ' "�` �`:�*��' s �±.s?,++� .�3��..�,--._ � . ". ..'requires c perrsi!:�o cors.�ucf.ol�er;--Prove.demolish. . ,._:. _ . .. , , . .im - - --- -- - -� -�- t ^ -`c ' �� ' � - �� - or repair any structure,prior to Ns issuonce, also re- � ,,.. ' ,� c:.:,-� '.�... .�-sK.,� ::, > - .. .__� - . . _- - -� . -"� F . � .;;.- . . quires ihe opplicont(or such permif fo ti�e p signed s}ate- .,... .: � . �. , � - . . . _. _.._.. . - - - - �-- -- '-- _ -`- ,,�*- �� '" �" < ^ ` = .-. . .- . -�� - ment ihvt ho is licensedpursvontlo fhe provisrons of rhe , , .,. . ` . ... � _-... . . „-.:: _ --: A.� Contra 1 1�en C C�opi � 9 �commenung wi•A � � -�- -�` � -�- - � �--- � - _ ,. . � -� 3 - Secfion 700d�of Orvmon 3�cr fhe$us�nes cnd Pro)es- . - . ��-. .. . . - � . -. `.`. �:-.: sions...Codei or�thor 6e.s exen�;,t, =r�from d ihe'�bcsis . . . . .. .. .. . . . . ... -__. ; . ., : -:.: , . ._ .::: . - � :. _, � � � - ;�:..-' .,.�� -- !or tFe a0eged�exe.mp�ion. r�cy v�oiati n ot Section _� -- --'� - �� �� � � � �� .. ��. 703T,5 by ony dpplicanl fpr o pormit sqbjects�he appl;- i -__. :_-_ __ . ._. .._. , .. .:. : . . . . . ' cant�f bvil-pertalry - . .. �_ - ., o of nat more than five hundred �.,.;.-: ... . . - . . .. _ . ..._... .. _ _ ---_,___:___.. _,_...__ dairo�s�ssoo;, ., . � � . . -.�, : . . . ._ : ;�. , . ,e.] as oa;ne �f�tes oreperty v+-�I��.do 1Fe.�wrK.ood . . .. . _.... - - ��� : , - -- - � � � � � - . .-, - the-s;r iure s co�inte���d or f ered for sole - � ' ' "��- __.:_�. ` ` .__ _ ___ - �� - �� � lSec.,7044 Business ar+d Proless+ons Code� he C n7rdc- .. _ . . . ... _.,; ._ .;.,s. . . ..... �.� -�.. . . �..-. .. . � .... ,,:.�.f : �' ' +or's L ce e Law do s nol apply to ar owner ol properiy . . . :'-'-. .:�..' - _ .. . . . _ .. ' '_„., _. . --� - �sifio bu�/ds or impro�es-ehereon,-and who dpes sucA � � � ���. . . . . . .... ��... . . ,_ �.� �^. . . w-or6 h'risP(f pro�ided t6a•such rrpro�ac-menrs cre no+ � -�'� �-" �- -- �'" -- � - ' ��� � �nt=nded or olfered for sale.1,ho�veve?-�-he building o� _... : ._�, - . . . . .. .. . . . . �-, _,�� - _., -� -::_�improvemenf is sold within one year cf completia�,!he � � - • �� - --- � -- - � � owner-builder will hvve ihe burden�of proving/hat he did � . � _ . _.._._. . .. - . ._:._ __, . .. . �.��.. .-.' �.....--- , .,.,_ ,q__.� .. . . .�nof build or improvefor ihe purpose-o!sale.J , �. � ._� . � : ,,.... .. .. ..._;_. ._. . �� � � I as owner of the properry,am e cl�sively con- . . . " ... _ .. � �. --._rac'in 5licensed<o��ro<ro -.. -p.�je.� . - .. g v✓�` . •��constr c'ihe , . -- ��� (Se<.70441 Business and Professions Code�The Ccrtfroo � � - - � � �� � -�� - . . . tor's C"rcer,se Cawdoes-not opply to an own f pFoperty `- - --- _who b fds or improves ihereon,and wf+.o controcts lor � � � � ` - -� - --- -- �such projects wifh a contranor;s)I(censed pu�suant ro ..: . _ __.. _ _ ...... _ ._._. .�.,' :. = . - . . - � � - - � �- the�Controctor's-Li<ense Lvw). -�- � - . . ' > ,.:-.�..... ..�.;.:�,.« c.0 . ... � . .._ ..._._.._ _..._.-..,__..._. _ __. _._. _____,,.. .. .__._�� �_,_ � � � �I-��m exer-ipt Jnder Sec` '_ '� �- - � - - - - . .._....__._ _ . ___ _.._____"_-.-__<.—� - - .... ._-. . : .,_ .�_.a.. � _ . . .,':� .:;:�. ,,..: .,�.....,_�, .� �� . ._ , . , B&P.0 for ihis eoson - . :.r-. , _. ; .. ... ,... . . . .. ,. -.> ._�.,,x:.-.. _. .. . ._.. . ..._. . . .-.. . . _.. . _ ., . ,-.-..._ a,_.,.,, .., ; -- . . . . �:::U. ... .. .:. ... ... .. .. . - _ , �.:. . ,:... '. . Date -.-:_... , .�.: � . ......, .. . � . y,_.., . �:-... a� .. .. ,-. .. -.�.s��.... � �� �- . � -�,: >.:-_. .�.�..� � . . .� _ ,.-..�� �- _.: . . _ _ ... _. .. _ . ._ � _ , Owner -,_ _.. - -.. .�..._..- ---,�,. ,.����'�-'.. ;...� - . . . . . r�iw .. . � . . , ... ... _.._ ,.e. __.._ . . _ ._ . - . . - . .. ; _ _,:- �_. ;_�_. ._..�.c.;..:.. :-' -� , .,. .,,.. ,.�. . INSPEtTOR'S NOTES . ��:�,.. ,_.;. . . �.�,. ,3. �,._.,�_„„�„ . . _ _ -_-� - ..._ - ?-�-^�_^rn���.�b:��w :��..,s�s�& ,�:�.`�;�.�. _. .