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E ���'�^,�^T�°^�°�°�p°� APPL^IGATlJO1�I,F�:R�P1�J�I11�B_t���PERMI�'
I herebr affirm�ho�I hove o eerttfkata of cataem rp setf �ppypTw
' insure.or o cOr�Nk4te af WatkerM'Comptfdsctlanlnsut0lue G�@i3(Rflt,liW'8r�� ..� � �
o�o cen�f;ed:mm�+�eat[Sec.39�fOc mtv�.) COUN7�f QiFI:05 ANG�L�S Bll)LbINGATIDSAF.Ei.Y
� aoi��$�„1�eomaonvFrelnom�_�tidemllity
I' �� CerMfiad�coPY ia heredy�t�nnished: � -. - --. - .: - � .. . - - - .. - --_ ^ . . . - . - .
� Cenitled eopy is H1ed with rN�ccunty buildlnp�iMPe�- �A4PUCANT 1Gfttt�N( . dR"IYRfj � " ;,'�'�,�� -_ � -
I+ tfoodOP��e�K. t�M¢ER FO[it1REORIfEf1A � e!t ��y
� Dcte.,l(1�;7.!F�_5 avPrica� _ '. ` _- _ ' �' Q
� CERTIFICATE OF Olv sR¢�wORKER5• . � � � enmtua � � �� , : -- .._ �_ .
i corasaaa�iNsuRa,riCe � �R wvr�a P ;p��� a� Ss�,, Ga.
¢his��nbna�sdref 6t. ohi I�t�'4E�h+•wofk Inrolwd by
k th�prrmlf i�fer eei 1�un�r�dPdoUan(StOo)exfi��s.Y 3 uvnnxtr �¢ss
� I cnnlfY ihm�in ehe p4Tfor�nca=of the�work ior whieh�hia � -
k permis is issued.I shOlF nofOmPloy mry pqnon in am�rnonner / 'S�� "� � . �- .
w w m ro 6emme wEjed to ihe Watkers'Comperqonon Laws. � � . �
;.. � .ORNWASl�R ••� OOW.RACTdR .
f ome �PP13mM . � ft4TXESWASMER �ss 1 Z85 M8 _oli8 AVe.
IVOtICF�APPLICd(Ni: Ft; OttOr mGking ihis¢lnlfimte of ���R�� � - �
�f, �npnon, you ehqnfd demme Nbj, w tFe�Wwked
;, , ,e,,,a;,,,v,�,•�;o,�,of�t�o�oho��"oa`e,Y�muse forrh- �����yy�M "'"Riverside 92503 T�' ND371-500D
;�'compiq with cuch�iaiont or t6is permif ahplf be �TA7E -
dOemed rIIPoltBd. J W16EBl�A7ER �„� U�lVSE NQ _ �
� wCENSEp GONTRACTQRS OEC1ARnTWN oisntier r�q SSEP eY
� t harotiv atfnm�i�rbam ticqroed ualm qror�afam a1 cFupre.0 / cns srshen � wnfls
I IromManan9.wieh 6ec++on fpOp)o!Otrisivn 3 of�he Rveinme o .
und aofeuion�cnde,and�ry��erme�s�n foll faRe ond effen. ����� p�Nyy; d
� � cwr� 3��.� vauoatioN o
Licanse Num�Or �Q e�� ��.�,^Lle.Ci�m n�_ �
� ea�r.a��o,R.C.R. �lumbtL� i0'/7/85 e� �
�,� � I am e:empF under�bec. � � ��
N
l B.&V.C.ior rhh remon � --� 2
Pian check fee
�� ���� VIUMBING PFRMIF i55UING FEE 6 .
; �s�.� q Q _o�<<r-,
!
Tornt c�
��* � Vlnn cMeck appYicanr � i; • « � s
I SW&tE FAMILV - ��
I, HOME OWNER-BULLDER DKlMAT10N. Nm^e •C . . �. � � ) e . ,',�..S(` .
f I haroby afflrm that I am e:empt fram the Conhoctor's tielnse .y
k i"�fo�the folbwing reason(SeNfan 7031.5,BuainMe and �reu 12! 5 �8, olia Ave_. 4 . �,,�'
j r , ,'ss�ons Codel: City '(Z,�1VET$� E TeV.No, �5' ;.�r.', .. .
�� y I,rn owner af ihe property,will do ihe�wodc and the . � J ���,� _c c
� structur4 is nW"MEnded or of4erBd for 4fie�Sertion , � ..• ..
� 7044.Bw�nes ord Pro4e»iona Code). �
CONSTRUCf10N EQ�QING AGENCY .
f I hmeby aff'um Mot rhera is n ceranueilwr hndinp.ayancy�ior
k tha pn�ormonce af��he watk fnr whieh�hia peunn is isaued . � '
fSee.704Y,CI..C.).
j tende:s Nome -
I
I Lendei a P�dross
I ee.rriy�hm I hcve-rsqd ehis qppVieqtion a�awt�tFp�thp � �
� above infc�rt�ollon i�correc�.I ppr0s ro wmpty wilh alk{�nnry .
� orrlinonce��onB Stare laws reyuioAng Vlumhinp,and 6Ero!>y .
'�� auNiarize vepresemnthrm oi fhis Cauary.�o eruer upon tbe . . .
, obove-mentiooed prapeqy fa�n7pecrinn purposes. �
�It SY: ��� 1Q17'f85 SEEB�]►�I���OK�7(PI:AflATICiRY4At�C�AGb
9 Signoture of Parmittee pote . .
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.nFazOVn�S DaTE MSPECTOR'S5IGNATURE INSPFCTOR'S NOTES ONJNER-6UIlUcR DECLARATION
UNDER SlA6 WORK � I hereby aff�rm thor I am exempr 4rom the Coniro;�or's
p ROl1GMPLUM8ING License law for the fallowin9 raoson (Seclion 703L5,
� GAS PIPoNG � � � Bus7ness and Prolesslons Code)�Any dly or munfy which
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GA54ENi � requlres a pern,lf�o construcr,aller,improve,demotish,
i HOT WATER H[ATER - � o��epai�any s7ruclurr, pripr lo.��s issuanrn, also re�
� qu/res ffie opplimN for such permli lo�ile o slgoed slafe�
FLUMBING FIMURfS � � �� ment Ihal ho is 6censedporsuant lo ihe pravislons of the
� GASTEST — �!/f� Conlroclor's Licen;e Low(Cfiapter 9(commenUng v✓ifh
� UTILITYCO.NOTIFIED - - ' SeUlon 7�00)of Divislon 3 of Ibe Cusiness vnd Proles�
� � . sions Cade)or Ihaf be ls ezrmpl therefrom and Ihe bosls
� r c� �� � lor fhe alleged ezemplion. Any vtala�lon of Sccllon
� FIN�L � - �Gnler n�e Jront � - ' - � � 703L5 by any vp,^.licenf 1or c permH subjecfs the appli-
� cant fo a dvll panol;y of nat morc than ilvc hundred
� . � dolfors(5500).: �
INOUSTRIAL " - - ' ' . � ' � ❑I,as owner of tho property will do the work,and
V/ASTE AFFFOVAI ' tho structuro is not iNended or cffrred for sa!e.
, � . , � (Sec.70�4.Bustness and Prolrss/ons Code: Thc C��ac-
�� - . � . � � , for's licenso Law does nol apply fo an owner ol F� �'Gy
, , who bvllds or fmproves tAcrcon, and v�ho dot....:uch
'� . . � • � – � � work h7mseff provided fhal such Improvcmenls are no� ,
. , 7nlended or oHercd for safa Ii,however,ihc buliding or ��
�I • . � improvemeni!;sold within onc yror of compl�}ion.fhe
� � � � . �" � owner-builder will have 1he burden ol proving ffial he did
� - - . - � ' ` nof budd or Improve for Ihe purpose ol sale.J
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I, 1 _ I om exempt�nd�r Sec. ,
�J B 8 P.C.for this reason
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Da�c
�i _ � � Owncr
INSPECTOR'S NOTES �
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