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HomeMy WebLinkAbout1016A (5) _ �. _...,..,.,. ,.... . ... �.__,._. _ , . _ _, ,. �.. ; �� ; _ ,. .. __r..� {'� � WOYtKE7L5'COMPENSA?IONDECLARATIpN - vanaow � �� f � ` -3 hereby af�rm «� � he�s e cetUficate.of.consent lose(f �a..,,�x�o� APPLICATtON��FO,R PL..UMBING PERM.IT . � �, - � �insure,or a ceetlficatc ot Worken'-Compensation Tnsurance;ot .. . --,� . � � � � ��' �� �. � i � a cert3�ed Cripy thersOf(Sec.3800.Lsa.c.) �. � - �COWNTY pF� � � ; , � 40S ANQEIES BUILOfNG AND SAFETY ' � : ! t,. .PolicY.No...,. �. . ComPany �. : .. ._�... ... ..r. .�.,. . . ..�_,. . -��.. �"'�� Certif7ed copy Is hereby furnished. � � � ��.��� FOR APPLICAN7 TO FIICIN 7PWINT OR TYPE) � �� qODRESS-�PG�P �� ,STG��WE' �-'� f�ertiPied copy i6 tlted with the county buildfng insyection NUMBER � �� FIXTURE OR ITEM ' • PEE � � , , �OCALITY �a -depertment. '��� . � . . WATER CkC?SET - � �� '� -Date � � �� APPilcant � � A E5T , ; � � ' . � � . . . � BATHTUB � .. �'� CROSS8T. .C°�/S�F + � '�. _ CERTIFICAPE-QF.EREb1P710N FROM WORKERS'.�. , . ��COMPENSATIONINSURANCE . �� -. SHdWER - . ���,- �� OWNER _ 1 S , � - �� :� � . . . � - . -1.AVATORY MAIL �,. ..i . . (This eechon need not be completed if the ivoik involved AOOReSs � :by the permit �s fo: one hundred dotlazs(SIOD)or less.) SINK ' p cirr Te�..Na. . mo i certify�that m the pedormance of the work Por wh �this � DISHWASHER �-� . � � - � � i �� �� � � � CONTRACTOR �� �permit is]ssued,1 shal[not amploy�any pereon In ner � � OC.� � so as to beeome subject.to tha rs'Compe��tio we. ; OLOTHES WASHER ,� ��� � � ' AD�FESS � � , �� � �� � � ,`Date `� �� ' Applicartt - �-� � �� � � ' �SWIMMING POOL RECEP7tlR . - . �NOTICE TO�APPLICANT:if,after.meking t is Cadi icate of GITY- -- . TEL.NO. ��.. W � `Ezemption;.you should Oecome�aubJect (a -the��Workers' ���� ��1.AWN SPRINKLEF SYSTEM � � STA7E � . . � IIC.� i . Z . � .�Compensation pmviaions�of the Labor Code,�you tnust forth- . - . LYCEMSE NO. ��- � CLASS �. � . with compty,"with auch..provis#ons�or thts�pe�mit ehall he WaTERHEATEFl �deemed revoked. . . . � � � . GAS SYSTEM -�.-0UTLE73 �DISTHICT N0. � PROCEBSED BY � � � ' LICENSED CONTRACTORS DECCARATION-�� � � ��� . �� .OU7LETSOVER . � �C1�� I .. � �F hereby aff3rm�that I am licensed 4ndar provietons ut Chapter ��6 PER SYS7EM � � � . . , ' . j 9(commencing with 3ectiori 7D00)of Divisipn 3 DF the-Busi• ��� � -� - �. � --�. ���� � � � FINAL., A ��N .�� ' ness and Ptofessions Code,and mY license.ls in fult'force and Q� �ATE��— �� � y���—T . � ��: effeet...,_ . .._. . � . .. . . . . . � '�. . , ,�.. License�Number ��L1c.CIass . .. . . .' � BY�L. . �..�. .. , . �� � . � . � E'Contractor . . ��Date� . � . . � . � . .. . . .. � � � � i � t am exempt from the licensing requ(remertts ea t em a PIBn CheCk fee j �' 5..� licenaed architeet or s tcgiatered professional�engineer �p�UM61P[6PERM�7ISSUING�FEES- a. � � �� � !' � '"'��ticting in Iny yro(essional eaDacity(Sectiort 7051,.$us• � � - � . ,. ', � � . ..inas and Professiona Code)• � . - , . ' �.. TOTAL FEE s:�). .. ' . � . �. . . ; . . �� Lic.or Reg.No. '.� . � ��. Date � , � � Plan check aPPlicant �� �. .. . �. .�Q�4.�.�.a�� � - � � - �. HOME OWNER•BUILDER DECLARATION � ... Name . .' . .. � - . . . . . -�� � #.,�'�r�j,,5� . F�� � � . . . � . . . . . ..... .. . , .. .. , �. .� ... . ,.. .. , � . ., 4�. I'here6y�affam�that�I am�exempt trom the.ContractaPs � Addr�ss . � . � . � . . •�� ��� License Law�for the PotlowtnB reason (Section.7031,5.Busi• .�. CitY � SaI.Na. . . . . '' t��0���� �: nessand Professions Code):�. � � � - � �,�� 1 2 5 0I� r. �C,as ownet ot the property,-am ezclusivety contracHrtg � �� ' � � .with licensed .contractors to construct tha� project � � - � j'Z� rJ,"g,���.� , � (Sectbn 7044,Business and Protessions Code). � ! ���': � �� CONSTRUQTIONLENAINGAGENCY � � ._ . . , : ..� .. . . ' � . ..�� . � ��! . � I hero6y afi'irm that there.ls�a eonstruction knding agency . . � , � � �for the petformance of ihe work for which ihis petmi[ fe � , � . � �� . .. .. . _ � � issued{Sec.3097�Civ.C.}. . . . . � .._ .. ..., .�.. ��.�: .. �. � .. . � ' . � � ..i . . 1.� Lender's Name.. . � . . . �. . � � , .�. . . �� � �. . . . . _ .. ,' �Lrnder's Address � . . .. � . , . .. . �. . . _...- .. . . , . . . . i , . . .. � .. . - , . . ! . � . t:,� . . : . . . . .:; ._ . ... , , , . . . . . +' I certify thet I heve teed this appllcallon and eYate thei�the � � � - �� � � . � � ', �.: �above information is cocrect.I agree to comD�Y v+�tfi alY County .. .. �.�gg£REV ERSE FOR EXPJ,ANA'fQRY LANGUA6E� � � � �-� �� - � � �,. ordinancei and State iaws regutating�Plumbing,and hereby � - �, , � � - , ' � ; i _ . � ��� f,,�authorize reQresentatives of this-CAunty to eater upon the � � � � � � - � . �� a6w- entioned propert� r ii ction purposea.� � � � . � , .. , .... . ��. _ - � �., . � )�� �('� �; �. ,�,,p'���[,/���SL � -�sBna�u�f Permitt D' ate " .. . . �. . � � , . .._ . �`. . '. .. . � ' ..., . , . .: .. :' .. . . �.� � , . . .�. � . . . ... � . ,� �. _ . .... . k"' , � _. . „ . .. v,..� ,. r , , � APPflOVALS� V �ATE INSPECTORS SIGNATURE � � • '�NSP�CTUR'S ItlOT�S ��� �� �� � � ,,.OWNEB-�UILDER�DECLARATION ,�.. . � utv�ER SLaa WORK - ` +'t'��" - , .,.,.. , .., , . , _, .� �� � I hereby aPPrm that I am examptProm theContractor's �toucN r�unnaiHc � � �� ��-License�Law�fm��the�foibwi�feason(Secrion��703i.�, � �n5 P��r�tvG ....:m�,.,,.tZ�� _ „. . ,_....,..:.., . . ,.... . .....�,.. ...,_.... _.,.... �� . ............ .._. .... .. Business and Professions.Codel.c Any„city or coaHty� � � �aSveNr . '.�. :�� , ; ,:�. ♦ � ._.,�' ._...._.. '.'._.. .��, .�. '_.-..... .'.. ..:r which requires a permit ta corrs?ruct,�after.�tmPYove, HOT 1tJATER HEATER. .-... .� . � • � ...-t. . ...'. . . ' :,:r"� -.` ....� n� . r P�. Y.6tJVCHf/¢�, IIW'to 'tS.iSsuattCO� , - demolisk;�prre are P s PLUMBINGP�X'fuREs.' -.... ��..' '� .�'? '' . . �,;�.�� ,�,-; aLso requrres the aPPhcani for auch�permit..to'file-C � -� �i` ' ��� _ ._sfgned.,sratemenr.tNat he;ir lkensed.Aursuant.to fhe� , �ns7E57 � --; �. ��,�. .. ., .':� .:;�> �� ��, : �.. .,'-..,� �; .provistons of the Coatroctor'a License Law/CNaP�er 9 . ��. ...... .. . -- � --����.. .�.......... . �:....._ . �. .... . ...".... '.commencin �'with�Sectton��•7000 0-��Dinlsibri��3 o the ' UTILITY CD.NOTIFIED . �... '� ...'� , . .... ..�. .... . � 8' . . � f f ��.��- -�-��� ---- - � � �� - -- - . � . � �' .._ ; � Busrneas�and�Pro'fessions CodeJ�br�thce he ia exempt . . . .__ ...... ;_... .... . _.. ___. ` � ' ���' ' therejrom and the bacis for ehe,glleged exemprion.Any�� F�N�-._. _..._.._.�sr�le� o+a-S�1aur�d= ,. :', . , � , _...._ . . , _._.... _ .... ..._ . ___..... " -. :" vio(dtion of Sectton 7031.'S byan,�aPPlicpnffor'trt�mtir , -�- � � subjects the app(icant to a civil penalty of not more thare � '�i.::_'� ' .,,_' .._ ; .. .... _. . _ . , . .. ..._. . _ ..-__ ._ ; _ „ ,.;. � �ve hundred doltm�s/$S00J�.:. - -. . � INOUSTRIAI "�' �"::. 'r . . .. . � � � '� . �.���PP�uA� , � . '�����`p d;as ownec-of-the praperty.will do.the work;aad _.__ _ .. .�.. _ . .,. '�. . , ,•.�- � � : ��:-.. , ..�. :'. .� ' ...Yhe Strocture is troE,iutanded on offexed forsale. . .:. .. . �.... ..---.__ _..... ._ __._.. ..._ . . . .. . _. .- ._... 'jSee....7044, Business antt Projesatons Code: The�Con- . >. ' . � . `trnctor's Girense Latv does not a p7y to an awb i oJ ' !, :.,._.._. _.,. �. •, ._... r .. ..._. . .. .., P . �, . : �. -:��� . ,: . , .` . -�. ; _. . .. . . :�.. �ProDer'tY.who Gveifds or improves rNerepx,.anQ who'does . , , ... . ...� . .:. . ._ . . ....�-_ �._._.. ._._. , -_... ... . .�.sush.work�htmself:pravtded-�that.�uch f!nProvemerits � .., . . . ; . ;.� . ;, ,,, � �, .:.�.:. ... .. ..:.,.. ......�, . .. . .. . � .,.are;noL intended�.or�ajjered jor�sa[t. (f, however�.,the . � , ,..`�' .. , ... . . ..,' .. . ' ��� 6utlding or inaprovement is satd witkin orre�year�.oj I �. , � .-_ , .,. ... . � �' � . . . .... ., ._��.�. . ,�:..: .. _... •����-,. � rpMt' the-nwtte byilder wv1-have the burden ! � ' co p.lF 1�.� +Y. 1 . .P f � � ;.-,: ' " � -. ;..-.. -..-. ,' :.-.;.. - a... ojrprov�n thpt,he did nar build or rm rove or,,rhe i.. . __ . ...�-. .�� , Pu Pmse o aole. �. , _ . . a; , � . ,. . , i � . . . . , . . �..... . .. . . . _. _. :_ ._. _-. , : „I am exempt ander 5ec. �.,.;.,: -___ _. ....:. . _ . _ � , ' . . _.B&P.C.forihig,reasou I �: - ; _ , : t. � _ , ,. � , .,, ., , ,. ' , .. D'aEe s:_ . , � ,,, _. ' , i _ _.' _ : -- ' : _, ; _.._ __ Owmer A d,t t7 t�?. _ ,,:;, ;;;.;, _...__ _ u._.. . .. ;a� •�• M IaSQECTOR'S NOTES. ...� ..:'.. . . ..__. ' ._ .._ __..._ , , . � . , �� , ..� ;,,;;., . ..,r.:. .. ,� . �;. . . - � -:,�, � .� . Q�c..i �� r � _ : _.:__. , _. ..__ _ __. ,. ,"> c , t ; �,� ,,, ' ., . ,. ,,... _.,, ...,. . .,. � r',:;.. .:•» - , ., r , r �8—��St . . , � �.F�. . � . . . . . � .. � . . � . , , . .. ., . , :_ . �..., .,. . . - . . . .. . . . . . �... ,..,,. ... .-s,��,� ,.,i .�..� '. ... . �.. . . . . �. . _.. . . . . , . ,. � - ., ,. � . . . . :�:.i:.. ��. � . . . ... -� . . � � .__ .. . .. . .� .�: �'t:�:;..s � . - . . . . . . . t .. ..,_ . . . ,. . ,.... � . .. . . . , . � - � . , �. . . . . .. �, I - . . . . . - . ,.__" y'. t \ . `'�+ ��.,