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HomeMy WebLinkAbout1559A (9) _ _. ._. .___ . _�_:..._.._.. _. _. . ____._.. . �_. . . .. _ .. .�. .---_ ��� WORKERS COMf'Ef�AF10N-OECLARAAON PL A� N ry�■�B QM 338/A � I bereby affirm rhof I have O t�lrl9flaal!aF mns6nt vp�a1f �Ary�rp, ��"'''"��'"'�'�""-������'�.'''�^^���`��•""'�*'� i�su.e,ar a caniiknte oi N2rkarYl�m p6�yqUan feiy�nct. �Al��REY.IOiat) � .or a c�e�rpnf�bd mpy�hacaab(59c 8fi0Q ip6:C J � C�p(V�Y�IF 1,'QS.A�GEL�S BUIL'DING:�AND¢��TY Pa4icy'rM:'1��.Q1F� CumPa �1�F308T1�& �lIl1i� . Q Cer/lfied a3py it hefOby��'�iSFOd. . .. fOR APRIUNi�iO F1lk IN�PRfNT f]R TYPE) � -. ... .. �_ _ .. .- _ . � Ceniflad�cOPY�isRied.�ylitifisenumYhvi�11n4int4�fso- _ ���FI G'ET� � - �TYI1�;5 Z3S-2�.44: ��oo daaona�ae�c �uc+naecR isEis+ � 'tqc�n Di.�[td�, f oo� - _ �� ..__ _ _ - — --- ' -` �'sx.Di�d Sar 81 i�and Ave. - CfRT�fl�`C!E OF k - 4aT�+tUb: � � . _ _ GUMPFN 116I�I�1��E� SHiSYI�R � , �j ONtNE¢ - �. �_.�'C5 �'iS�. (TMiatflonn�id�oi�reqmyT•]'�dlfMhi R�rS[rfd6y �h�p�rmN�a fe►un�fiundtlidS�olla7l{} :q6��[i:F Wv�sY01M d. ��F��d+�7�15 �'].'if8 I certHy efw�in tiie{T4tfRt�b 4E�I1C�cvDflc fC�n wFich eMa - � -- � � -- psrmit is iuued 1�FR9ttxtp7al�ftpy , �� �nany manner �' ' .��d� f+T�' tTeppOTt B2&qTl ��^� 940-U500- so m ro bemme wllteer ro Mn,iN�rk�penwflvn k�ows. ���. . . � _ - . .. � °ON"�"iCT°RR�G,R P1 Itsc. � puTe nesnfiopN. _ . CUO[FES�5V�#B � .. � - �M�"'�711F i0 APPlt(„ANx:if. dNCe�t[Okirp ILiiS•{�bfkO1B of - . � � . � �� SWtMlV0�1CrPOOI RECE7IGR . . - ,mp�ton, ycn afioufd�6ecomv�sa4ieee m�Fi�.�6!arken' atr �{1V�C�2 Ta.r+0. �n-+��QO . � �omaensnnon p�pvnions af�rka ta�ae�jdm Y�+Musr ioAh- .u.vvrx�CiN�n[rtSrEtpe . � wi1N wmply w1tls auck�pforyipny� �iaa F!lrmlt(ball ba �gh �II �. deemed.evQked. watEk+�Ea�r � -. .� uCENSE n�o. ���f�+-�� --- .c+sss_�r��. ucFl�t�p U3r1tRA4iGR5 PF.CtAruTl� oisrwcrraa. er I MO[eM afFirm iirGf*4'�RCDns1l9+uYJ6c f�Ia�iYi��uPter 9 �4AS6vi�� ��� QUAE�B �: � . - . � � (commancirr9 wi1H 66tl[pn y00QT pfp�q n 3,gj t6p.$psinest ovER � > nndVro+eqiArotA3ls.ond�mYtkeW4�ibfioU#gTC6djRS�effeN. YSiFM �/ - . ' _ . � VALIDATION � - Lisenae Num6er 336�.c�, ��,,,, . _. . . p� �-ra'�sug..J�aA�1f�L.84 B �� ; COMrOCT r„p, � . � I em exempr und"ee6eo._---- -- -------- �� 5�9 A � , � B.6P:C.frn rhis reawn � _-._ _ _ $+`.• •�• • •5 2 PIAn chack EBe Dnte:�,_ I •b 5 1,Q 0 � - P[VdA�R�ERMtI��S"r iFF{ � � • •b�1.00� Sipnntu.e � � Y(jTAi.FEE . � 'S/ GQ' � ' v���he�t apvuoam 0 2 1 5-8 4 ;�[�LE FqMIt'� � HOMEOYVN�R=$EYICREIiQEG1ARAt/ON �+tame . .� . . ..�roby affirm Nwi f am exemp�ham t1re�p o�'s license -� - � �. � �. .+:w rMe�iaitowsng�aaaon fSeaton 7(p 1�8usi�au and �fMi I " �:i$� V 8. Rofess�ons Cade� Ciry'j�{V2Y5 te�.No.���..+5 Q� �� #1 4 7, � � ❑ I,as owner of�htr prqpgl'ey,wil!�o�ha work alld/he � . s�.�cruro�s nm�mqndqd or offefed tcr a�d�5eaion . •• �5 7W<.6usinear and�Oiples�ians Cade�. , I • .,'{.�0 � CONStt2UCTIClV CENQING A�+ENCY . . '�. 1 hereby oftirm Hwt ehnro il o caosslroc�forv YendinQ ay,pncy ior � � �,�� . � 1he pedarmonee af tha wmk ior wluch Ihis perort�a iysoed � . . . . . (See.309I,Ci+.C.). � G1�� . Lender a Name 7'Pa('„i_.�'iyr�^�grQ�- Lendef a F�d/eS�.�ea�:L4'f 93q'_ . . . i cenMy n�i Mm rood�Iz 4kEll�Ra[F atW i�la�hat�ha . ��. � . abwe'rnformntbn is aoneer:< ��H FIf*�vlkCuNY�t`aovNy � mdtn�aas anrr Srpte ipws r�ng.PlQ�yin qtrd:kCraby - �, w+hac�ze roprasanKtwez oF 4 Gnun�p ea��pDn ika � �, . ot��me�eon.d p.oae�*r�r m,� �s��e. S1€E�$5�E�Str��BP�IA.rS�,itY tAH1��UA�+� R.C.R. bq: .., i fr 8�+ � Signon,ro oi Perminee ' ppfs - �. i _ . - I � APPROVALS oAie . 'S3NiNniVRE - �NSPECTOR'S NOTES QWNER-BUILDER DECLARATION � UNDER SLAB WORK 1 hcre6y affirm Iha�I a exempt from Ihe ConiroUor's ' ROUGH PlUMe1NG � L�ce�3c Law for ihe followinc� r eson (Secfian 70JL5, '. GAS PIPfNG� � ' Boslnass and Professlons Code):Any cNy or counfy which GAS VfM requlres a permN fo consfruc�,oller,Improve,demolish. �� or ropal�ony sfruc�ure, prlor fo tfs Issuance, afso rc- �, HOT WATER HEATER - . qulres ffie opplitvrtf ior such permlt fo ii(e o signed stale- PLUMBING FI%7URF5 �- �� menf fhet he is licensed pursuon}fo 1he provlsions al Ihe � GASTEST . . Confractors Llcense Law(Chopler 9(commencing with �. UTILITY CO.NOTIFIED Se[Non 7000)af DfvJsion 3 0�1he Bus�ness ond Pro�es� , . , �. . slons Code)or fhal he Is exempt fherefrom and Ihe 6osis � - - for �he alfaged exemption. Any violotion o/Sedion FINAL �� . �� .�'��[Qr on �ron� � � � � 703I.5 by any applicanf for a permii sub�ech the oppli- canf to a Gvtl penalfy o(nof more Ihan livc hundred � . do7fors($500).: ' � INOUSTRIAL ' - - ❑f,as owner of�he propeny wiil do ihe work,and WASTE AP"rROVAI .� ,. � � �� ihe slruc�ure is not intended or offcred for sola� -^�. � � Q 1n.�,. (Ssc.7044,8ustnoss and Pro(ess�ons Code: ihe Ca �? �. J-II-'O ��v�"' ���J . PP Y P� P Y , ` y� ?t-42�- /Of 5 GNIILB LOW fI0�5 110�O I fo an ownor of o ert � � ��� ���9 � ..�.`�-���F-- who bWfds or fmproves thereon, and who does s�ch /� � work hlmsalf provlded that such Improvements orc nof � _t.�. �� �I � � � inlsnd�d or o(fered lor sofo.ff,however,}he bu(Iding or n 14 'U,{-f�r 7`"�-[/ L �2lrC Improvement Is sold wl}hfn one year of tomple�ion.the ,' ��- �-�(,,��•�.a� r..�,��i owner(wllder wlfl haw the burden olproving thaf he d�d ,�..�.�7 q `�4��L�lS2Vif �-�•�y� �n.l.�ri nof[wlid or improve for tha purpose ol sole.) / � ' �, /fJ�,�n � f f ��� ��2�J Iamezemptunder5ec. , v�-�ts �T� ���-�... �. �-�„y�L� �� �` ��yL, � - B 8 P.C.for this reason . �''t �(J�-� � � " 1 j��C ..._._---� � �ate OwnCf INSPECTOR'S NOTES � !