HomeMy WebLinkAbout1561A _ .. .. . . __. _ . _.... -_ _ ..... .__... _ .._ .... _. .v. .. __._.__,. ... . ._ ___ . _____ .... . . ,._._ � _---,-- —
', � WORKERS WMPENSATIUIV DECIARATION pppllC�li'�I.�JM+�F4R P�..liMB1N+G PERMIT `�
� I hareby aNiom�Iw�I Mvs o cenHko�e of corue�+�o mit ay�rq. 338JA
� insure,ar o aerU4iN}e of Wakeri Compensofion Inayrqoce, CB B�7(REY.10�81)
orncemtcedcopy�hereef�ee.3@OU Wb C.) CqUN'fY0��05.ANGECES BUILDINGANDSAFEiY
Q�1�]�:].��..Campnnlr�'']�3`ET�T�Ymrl
4rrified mpg is keraEY furnifhed.
� � FpR M%.I�AFIT TO FlLL IN(RtINi pR 3tPE) BU - —
CeBfied copy is flted wi�h ehe eounry 6uiWYrp itqpac-
lion dQ eRf. Nl1MBER FIJfNRE OR ITEM � FEE �� � p^V
oore 2/6 $4 _ A�ncQn,�-�S': ' ,f' weroztwsEr � ++P�
c�r+Tr��a�aF e�nnanqN�wowc�as ea*w nria 0 ... �'s+. Di�d B� B1vd/Gr�z1d Ave.
connv�r.�s,at�o�nvsurtnNr.� �— SHow�x 3i► a""E" Psesl of So. Calif.
(This Ntlba M+d nM b�eelnpt�N$R�b�wotk�lnvoir�d by _ ��i
fh�pormN u ior an�fiundNd.d41f4n(f1TfOj m i�s�.1 � uv,uoer ,��
� I¢artiir�hol in ehe Qetfarmence u4 Ihe work for which��is
permi�is issvpd 4:Nqll�nnt emPloy mvy peaon in any manner SNK 3� � CtiY Newport BesC�� m.�. 540����
� so m to 6emme aubjec�ro Are Warkers'CC�nnpe[�wtion Lows. � p�w�R 3 �
o cavrruacr°eR.C.R. PL . Inc.
oo�e _apn�rwm ame�swasHEre 30. — nowffss
/"'�ITICE TO/iPPtKRNT: It, after iaokinp tbis Cen�wU of ���� 12 �S 1'1.$AV2.
. � ,inption, you ahould 6ecro�ns aub[ecr�ro �he workers' ��Ty � p�p
, �ompemation prwisions af�bn=YaBor Gcde�pou mua�fonF- u.vtta��t�rpIIpRsrSlEnn � .. �
� with comply wvitt+ �uch prov:siGr» or 9�Is psm�ir ahutl be AnTE - uC.
� daemed,avo�d. wA+�a«Enn�r i�r,t�iuo.33fi428 �� C-�6 ,.
ttt�NiSW EnNxRACtQRS DE�tARA7�CN 3Q � asrwcr rao. o�o er
I hen6y afflrm Mwr+�om liceemed uex�pr prmisioru af Chapra�9 "��Y�'^ .'�� �� � "'
(wmmencirp.wi�h Sectt�7�OW)�'DivisiOn 3 af t6e Buoineu �pµf�FtSpvER r�n . �'
' a�Rofessiom Code,crnd mry lics�ue�,o in fuU fwceand�effetl. S�'�� �v FINAL �
i VALIDATION 0
! Limrne Number ��b�s�..,��.lic.Cl�as{"�Ei �� , ���� � OVC
' co�o-auor��Pl��nhtin� Tnn,_._ 2/6/84 _ e`�"` � -�/ :s_1 5 G 1 A �
❑ I om exempt under Sec. , ' �� ' ' ' • '�J y
� B.&P.C.for�his raason Plan check feg. i •G b E 0 0 �
ooes:
', P6UMHINO oEHMFT ISSU�NG FEE S Q '�D �o o C!C�iJ.Q�i�
Si{r»'Nre .TOTRI FEE . CO O G� :'-H L4
. Plon check applicont �
sw�►�F+anniir � `¢1 4 7.7
� HOME OWNER�6t7IlDER�ECIARATION Nome
. ���reby affi�m iho�1 am exampt kom fhs Coniraqor's Lice,ne �d�� ���� - -I;g;B,Ave. #• 5
� ...v for the following reoson(Spe�ion 7031.5,Buslneas and ��,,.,...s
Profeuions CodeJ: �4hf �,vG�p:�,� Tel.Nn.3]],�"500� � •jl � Q�Q
❑ I,os owner of the prpperty,will do�he wo�k ond the - ► � � �� x
. atructure is no�iM9ndqd or oNerod for wle{Sect�on
7A44,B�nineaa and Frafenions CodeJ.
�'210�84
OONSTRUCTION tENpING AGENCY . �
I Mreby o}Eirm Itip7 Mere��a o cansiruction fendlag oqe�y for �.
Ihe petfnrmanca of the�wqrk for Wkich IMis permit is is7uad �
(See.3097,Civ.C.J.
Lender'.Name 'SeC1II'�'L� �x�1C �c'1Il�C
' Lender'a qQdreas��p�t �'aC�l• �.�i
. I caniiy rhm 1 hare roqd Ras appf�cn�ion and-sopfi9 1h41 IM . � .
abave infwmotion is correu.I agree ro camP�Y with a{I Gpumy
' ordinanms an$Srota lows re�ylWlny Plumping-Ond herebp
, wtFmcize�epresentofives o4'tl+ia Cnw1y tq eniar upon�ha
'� aba.e•men�brted proPerry for in�peerlon puRposes.
�� �REY�It��EQR'�I�P�BNgTDRY 4AHGLACE
R[�a �y�_ll���2/6/84
� Signa�ure of Permine Dote
�
? INSPECTOR'S NOTES OWNER-BUILDER DECLARATION �
APPROVALS OATE INSPECfOR'S SIONATURE
UNDER SlAB WORK � I h�reby affirm tho�I om exempf from the Controctor's
ROl1GHPLUMBING � � � License law for tho F011owing rea;on ($ecfion 70?L5.
� GAS PIPING � � Buslness ond Pro(a;sions Code):Any clly or coonty which
GAS VENT ' requlres a permlf fo consfrv[t,alfer,improve.demo�ish,
� or repa(r ony sfrudure,prlor fo l�s Issuonce, aho re
HOT N/ATER HEATER _ . qvlros fhe appllconf lor surh p<_rmU 10 lile a slgned sfofo-
� FLUhiBHJG FIKfURES � - meM fhaf 6e fs Ikensedpurwanf fo fbe proNsions of/he
� GASTF57 � Confrocfori L7cense Law(Chapter 9(commencing wi�R
i U7ILITYCO.NOTIFlEO � � Sectlon 700�)o{D(vislan 3 of fho Business and Profez-
slons Code)or lhaf he fs exempt fhere/rom ond}bv basis
� c� � ' for the alleged exemp}ion. My violation ol Sec�ion
� FINAL � � Gnla�na Jrnnl ' 70JL5 6y any applitan)for a permlf su6jecfs fhe appli�
j cont to a cfWl penalfy of not more lhan five hundred
i -� " _ dolfars(5500J.:
b IN�USTRIAL - �i,as owner of iha propeny will do the work,and
WAS1E APPROVAI � � the 5'ruclura is nol intended or offered for sale.
I, � ' (Sec.704�,BusinessaadProlessionsCode� 7heCc^_
�. . - . tor's Lfnnse!aw doos not apply to an ownor ol property
i - . who buNds or lmproves thsraon, and who doas svch
i , , work Flmself provided ihot sucfi Improvemenfs orc nol
Intended or offered for safe.1!,however,}he bullding or
� - Improvemant Is sofd wlfh(rt one yeor ol complelion,}he
�� ' � owner-bulld�r w711 have the borden o7proving thar he did
4 . � nof bulfd or lmprove/or ihe purpose oF sale.)
I am ezempt under Sec. .
. B&P.C.for th�s reason
Date
� Owner
.. INSPECT�R'S NOTES . _. . . '
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