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HomeMy WebLinkAbout1563A (9) ,. . ..._ ---. .__...__.. ._ __.... __._ _._. _. _ ...__ _. _ _.. _. _. _ ..__ , �h��,�,"`°r`���°�"��,�"�"�;M m.eff ,�ppfA APP-L�IC,�!�'��lp�;��R:�'I.li.M�1h11G�P�RfIP11T 338/A � �, i�nure,or a mrt�k�ple af Wo�kb[Y CamPilnw114n ImtKCoce: GE BY1�(RE16.lOrB►{ � w o cert�flefi'cp�sr�hernnf(4et.9�1R trila.C.) CQUI�LY Cl�'1:d5.��11�s�_L��- $111CD1��'i�111�D3A�ETY 9ou�bi ;�_c�+n�F'i.��ati�`s F'tn3d �, Q� CeniRed m�[�is her�fumhbed - ipF�va��Gawr TO viu xa{P¢uvrOR trB�-:.-_.- ..-- . . ._�- - -- - � �-- -� -- �� CertlRed mpys ts�f1Ybd�witk 1fie�my�»y buf&Jinp inspec• -- � . .. .. . .. _ If4n dbRGM+�i�N, �Rik1�ER iq[Il1R!(X!YfBY� - � � F# _ .�,_6__ . - ! - - .'�,� ome. 2:15/84�._APRURanx' . _.:- r : . � ` . .� � vY�kR�lSEs . 14�N,U'r�7�110R1C�:Ac� - - . .._. _ �ar¢rea.�r��fa wt�r�:as _ _ . ��rnue , � . ..! - �td� �I:6td� �v�, ior�r. _ _ (ihiss�tlTo�resedmoiM�;.eompl�i.dMfF�wr+ Involv�dbr $� �`� � � �� ��' �g�` � ths(wm1tlY�yfer e�i hu�aivd delfen�1903 d�iss.J ���q�, ,_ �� � �� �camfp�har in+Me P�ormmnnea of�he work for wh;ch rf,is s� e�n -. . ... . . . ___ � . per4fiT.i:issvld V Lt101►r[ptllFlii��i^aRy�pnoa inany awnner � '�' F+ � IEL.MQ� � to�M bQm1Yl�s4���fOIhB WO1�ce/s-fAmpe�ROtbT lows. � -. . -_" � ow�uvwsr� cavtanrcai R�C R„ �'�..pro� , �C. _ _ _ � nu+e-..-..�-..,,,..ApRlrcon� ccom+Eswas� - ifGE TO A'PPLlCA1YT: fl. aEtet erwkiag.lhia QCnffiepte a� - . .-. . -` ACORFSS '�. 8�'j� �.� ' /'� , ` /mqnan, S�Oo iPO�Rt�eoin� t�tb�a�ec ro the Warke�i SwWtMWG000�RELEPIdt : _ .. . - -.. . .. - ._ .. omRensmroo prm�lorA:af the�1e7bc�Gade.rau muar fo.+h- uwniseRs�ER s�aJEM � �.VP.Y87.C1E � �3��-��0 � wi�k ccmp14���ti sn0i Ltp�ronx rn ihis permh sball ha . . . - ' denmed ro�aimd, w���pe - .�, sr�`� wo. _33b'4<'18_ __ �aAss C-36 � � ���CQNfBMCt4tL40Ec�1Rn'11Q1�t .. -. rnsr�rraa- - -- 6r- - - +ne�akor aenrrn nsa*�am r�q 4�d uPWlt gl4viaiary44F'Chppter 9 ��M OVRER � ', Icammpndng,nea�tv bDcuan I�QaI?�dF G�w3tary 3 af Qie Swineu ,pp� . O� --� � ands'Moteqitltq�S�cndrrry.lk�tr¢Aia infvil fo�qn�lAffec�. � 1� `�� yAUD/[TICN V j �ue�se Numher �`G+�f� ��.am:+..,�36 � ' e��to,�p�.'�1s1'Zi� Ti�coo,e �1&/84 `�n�,v. � � V ; Q 15E:3A � 1 am eaemp��mdm See. � 4 �, B.6P.C.for thif reaton .._ ____ ___ -- .. . .-.- . - �{•.• • � �,rj = PIQn chgck f$� I •3 5 2.5 D Dare: vtul�lNG oERMM��StJ�rIG�EE$ �' Signaturo . - - . :� • •J:%2 J�Q=' '., 'TOTAL fEE �,', � `= � a�an�r�eck aPpt�cam _ G 2 1 5-II 4 ' SINGIE FAMIk� �,, � HOME OWNER�6lIItOFft DECtARATfpN Name -� , � . � __�a�r e�ta/1�r+amexempt�tom�h¢�mrr�dar�lironse 1 � l.]:Fi A�ie. CT�` fi 4 7,E A . owomp rse�ann�uton X�i1.5.eua�nasr c�d� +�ddre�s . asr VmfeniortsCqde): C+ry - let.No: • . . . � ', ❑ I,as rnyner a6 the p�qpp[ryt,witl do the work and�he . .. _.-.-. .. - . . .. - � � I ���, O �, avuupH!q rto�iMqniLed�oHl�Ad for anle(SacAon � >OAd,8usinAis d�PiQfessiom Cade). �2 O€ ', CONS7RRICTIQN lENOIAVCa AGENCV .' � 1 heropy cfFlrm rho�ihare ia a earoJroe�ion lendiny ogersy for � O E. n .S�S the pprforenpnee�of[he ryQr4 for M[hich�hia permit if iss�ed . . (S�t.3R97,t,v.C.j. f 1 !.9 A kender'a Name aSPrCL11�L"�L'dQ].�1C.,Dr3lIK '�' .�• • �Fj � Ee*uier'a AddrounTawnnrr_Raani�_ f`.A .. I • 5 0 +cenliy rMr M tsxv���d'ihYa aPRi�t�n ard"sTA�e rliot�he • oba�e�ntomwtton�s mvaW+ +n cqmtply wilN au(ypunq �� . .Q 0� F� orEkqnces pA[!Slqtpr iOlri�OB o�wnb:nQ ond Yiereby � ou�haim roP�esa�+nn�.e�af Q,ie ueayr ro eiYer�vpon�f+e .. . - . � •��,1 D" a6nre.merotenad�peoa6�for�,y,a�a�qyepn,s9s, ���1;.. �f�...G.�/�.� z�e�s4 �i������rr����tQ�rr_.�et�t�� i5 qriWurg oi iarmiM e � T pote . narrtov.tts o�ie INSiECTOR'SS�CiNAiURE INSPECTOR'S NOTfS O`NNER-BUILDER DECLARATION - UNDfR SIAB WORK I hereby affirm tha:I am exomol from the Centrncbr's , ROUG4VPlUM91NG- Licenso Low ior the (ollowinc� reosan (Section 703L5. � GAS PIPING. � � 8usiness and Pro(essions Coda):Any tily or rounfy whrch GAS VENT _ roqulrvs a permlf fo conslruct,alter,Improve.demolish. - or repolr,any siructure,prior fo Irs Issuonce, olsa rc� � HOT WATER HfATER - - � quir�s f�e appliconl lor such permii fo hle a sJgned sfofe� � PWMBING FIMU2E5 ' � �� ' menf Ihaf he Is Ilcertsedpursuanf to fhe prov/sions of fhe GASTBST � � � - Conirodor's Llcense Low(Chapfer 9(commendng v+flh � UTILITY CO.NOTIfIED � � - - Seefion 7000)of Div7slon 3 0/�he Buslness and Pro(es� , sfons Code}or fhcf he is ezempf fherelrom ond 1he bcsls f c� - - for ihe alleged exempfion. Any viofation ol Sec�ion , FiNAt Gn/er on _jronl � . . . 703L5 by any applimN(or a pormit suhJech the appl!- conf fo o dNf panalfy of no�more �han five hundred . � � , dolfars(5500).: � INDUSTRIAI _ . � _ ❑I,os owner of iho properry will do the work,ond WASTE AFFROVAL � � tha structure ia nof in�ended or offered for sola� . '� (Sec.7041,Bustnass andPro(essions Code: 7he Cc �_ ' - � . . br's Uc�nse Law do�s not opply lo on owner of property � - . . who bWlda or Impreves}harron, and who does such j . , . ' � � , � work himself provlded ihaf such ImprovemeNs are no� ' � � � � In}endsd or oifered for safe.If,howeveq fhc 6Wlding oi . , lmprovsmenl 7s sold wlfhin one year ol completion,thc � � '. � - �� � � owner-buifder wlll Bave the burden ol proving that be did . - � nof bvild or Improve(or Ihe purposc of salc.) � I om exempt under Set. , - - B$P.C.for ihis reason - I Date Owner INSPECTOR'S NOTES ^