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HomeMy WebLinkAbout1636A �_._ ,___--__-_ _------_._....._.._..__.___.___... _._...,_-- _..,......__�__...____-----_---___---------- ------------------- --- --- _. _. � "� `"NWRKERSGOMPEf15AT1C�IUECI.ARATION ' 14�PP�.1��4�'�D�[�I �OI��LUNIBIN:+C P-ERM_IT � . I hereby affl�ru ehpt I hmep�o MnNimtp of ca�oem ra.aeit � � � insure,or o ce4nlEtct�IB oiN�k anC Cnmperontfon ln:umnce, Ce�(uEv.ioist) � a o�eme�e�[�ait��t'��taaf(SDe.3@00.bb c. COUNT�+Y O�C05 AFf�"s�L�3:' HUICDING A�I_D''S7IFETY , avNo[�_Ktomvany -_- — . _ _-- :-. . -. , - Cerlitied copy is herpby�umiahed. ' fQR AVRICAN�TDiLLk IN(PRINT OR.LVPE) g��' 1 � � Ceqified copy is fl�ed�with�hp wunry boildlnp inqpeo- .- . - - - -- rlpn d�pi�Kmdnt. / � NUWBER Fl7CTIIRE oN I7FM O � f� (�un I[[[ QO�e�_�-�..�..Appiiqonl _ "._ .. �Il1M1�T+•�i WATERC1C13E� _ . NEAR�Sj - -_ {; GERTIflCA7EQF. _tLONIN$t1RKdCE�� ��� OW��T � .. . � . �. � btf0�$ � Rdi:�.crron�•.amo�wepmpr�ad:iE'Q(�yue�(qlnYaT�i1bY tiW� IB�p5tmit�s fer ani hpnilt}tlnle JaH.(;5�0�4FL���1 dAv�tdtr notf�ss +centfy�hw in iR�pptTomeqrt��Iff��ba•w(itk E�„vhkk ihp , Ipermui3isaVRl:Fah�(llknpt4�Yil0yAl1y��nn�nranvmonner �K cirr i ra. w oa robamme auble�ats+k�l�VltatRsra Qbma�n�arwn tawa. �aSr�➢7n5�+¢a oaNrRncrari r " . . .. . -- - - ' 4� Duro � +,�,- . .nnpt6��e . .. ClO6�.S WASHER ,�p� � � NOTICF TO APPIiGlRJT: if, dfias Qi4kir�tFi3 Cantfialle of ���L��� �� 7� . . �� Fsempvon, rou .bmdd Q. svbiacs ro �he vltorken' - �p GompeeucWpaprp��Ans oE�wtl3tr tode;rpu mu�e fenh- -� � _ m. II with mmplp Witk 6pCh �t�6FLN�4RUdRYERsrSlElv� - - �f �� deemed�revekod. �Ov4i0t�or tbia PaTmt�ctiell be ��t1t4lJSE N�. 42$15��._ �$ . IIC.EbI$�¢flONIRAC70R5 DECtl�RA�S)lSl ���� - - o�srR�cr N - vRO�SSED ar � I herobY aEHrm�hmtomliseruad�mder q�tion�qf•C�roFTe�v C�ns� wT1E�s �(J' ',4 �commo�cu+q w��+S��an 7000)of dwW�s$�aE the Bw�nesa �R F1w41 � . ' VAC DATION � . andCcofessf6n5Codb and my licewe ia ierdyqfnfJ��a�d effeu. ��M " Liepn�a NumbOr,,,��S�J�y[ Lic.C)ass R.- ,� � ..{a�i�l�1'�.. ;� DATE � � � a ([+'� , fINAt 0 � 1' co��.a�+4� ia� S-t9-E�h s'� � � QI am p�empt vnder Sec. y B.6P.C.far ihis racwn ,►y�(�b C�7$�{`.C4 ffQ�E � - Z . I oate{..--.,_--�. - - ► �1 6 a 6 A � �n�TtG�ERHu*�suwo�s l Signnture - - jt��• •�5 tUFA/fFE Plan theck aPphtGM � • • � �.5� SINf',akE EAIVIItV � - - - , ►tON1E QtNNER.Bt11lpFR DEGCfRAnOM Wame . r� + 1 �5 0:� I hnehy oR�irm�har+am exemp�-trom�hp G-anrratror'�lscanse ---�---�-- - - , low far ths falYmwiey_reaTqn(Soetlon/?�l1.5.Bwi�ea and ���s �� G���E�'�8 6 Wofe�siona Codej: f;ry ' t Tei.Nq - . ❑ f,as rnnner ai rhe ppr�q�p�rry,w�ll�lp�ha wolk a�d the - � � tnuerore is rrot in�qd Qr offec��!'fAx W10 FSee�ran � 70+u.8usineas and eafes�tam CaAs�. � CDNSSAWC?�ON CENpIl1G AGENCY ',� I hero6�affiem MaFQ�8r9•iS 9�aODth'Ve�ipR 1QnGIng.�Oge�xY for , �ha per#ormanm of fie war4 fer wMari�fiYs perralf is i6yue8 . �,I (Sec.3047,Cir.C.). . f lender'a Name . . � lardy's_P�Mff '. � I cantTg�hat+hm�s read tht3 qppTko�`an 4nd�ip.M�I�#ehe � above infotmmion is emlC1.I apf�10 cOrc1E519 wft6 ali`Qa+n�Y �I i�aces 4nd Star9 Iews�pynttiMg PtorilbirtQ and-hetaby , � tze.e�reser�lroa ot ihis Co�rny ro e8ms upon�he a evt .. �perK lor ir�pncrkioQwG03G� S��IlES/��t3��R EX�lAlY9.7pRY'1AFI�lTA�� pK.c,ta,.a �"Il•'� � igtwtu.e 'Perminlle DaAe . ^�..� , APPROVALS DATE intSVEC�Orr55iOw,7URE �N�EQOR'S NOTfS OWNER-�UILDER D"eCLARATION UNDER SIAB WORK - � 1 hP�eby offirm thai I am ezempt from ihe Contro.-to�'s ROUGH PWM8ING titense Law for the followfng rcason (Secfion 7031.5. GAS GIPING Buslna:s ond Pro/esslons Code):Any Gty ar counly wh�cb GAS VEM reqofres a permlt to construct alter,�mprove,demolish. ��i HOT WATFR HEA7ER or re�1r any sfruclure, prlor to 1fs Issuonce, clso re� � qWres fh�applimnf lofsu,h permif to li(e a signedsmfo- '� GWMBING FIXTURES menf/haf he Is Ncensad pursuanf lo fhc provislons of fhe � GASTEST Confratlor's Llcsnsa Law(Chaplsr 9(commencing wlfh UTIiIiY CO.NOTIFlEO � � Secfion 70P0)ol Divfalon 3 0/fhe Business ond Profes- . sfons Cod�)er Ihaf M is axamp�}h�rofrom and fhe basts c7 for �hs olleg�d ex�rrrplion. Any vlolafion ol Sec�lon , �� FINAL , �n�pr on Jronf 703).5 by ony opplicanl for o pormi�subjecfs Ifie appli- eont fo o Gvll penolty of nof more fhon fivo hundred . dol(ars(S500J.: WpUSTRIAL � ❑I,cs owncr of ine property will do thc work,and WASTE AP7ROVA� - Ihe 5«uCfUre is not intxndad or offered for eale. (Soc.70H,8uslness and Profsasions Coda: 7he Controc• - : . lor's Lk�nx!aw does not apply!o an owner of property � . , who bo(!ds o�Improves fhereon, ond who does sucb � , work hlmeel/provid�d�hat sucb Improvemenfs o nof � lntendsd or oH�rsd for sole.I!,however,the bullding or � . . � Improwmenl h sold wlfbin one year ol compleNan,Ihe owner-bo!ld�r wtll have iho burden of provin�fhat 6e did • nof bulld or improve for Ihe purpose of sale.J . I am exempt under Sec. . i B&P.C.for this reason I. Date Owner INSPECTOR'S NOTES i i