HomeMy WebLinkAbout1636A (9) �_._ ,___--__-_ _------_._....._.._..__.___.___... _._...,_-- _..,......__�__...____-----_---___---------- ------------------- --- --- _. _.
� "� `"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
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{; GERTIflCA7EQF. _tLONIN$t1RKdCE�� ��� OW��T � .. . � . �.
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IB�p5tmit�s fer ani hpnilt}tlnle JaH.(;5�0�4FL���1 dAv�tdtr notf�ss
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w oa robamme auble�ats+k�l�VltatRsra Qbma�n�arwn tawa. �aSr�➢7n5�+¢a oaNrRncrari
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4� Duro � +,�,- . .nnpt6��e . .. ClO6�.S WASHER ,�p� �
� NOTICF TO APPIiGlRJT: if, dfias Qi4kir�tFi3 Cantfialle of ���L��� �� 7� . .
E Fsempvon, ron .bmdd Q. svbiecs ro �he vltorken' �p
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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 .
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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 CaleJ: 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�pscrkioQwGOdCa S��tt�S/�it3��R EXBIAl1�1AT0RY'�:AN�ITA��
pK.c.a,.a �j�'Il•'� �
igtwtu.e 'Perminlle DaAe .
^�..�
, APPROVALS DATE intSVEC�Orr55iOw,7URE �N�EQOR'S NOTfS OWNER-�UILDER D"eCLARATION
UNDER SIAB WORK
- � 1 hr.reby offirm thoi I am ezempt from ihc 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
UTIi1N CO.NOTIPIEO � � $ecfio�7P00)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
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