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HomeMy WebLinkAbout1578A (9) .�. WORKEKS C�?J�PENSATrO�I�DECL/�RfCTIOf� � •._' .�`�' /� •.�.. ( �•./[.. /� � p. ` � �'��, eg :.. ��--�� � s_<�;�,w._. I he e6y a�inn rhot rhave a certificate of consent to self n ��������8�� �"1P��1�/'"���V� ��1� ��� AA �� 76A567A fY, �.P' , syrs ar a aertif cate of Worke[s'Eompensat�on Ins�rance,or o� ` 'CE�977 jftEV 8,�86� " '`` - - ��' ��� '' �-� �� - - :c�rtif ed copy�ihe co4 iSec 3871��Cab.C) : '� � -� y,�.� . �.. ' „ r�.. a� �-"- "� Pol cy No �8$�B� " :Company o .�i.,:: �...�_..= tOUNI`Y OF`L�S��IC�sEL�ES_,a¢"��.' �� 1SEP��OF P(18�IC- _ RKS�� '�� Certified copy is�hereby�urnished ~u�����_��nlfY �. � � . .. � . . ,. , ....:. . . .., . .. . - . �� 'rOR APP(ICAN7T6 Fl f,��PRItiTORYYP`�;" - 3U LD NG_ � Cerl�iec�F�copyisfledw'fhthecounfyb � inspec A, . . . --- -� - ^ ApD'�'e55�Z,�62Q �L(�/]B�� �}R� � n A departmEnr - � :<� ) _` NUNiBER FtXTURE OR i7Ela - -�- ---- .��. � , �� 8ISI$$ �.,;_PP � , : �i� � � �` WA7ERCLOSE7�T0!LE7; � �. . `� . YVALNUT,� . - . �. p�#��• CCALITv. .��-.�..., . ..:� ._,...:. ,_. Date A IitEFrtR �8 .,._. ' '._. ... . - ..-_ -�8 U�F \�ARE55�... . CERTIFlCATE�F EXE,�"fOF+���d�`ii v�7b'�It� eArH.7us c�zoss 57: .` -'� - � corvivFNSA7ic3nitNst3"I�aNCE" � sHov;rte � owNEa.pRES�.E`Y OE'�����0�`�1�ER � (Th s secf�oo need noi be iompletsd i�the work imofved by � � 6 ��. � - _ . the perm t is For one hvndred dollors�y 10� or less. �- � 21{ �Q. a�DRE55.�]991 M��7'���,��SV V��`���"����� i-., , ,_ l+ � 1 LAVA'FORY - I ce 1 fy that m the performonce of the wo k ror which th s per= - . - . mU s issueo� I s6all not amploy any.-. n pny'm2Ynner'so� '(� SWN�"" `Ty jRv��E � - 'E[ NO 'as-to become sub�ect to the Work pensatioP Laws .��� �- . � _ � . ._6 �-0�6�0 ': . - D SNWAS�E`R ' .. 6 00� .. . -, ..�. . :., . CGNTRAtTOR . .-,. .:..,,-_ �,,,»�. Dafe -' Appl ca - - CLOTHES WASHER -� - . " - ao�aess 12785'"MAGNOLIA �4'f7E: `" NZSTICEICl dF;P�Cl�.`A,�1`,`�;-a{�er ak�ng this Certrf mte of Ez- -��"- . - �� em h,on, � " - '� ' � SWIWV�TING 700L RECEPTOR_ _._"- � - ..�_ � _� ..,.....�,., p you sho Idbecpme sub�ect to the Workers'Compen- � , � � -. ' _ CiiY sat on provisiohs of the Lobor Code,yau mvs+foiifiwiih comp-� - � � �- � � . � T - LAWNSPRINKLERSYSTErN` ` Y.-" -'-- .�-"`-�.--. E'-N� �y w th wch pro is ons oi th s permit sholl be deemed evok-. . � - :_. �� � $7ATE -" ed. - _ :., . :. ,, ...a...,..,�-..::��..,.> �. . .V�:ATER NEATER -� . . . t CENSE NO .'..Z. . �.:.. . . iC �`� LIC�fi7sED C6NI�AQ'6k��EC.LAfi2�7'�0'!3`� ., . � -� oisre No:.-.__' ' . azoce5s 6ev -- ._.. . . I hereby aff�rm ihat I am iicensed under prov�s'ons ofChapfe�r -� � GAS S�STE/vt 5 OUT�E75 � 6 Q�. � . - � . _ � -- 9�.(commennng w�th 5eclion 7000)of Di sron 3 o�lhe Business DUTLETS OVEq' � - � and P ofegs ons Code,and my I cense s n f I force Qnd ef-.. 5 PER SY5TElvi"�` :-' � � FINAL-- p fec� _ " D,4rE D�'���. VALI�ATION -... _;;��_;.. License Num6er 3��7�4�� Lic Class �- 3fi �� � - . _ _ � > � 2-�= BAR �(N`K-,.� _ �� �. �.m .�e � �-,� Finn.L con�a�,�:C"'I�:��lumbin�oare' BJ�i�B��-� ev ,_r,� r� �� _.._ o � I am exempt under Sec � � _ - �- - - . � - �� -� � � - - U W . - B&P C io th s eason ` � - � �. - � ' Plan check fee , Z ` ` Date � . � PLURAB]NG PERMIY95SUlIV"G FEE$ . . '. S�gnafure � - ...-��10 �..$0 . . . _._ . �� __ ...�, � ,- . ,.a ... -:- - ` � � � - '.-' . . ," . TOTALFEE� -- � � SfNGLE FAM7L4" " '�":' ._� .:.." � � ^��.� .. . .. '"""""'" Planzcheck a -... � 4 � . - HOMEOWNER�UIIb`ERD�'C�A'�,45°IO`��"" � pplicant _ � . , __�_ _ � . : .�-.- . ':. _ _ .,� ;i: ,...:_ � �. .� _.� . I hereby aff�m�i(�or I om ezempt from the Conlroctor s Licertse-�- Name� � � , ,.� Law,4or the follawing reason(Sechon 7031.5, 8�s�nes5 dnd-- � �- - � � � i� 1 %�`,`_�'� _ -' � � �:_ s..a._ u� .�..- --� . ProfessionsCqde�' - - � Addcess `:..� .-. ..�` . ... .. - . ,. .,. ...�_.-- �� -. '' � r � � ... _ ... 4 Ye - . . � i,as owner of the property, will��do ihe work ond 1he_; C��Y- Tei.No - � v � '. structure is not ntended or offered.for sale( � - . �-�" �----�-� --�-��� _ . . _ . Section 7044,... .. �- ' . � .;, , -Q�i . .i-i, ' Busnness�and Prafessions Cpdel. � - � � . - � � . - � - � - � ._ . __.__�. , � -. � ��._ -: „ .,,�.:.._;.._�._.._�.�,.>,. w,,.,�:'.r............_�=�a,._...� -..�.--.�._,_-._.._.;-;�.,..,__.;> :► . . . . . . . ... :�. ,CONSTROCTION�LENb1NG-AGEY��V��- ., � .,n , -�_._ �, .�. --�. ,__..._--v.. _�.._�.s_ . ._;.. _ . , . �_, .__ ..-.�,.._. .d .. >_ ,- ,, .. _ _ . ,.�� . , � . I he eby affirm-ihot t{� e s o consir t n le d ng�-agency`or�. . - -the-performontE af the wo k�o hich fhis permit is ssued - - . ._ . . (S�c.3097,Civ.-C.j:,._.. --._ .......,.�.... . . � . . . . . . . . . . . . ..... ..._. . . . . . .. . . . .. . . . .. -�. .-: ;- - _..: .' ..- . . Lender's Name. .. .- -: : .. �� '� . . .. . '� -� . '_ �' `' ;: : "-_. - �.t_ � - - � Lenders Address ' ...,_ ' _.,�;. _--....,.,,:y _, �- ..__�.;.- ...w..v,_.:., _.. _. ..:.�. ., ., . � ......� v_�� . � � , ... .. ,. ,. . , . . �. ..� ._..� ..,_,� ._..._,_.,- ' � :-:._ . = `.�-. ,�. _ . , . . .__ .. r .�. . I cerhfy ihot I have reod rh's appl cation ond state+hat the.� ' � . .. ... .. .. .�._.__, ._,<_.:.._ ,_ _._. .... _..,..-... a ... . . . ____ rbo e nfo mation s correcf I agree to comply wifR pll Coo'niy�� - _ - ..:-_� - - ' . _ ..- _.>_ .._�.- .,,�_� -,.--,,..:._e_.. a,-,..e . ordinances dnd Stat law;�regulat ng Plumb ,and hereby - � - . _. aui oriye represe tiv �: t6 s County�t nter upon ihe �� � - � � -� -- e �enYon o er � or nspect. &Qs . . .. .. .. .. �. .�. � .. . . � . � SEE�R�VER3�FC�It ES(�i�L`AT�T1�O..k'1�'C�l�l����'..�.._..�..�.,wu.r.>..����,..��.�.....�.�..�.�..��.,...,.,w�,a..M�,_._ .� u __ .. ___:. . ; ; �- . ignafure o -Pe7mirtee-.: ... -.�°Dpte .. . '�` -::. - , -�- : - . , � - . : . . _ .._, . ._„, � . _ •_ . ._ �,..�,..F: ��,.,� �:.: .;_ _ _ ,,,. . '-. z ,-' _ .� , . y, . . _ _ � 3� ,�... ._....�.: ` �; 'shiSP`��`i`��+'S"f�0`t�S" � ,-� � �/NERBtlIE.DEFt_DECiARqT10N ; n. �,� - . , APPROVALS OAT�'���SP�.b`FPS STGNATORE _.. ._�__.,-..<..,. - .. -- - r�- �-m >.-�•.••..^�.,�.„..,,,,..� . - - ���isrgtiy a;fTtm';►iet t am ex'aiYi`pt from Me ssoneractors. , uN�easweti+oAK'_� F 4icense Law for ihe falioveing reason (Section 7031.5, _._ .d4.x, __ _ ..�._�_ _,..._..__.�.. . .... - aouGH Pw�nsiric = �sin`�'ess an��ions Code). Any cdy or county ,._..:..: p _ - ^�� which.requires a permrt to'aonstruct� alter. lmprove. GAS PIPING � ...._. ...-:..x..-.�..,x,..:«us„n - -.r..�,e--+;rz-�a..:r...d�4�a.-aa.a.. ... . � . .. dem011sh or�spau any struoture,pdor to rts rssuancs, cas veNT__ s``` _„ ',,, also requires the applrcant+or such pa�mit tc file a signed - � .-,_��,>��,r.�-.,.�.�s,,�-z Ts-aw.���.�., H07WATER�HEATER ��- " � - � � �-��Y *� � . �.- s atement that f?e is Ucenseo�ursuant fo the Arovisrons _ _ : .._:-., . ..- . �- ' P�u�si hc F1zruPe�' oi the Contractor's Licen'se Caw(Chaptar 9(commencmg - -Y - � ` �`�"'�°"`""`�""""m""�`-'"""'�'`'�:< '.���'wiih Section�fJb�)o{➢7visron 3 of the Business antl Pro- 9AS EST _�_ ..�,��b.-. �'^m't ��. . . . . . . . �... fessions Code)or thai f�e�s sxempt therefiom and the UTlLITY CC NOTI�IED �,:.- � ' � . .:...�....,.,,e„a,.-, ..__- _"�'--�� __�. ...: � - . . . . --�_� _ _ _ ...._�:.. " ' _ �sis""�or t�e,aiTeged axempfion.Any violation ot Section 7031 5 by sny applicar;tor a perfiit sub�ects the appi'r --.-.-- •��f�--'-+w-c7 ----�----�-���-�-�'^-� —' - �` '^ ""'�"""""��""' ��"`c�n[fo a'aivil fienalty of not more than fiVe hundred � F3NA� -- G f¢ on .3ennt - . . _... ,,.. : . __: ,=,�..e.. ..___ doflars fS5tJ0}. .�.�.�� �x_.:_:.—. ����� _ „_. .,_�..�. __ - . . ;.. . : . ....[]!,.as owner of the ptop6r4y wlll 8a the woAc,arM Y . . �-- � ^��r�-� --v�^�--^^_��=�� � . _ structure is nat in4e ded ar oftereA for sale.: , _. INDUSTRIAL . . ... rt.�4 _- �'.�. ---� """""°`�itlPio'fessionsLbde 7heConfrao- WASTEAPPAOVAL - -� `�. -'� "` � ��- � '� � �--" (S�BC-��I/S1I16SS . ._. ._ "- — --- -° - � �_- - --Y�s tor s License Law does nof apply io an ownerof property � _ ��� �_ _ " "^' ""'-"�""`"" ."who tiuilds g�iinprov�s thereon,and who.does such work . „ ��� ��� , hrmself orovided thaY suct,improvements are not rntepd- , -- "` --�--�-=�-�-�-�- ��`�r oNe�ed fo'r safe.!t,!�+owever,the building o1�m- - . ;. , „ provemenf is sold wrthir oire yaar ofcompleticn, fie _ W,_� • ----•- -� � " � `""""'�--� dWiiBrber7der wi!!have the durden oi proving that he did _ _ .. __ not build or improt�e for the purpo�ot sals.) __...__�„,,,,��, _. , _ , , . . .. �. c __ _.. �.�.- _�..,x.»�. ,.., _:,..e.,_�__. � _� ` ; 1 am sxgmpf i�nder�ec.,_ v_.�a�.=...a.,.,.�...a- �___ � �,.,_:- .._:�-. ,�.�, ._._. �.�. ��.. : _ , _.- �8&P�:sor thos►�sartiµ .,Rs.:�ww��z.,....,,� . � - : . ,....�,,�ti Date � �,-�,r -���r;�-�- ��,�.�� .e__ .. �,._,..�,-�..�M,..<�� .,,�.,:.r,,.�.��:.�: Owner ���.���� �` � � : ...�. ,.w � IN��P�ECTOR'S NbTES � ,„�,� ���. �_�°-�--� � � x_�� � - .� ,�.� � N- ;� __.__.� .�,.�..v w ��.�����,�..���,..��= �.. . ,.�_�-- , 1 � - _�,�w .��.,� y . ���,�. -����s.�-• - - ,�._ � �= �.�, .,,__�, _ _< _._,� .��� ,_ . .,,, _ . __ �-�-, �.�r.���4,�,ro,��., � ��. - . - ,_�=�_ � ��. � . _ �_,r�....���. � _r.' ° __ _ . -.�_ �..,_ ...z,= __ tu, �._>_ . . . . . � - - �._... ,. ,_�.._�. .�--�.,:; ._..;�a�.�:.`.�_- . �;.���rm�,�{e�.�.�?��'�5. - - � . � -. � � - _.�— ._ .�-..m-.� . .,., ,.xr-�_ ..-.-t�.: ' _.. ... ��,. .. - .�- <�,s.. -F„�.. ,. .... -. . ��,,.y ,,a� . . .:.,.,..,._�...� �.. � ` . - - .: . -- � . _ _ar�,.� .,�,�s�, .v ..� ..�v��I`_._ .�.. ,...""^ '� t w �..^"� .. . . ,.. . . � ._ . .... :.� ._. - .�..;:.,_ .._.-:: _ .... . ..,. . ,.. :., . :.�;._. ... -_::�,_. .:..,.� ..-�._ . ... -._ . ..}seE.- . ... . . . ..- . '_-�". , � � � . .___. . -. ---- '-"' . . . � .�....s�'�.M_.�. 4-..���'a a�.�-'"a.,"'r,.._ -.�..,,�c.a�-�.� , . ... _ . . . . � -.__ _.____ _ _ _ : . .. . . . .. - � -. .. -,�.3.-� : ,.. �:. -_ .���e:_.- _.�..-�{. ... . �xy,..