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PLUMBING ---------�----...------- Z ICERTIFYTHATiYTHEPEflFORMNVCEOFI'I{EWOFlKFOfiWHICHTHISPI"f7MITI5155UEql MECHANICAL __.,_,__.,.____._ (� SHALLNOTCAAPl.OYANVPERSO�IN YMANNERSOASTOBECOMESUffJECTTOTHE � WOFIKERS'COMPcNSFTIONLAWSUF ALIFOHNIA,ANUACR" TIfItiHOULOBLCUME INSPECTIONFEE ____....,,_._,_. = SUBJEC'(TDTHEWORKERS'COMPE�ATIONPROVISION OFSE, ION3700QFTIiELA00R / CODE,I HA FORTHWITHCOMPLY 7'HT O 'P OVI51 5 G�� ISSUANCE � Y-ii�µ'�__....._ I� �} —.'_ An 1!. � W OATE:?��1 �� APPLICANT: 4 YA� SMIP a Q a' G.s � J WARNING:FAlI.t1RF:T05[CUfi[WORKEflS'COMPEhSATIONCAVERAGEISUNLAWFUL,ANDSH�LLBE ENERGYP/C __ ._....,_...._...__ � SUBJECTANEMPLOYERTOCRIMINALPEhAI'fIESAN�CIVILFMESUPTOONEHl1N�FEDTHOUSAND ENERGYPERMIT WLLARS(5100,000),IN ADDITION 70 THE COS f OF(:OMPENSATION,UAMAGES h5 PROVIOE�FOH IN (�f��y(y �--��---- J SCC7IOY37oBOFTHELABOflCODE.INTEHEST,ANU�ITORNLY'S�LES. RETENTIONFEE: �IID � � IMM1E._ . � d CONSTRUCTION LENDINGAGENCY �� ��. PRE-ALT FEE: p -------....,. � IHEREBYAFFIHMUNDEHPEN�LTVOFVEFlJl1ftYTHATI'Hf:RF.ISACA4STRUCTIONLENDINGAGf:NCY ___ _ __ FOR THE PERFORMANCE OF THE WOHK fOli WHICH THIS PERMIT IS ISSUEU(SEC.3077,CIV.C.�. Z W .._..__.'_—..._. } LENUER'S NAME...'_"""____"......_.-. _ � _'__'__"._.. � L[NDF.R'SADDRE55 _._._ , w� TOTALFEES I CERTIFY THqT I HAVE REqU TIIIS APPLICATION ANU STAT[111AT T11E ABOVE INFOHMATION IS CDRfifCT. � � I AGREE TO f,OMVLY WITH ALL CITY AND COUN7Y ORDINMCES AND STATE LAVlS RELATING TO BWLDING � CONSTRUCTION,ANUIVF.qLk7VAUIHO111ZEf7F.Pf7FSF,NTA'fIVF.50FTHISCOl1VTVTOFkTERl1�UNTHE ° z AE30VE-MENTONEDPROPERTYFOflINSPECTIONP es. COMMENTS p _......'_'--""..."— � i , 1��"�� l � -- _ � ��r�, ` �----...:�^_.u.—_ -•..� . --...--------- __...� - --- Q PEflMITTEEN EIPRINT): � ^� -e .� . �!l '____ "_.._. ..._-'_'...._....._ '______ \ ��� , ' (n � �.,,.� �, "� :.�a.i? �' � L. �-__ - ----- - --.... SIGNATUREOFP. 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