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1737A (10)
ernticaf r•�t��ate . .. . .. ... . . . "' . �, �:°��ed copy ihereofworke s Compen a�on���f fo seff /�� � —..., (Sec C -""'^^,,.:. .. polc Qco..� 3800,lab. � � .nsurance. CEg667A 17 PLteq-TlO� �y p� � � ..,.,_.�_ ❑ �..�`zl om 7,� (Rev.toiai; �a�![ � `w, '� . ._, 4�� Pan_'+�-.4�21I7 . .. �-��,... .._ ,� �� Ce t 5ed copY s hereby furn shed. �p���T"`�4�n1't3r. C� - � . ����`�7YG � �..�.-�.- . Cerhf�ed co UN7Y pF ! ��R � mx���io�departr�ynt filed wHh the countY b�il ,,, �DS ANG6LE5 M�T � � " W Dofe�_�i/7 n����9� ' 9 inspets .�R APPLICANT TO FILL� ::... . .... ��Bu'L��NG AN�SAFE7y � � � ,� �°°t'��'�,'�'-'-���°�.iAPPlicanf]�f'1.7 �L_ �� �i I NUMBfR � . NIPRINTOR7YPE� . . ��n,Q . „"�.v FR7IfIC:q7E OF EXEMp ��LL� � .rt . .FIxTUREORI7fM . BUILD;NG �.: �� ' ����. . "-��*3aa"`..COMPENSA71 TION F�O N EORKERS' �"`3 WArER��o � s seNion ON INSU - � �9 . �.�,,� h�°�,permih is for�not be complefed il fA. . .. . ^ . . SFT � FEE q��RE55q�J�,�� � /f BA7H TUB � !' COCAUTY � / `� �.� .��m�i�fY�hat in•henperfo mred doHors(SI00)orkless�ved 6Y .. $4pWER. � � NEAREST��Dl�O�a.BB.Y' . � �" .s ssVed �shall n once of ihe work f .. � . r .v . 6Q�,p .�.. L. J:�L_ CROSS Si. L ��x s to be��e�;;y�en o�hepWorkeryp�rson in onY manner�: � . LAVA70RY - . . OWNER !11 j IlP S.�RahCiy� '�* '�� ompensation Laws: siNK �.:.. . " �.Sal]'th .C011p,t k� �are Maii Y' Cor � NOTlCE 70—�'4PP��cont ��� - � � . ADORE55 ... �Compfioq.YooL'sonuldlf afre makm9,ths '.�.. ' '� .� f � HWASHER .._... . CITY .. .. . . y,��� pensa�on�provis o beCO11e sub�ec� Cef�f�<a!e of 0 �OTHES WA . . . �, i h complY w�lh ' ^s.of the Labo Codeto the Wo�kers' .. . � SHeR -.. ���.,, deemed,revoked. such provisions,or this y��musfforth- � SWlMMINGPOOLR . (P � � . . CONTRqCTOR R.C.R, P f �. �llCENSED .... .. .. permit shafl be .. ECEP70R �� ADDRESS � . 7EL N - '" � LAWNSPRfNK[f,�SY��M. . �- ca a ONTRACT CLARAiION � �2 78S �b �f ereby pff'rm�ho�� ORS DE Ma....1 .� -. � mmenc�ng W�rh �'�ensedunder Uiaiea � q7v no1ian �' INC,. � �ndPr Se<hon 7 provisions � HEATER .. .� .. . �.. . LiVe. - ;.�:� i ofessonsCode��d ��of,D��isrong .ofChopfer9 . STqi � � y �;.�t�'i+�"#x�,�5,,,�,a my license rs�in/���fof fhe Business GaS5Y5tf,1� [-- � � E � TEL NO. � v���,t� nse Num orce and OUTlETS. _--_ LICENSF NO. 3,3.b/�2 O be effecl.�' OU71.E7S OVER D CIC. ��'�C`o�"�'����`i n��'�P�6'{X--2-�_Lic.Closs�!� � ' � 5 PER SYSTEM . . ... � DiSTRICT NO . CIASS C`�36.. .. acro i� R UIIIIJZTI '-�II--, ( '"�� i am ex �ore 6/I9_�_ s e�sv + n , emP}unde - .. F�NAL .Ji��/1 ��r'.. FkOCE 5 . , Sec - � DqiE ��1 B&P _-.:.. � � . . — � . .,�,, ,.y C for fh s ...: � . � . �Auonrr � eason QN , � -- .av, ;��e.xb..�....... � . . . BY q�y�,��)�.... _ � r ; � f,�� �igna�i__Dafo � .. �c ��,.�e � z �_ Pfan check fee � t ..,�� T���� � �"�� _.y�� tl PLUMBING PER �� �� � � °:� q,-�.a,.c�f e�'a�'a ..,";�.�"�.r:.�5, t++,. ,... , . MI71SSUiNG ,� � r a�. , 3s;,'�e�?SIN " - . FEE . �OME OWNE GCE FAMfLY . , ..:... . j' . � 1 herebY affrrm� R'BUILDER DEClA PI°n c�eck o '..:�. T07AC FEE � - �F�roLowforihefoll,win�mexemptfromth�3a5�ON. sCicense . ���1e R•�C'''R,' ,�L'(�y,'� ���C� `' r � ��, � fessiorts Code: 9�epSO^(Settion or' � � -� ��� . '❑ � . .,. .,. .. ..... Business ond � Address . INC'�. Z�(],.. � i:m��.s.�m c� .. � os owner of�he - . . . �. st oc�u e �s noi inienrdedrrY,wilf do 1 � . . . City . a$no ia ve. . 7044 Bus�S��dFProfessions Code �e�oe ise�tbn ... �7e1.N .. .. . . . . .. . GZ���O �C�NSTRUC710N - �' . � �� o c_ti n s �hereby affirm,�hat there is a coND NG'oryGen�Y . . . . . � � . . . � c -.,,: . e pe fo monce of rh J 7`�,_��V� �ec 3097 � �� e wo k fo wh ch th s penm A95 n sued � . . � � �. � . . '''' .,..,x.: ,.. .:��;:.�,�w�� x:.�.M. ,.�..; ... . � � � � � � � idar's Nqme .. - . .. - . � . . .. . .. . .: .... _. �. , . . . . . . �:.� ..xw,:��:.u�<....... . . . .. _ . . . . . .. . 1ersAddreSs : ...:.- � .�•� ....� .,r..... .._.. . - . tY thor I hove read�tfiis aPPlication.on �... � . ��� . . �� . �� � S`info mation is correcf.I �..� ... . . . ..:�. . . ... . ,... ...: . . ... ..... . _. . . . . .... ... ....... . .. . �. �.. . . d state� ...... . .... °pee$e"d.,Slare laws reg 9a�e 9 P�VmPIY wirh all Counhe . - . . � . . . ... . . � .. � . . .�e 'P ese�raffves of rhn In Y o ed p 1 s Co�my�o�ng,and fiereby . � r ���*�.• p Y fO1 yPe t on purPoses.uPon the � ���� , .._ . � � . ... .. � . R d l : bf Pe m ltee 1'�e . SEE . � � ' �' �.... " Date �EVEIPSE FOR EXPLA(�ATORY � .. . .. .� . . ,��: .,�. ,�>:.; �, � .�;��r ,. �:: �;s i ,�� a3�r,..: ���'����."�` �z�-�Al�/GUAGE , . �_ , � , . �; .4... , .,.. .:.: �. , . ..r.. , .. .,,. ...;;. ,e,-��-� - z S-`^-�W�,-,iO'�',? ����'` r� .L, "` . .a�;• .,3.^:e?,. ,;s�Y�.G<r� A a ..:: . : � �� t � «w.�,,,�,�.,�,,,�.a ��,�� � i��.� :� �_t �����, ?��'s ��� 4 c :� t .^ .. ..,, - ..,;,,,:, , .: . ' ,v-�- , ��:� �J �";:^� �. �. , ., .. _r . .,� . ,� , �� - ., AP°P,GVALS' DA7E� �� INSPECTOR'S SIGNA'�kE� ' .�NSPEC70R'S NOTES � � bWNER-uI.�ILDER l7ECI.P,RAY�CN '-�-� ... -� U4�ERSlABVJORK . '7� 3 f �� � ' ��q,v�� � � � � ��� . I hereby dffi?rim ihof!um exerr�Gi irom the Conh�ncto^'s -� ROUGHPLUMBMG �`�.���:E .�' ,{�'. � ' LIC2�.SB Lb�V fo* ine faiiowing reasa� (Secticr, %O;I.S. GAS AIPING � ,yw:,y;;��+���y" ,j�:��' Business cnd Pro`e•,sinrs Ccdc i'Flny c;ty o,co-nfy,4n7cli GAS I�ENT � - � . � . �. �� � � reqwres a per�ni!b mnstruci,aker,improve,demoUsn � - � or r2poir ony struc4ure, prior fo�ts issoarce, c�so re . HOT WATER HEATER � � � � , . _. . � �� . . .�t{uiras fhe applitaFl?�'ror such permit to tile o srg�tea�sicte- � A'_UMBING FiXTURES � � ' � � ment that he is lic3nsed pursuont to ihe provrsior.s oF H�c� vA5 TESi .qb, �la"� ,�f,a�.q'� - . �- � � � Con+rtrc'ror's License.Law(Chapter 9 feommenciny wrrh UTILITV CO.NOi1F1ED � - SecPion 7050)of Qivision 3 of ihe 5�siness and°rofes�� .. sions Cude)or 4rat he is exempt thereGrom ond th�basis � c7 � � � � far the all�q2d c-xem.piion. any vio�vtion e5 Seciion �� FWAI� � � (�z{�r on .}ronl � ' �. JQ3i.5 by any applicanl for a permit subjecis ih=oopli- � � � conf to a tivif penufly of not more tFcn five hundred � � � � � do7lors(SS00).: iNouSTRiAI � � - -� - � � � � ❑f,as ow�ner o£the prope�:y will do ihe work.and 'JJnSTE A?PROVAI � �� � ' - � -- - the siructure is not intendad or offered for sa!o. �. -. _ . .. . . ; .., � . � � � -- .(Sac.TR44,8usinass ond Pro6esslans Coder The Con4ra � �._. �- 7 � . � -� . . : � . . }or's License!aw does nQf appJy to on owrrer of p;oper - � � -whv bui�ds or improves shereon, ond who does sucn �- � . . work hlmself provldod that such improvemerts ore not- _-.;._ .; .::. ,.. .�-. '.��. � . , . ... ..;.. , .. .�. . � - � -- �.:,' � ���. _• `�� �.��� ' �-�:.� � � � intended or ofiered for saJe.If,however,the buifdincy or _..- , . . ...-:: .. �� .��.� .>,.:. . -�.�..-..._. . . .. . �, . � : iinprovement 7s sofd within one yeor of comptetron,tne� . , owner-bv'rlde�w�if i ha+ro the burden of proving iha:Sie drd , . , �. � - � rot 6uitd ar improve fo�the�purpose of sale.j :.... • `. ; . , '�..'�. . �. ..... �� �° . ; " ' . ^ i arii exempt under Sec: � � B&P.C.for this reason .'t.., , _ . �a!e . . . . � Owner '^, .: INSPECTOR'S NOTES. . c . _ , _ _