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WORKERS�`COTfI'E17S;�'1`TO',1�f.''�Z"LA"R.'1`f161� '��'6�6'�k"3""� /��]D /'��+/4���� /�`e } -.-. /� -� ���",�.,�p�t-.�..�__ Y#s�as.'t,�-����/9_a.•�.�:� . .' � . :. '-CE806G-(28a1 .•V•.i/"�rr��6.IR9��4�V��LQ����P1� L.n . .v.'.c�t � - . ` - - � _ . , ' _.�',w,�..,..�.,wo-...-,.>.�.,�,.-_�..«:wa�wn�..a..��as���.n^`aww•" ".�"'. -, < . ....� �..... ..�... _..d .�, . [ hereby affirm that T`ha.�e'a certificate of conseni co seR"� C�UT�`I`�7�"�")S�(i���. BUILDING AND SA��TY i i iirsure;or a certificatz o(Wori.ers'ComDensation�Insurance,or. � . �� . � � L� ac�rti ed cop�thereof(Sea 3BOO.�ba6.�C) . . . . � .�. , . .-: � .'- . " -"�- `�' ����p� �"�/�,g� � � / FOR kPPLICANT 70 FILL RJ� P JOB r-5 � Policy�'�o Company�e�L�=`-r4�� _ ,, � '- EACH NO.�� FEE � ADDRESS J� - 111---fff-..; �,---- _ >: < - - New Residential Bidgs.&Pools . � � . �rtified copy is hereb;furmshed .�� .� �. 1&2-Family Sa.Fi , - � — $ . LOCAUTY" Multrfamily$q Ft. —� NEARE T -- -�• •-- ��• -�� CROSS ST Certified copy ix fiCed wiih the coun[v bu�lding inspechon Residential Svoimming Pools � de artmen[.- . . . OWNER�OR' p FIRMNANIE' ���Q'�� > Dat�., ..- " ' "'_ ._.. , .� .._. .. APP]�cant . . OutletS:��Rec._Li9ht�Siro.,._ ADbRESS .. . . . p��... ' First 20 . �. ..�, _ ..�.,_.. . CERTIFICATE OF�FX'E�IPTyP�N FRO�f�' �KElFS' �. Total No � Additior.al CITY T 1 N . . P! }. � CO\4PENSATIbfiY*ISURaNC� PLAN�CFiECK -�- ��� � � � � ' �.� . .. �. ' �� . APPLI�ANT __ ..._ . __ O (This�section need not be completed�if the work imolved. - � � . . �-- �igMting Fixtures�. First20 - qoD9e55 by tlie peimit is tor one fiundred dotlazs (5100)�ur less:j� � � - qddrtionai - � - � . .. �. � . TotalNo. - CtTV - . . . Te No. . .'..�.".-. }- I cettif}•that in Che performaIIce of tfie wqrk for}i•hich this Fixed AppliancesNot Over i HP- � f �7 permR is issued.I sha11 no[employ andperson in an}manner ,,.., � PERMiT . � � � � so as-to�ecome subject to th&3Yorkers'�Compensat�on la�f�s. Range'_Heater_D W_ - APPLiCANT � � Qven __Dryer-��-_W.IVI:'_ �- P:DDRESS � Z Date� ApPlicant.� �� ToP ,—FAU.__W.H....`_:,.. . �CITY-. - Tel No�. m - � � � '- Hood��Pan -_Other_ .. ��� � . �. �� �.: . B . �...� ..�-� � .Disp.�_RQom��Air Cond._ . . LICENSE PR�.��. � . NOiiCE�TOAPPY,ICATvT�Cf',afterma`�Cin ��iis ert��caCe.o�'�� ��-'����� -� Ezempt on-�}�nu��shouid Nea me sut+ject to khe.-4�orkers' � � - � -�EG.'NUMBE C�ass� . Compensatmn prov�s�ons oF ihe Labor Cp�e ou must forth�.�� �Power Apparalus�&Large ApplianCeS� . DISTRICT NO.�- . ���PROCE,SED BV.� . . with�comply aith such pro�sions m tfiis�permit�shall be�� S�ig g�Type HP,KW,KVA,or�IrViSFi / deemed revoked � �/i'S� Up to 1 inel. ' . . .°C ''� � .._ ... . .. �� .: . . ~ FINAL��-. ^ Over 1 Yo 10lncl. DATE f 1 � /'� VALIDATION ...-LI('EftSED CONl`A?:C1'ORS�D�E�L.�"I2�"CCO\`"`�'._.,.. - . . � � `�i� G � . . . . , . Over 70 to 5�incl. - . ; � __. � � FINAL I herelit aff¢m that I am f�censad under pro�isions of Chap[er .. Over 50 to 100 Inc. . - e�. �.� �^'/��-� ���" -, . 9 (comtnenc�ng�th Sflction 7000�of DiL�sion3 of t�e 9usi�` Over 10Q _ �����i.;wa.2J ness'and Professions Code.and my li�znie is in full foice.and-� � - effect.. � .. . .. ... �j�,i�j ServiCes�- ---� � . . �n__3� 0-200 Amp.lJndi*600 V ic.. se mf� Lic.Class �� , �- � � �-�µ - y �201�-t000AmpUnder80�C!`�� ���� �Contract � Date��i�'a-�t��� . Over 1000 Amp.or Over 606 V . . � �' 0�3E� ?PER-BLILDERDECLA[EATION�� � - � Temp.�PowerPole.&Appurtenances��� . _ � G ' � . .. .� .. _.... _ . I hereb: a'fFvin�tfiaY [ am�Ez2mpt�fmvi vhe�Contractor's���� �9"'�'�th One Braoeh Grcuit . . -License Law for�the follo�ving reastin(Sect�9n 7D37,5, BusG_',� Additional$ign Branch Circuits . . ness afid Profcssions Code): - - -_ � � . _ . � � . � � M�sc.Condwts&�Conductors��- ���� � L j � �6� �-.I,�as rwner.of the prope h ��lt do the work,and the Other(See Complete Fee Schedulel.— - � � structure�-is not intended or offered �or sale'��(Section � � .- - . . ... . _.. ._. __.. �e o a�o e Q � �-.-:��7044,Busin2ss and Profess�n�s C�de): � - - - � • CONSTRL�CTION`CEND7:�G`���iGE1�C1-'-� '�� . � ��� �� � I hereby affirm-[6a1 there is a cons[rucnon le�ding d enc,v ` � .---� � e �1 1.5 p for the perfoimance of^[he���iork fo }ti•h�ch tfiTs,-per`ri�t is,_,_� pERMITFEE -= �1$ub'-7ot8I) - � �� _ _ ,. . . _.,. _._ '. _ ::,�; • 9'1.CJOc�i .issued(3ec.3097.Civ.C.). - � � � � �� . � . l.ender's Name� - � PCAN CHECKING FEE (One-�ourtfi Permrt'Fee) � : l228-8i Lender'sAddre jF� ...�... .._.,_: --- � �.. � � - . .. -�- PERMi'f ISSUINCi�FEE � . .,�w+ I ceitify that I hare�read�this�pplicat�on and state�that the �� TOTAL-FEE � . "�� � c/ .:'� __..... . ..__..,._ . ..�� _,�.. .. . a6ode information is c�rrecL7agree tu comply uith all Connty � .-� . . . - -� �� ' - � � -_ � �-�,� _ _ otdinances and Sfate ]s���s regulating�Elecirical wirmg and-_� , .. �� - �-�-- ---� �--�" - """- "' ��`-- ` ` �' ����� -�� �� , __.._._ .>._,-.-_. w .�. .. _....._.. __,.__. .__,� .... . herehy autt or�ee represen[atives of[his"County to-enter upon � - . � � _ � - � -� -. -_. _. - -`..„�:,, .....q-.,-....�. �..;,,:-r_....4x�..,�.. �.�.. .._,._�...__-�-'.. �ihe ove mentioned prope[ty for inspection gueposrs. ��� - �- SEE REl'ERSE F�R�EXPI;ANA'�ORY L��GzU.9G�"��� '� -� � - � O�}/�h �,.��t..;rc.�t` /�--�"el` . _ �Signature of Permittee � , .Date .. - � - .. � � - , , . , _ ; �_ , _ . . , ; _ _; ..�, .. E��VNE::-��JILS1�"sg AE£L�Pc.�.`f'f3� ... � � � .. .:✓ ... . . . .. . � �� �d hereby.aftirm that 3.am esempC.from the Gontx;cc:�r'� _... . .. ... . ; .. _ ... .__>. .I�SPECTORS -��. :.:.� wi�:easo ^. _ � .�: APPROVALS � �� DATE. �Gf�:ATJ4E �-_ ..�. . .._ . - _ . -�License [aM�.f�r i�e�.folio �n Sec::on-7'31.5, .:, .... .. •," �.. .. .._ _ . .>_... " �&us n ss r�i�- Pra ess'wts L' e�'-An aty cY oun+y , -. ..- . �� . I ..:. . .._. __ , s _ ._ . - "'� 17Erw? OVVFR�'9LE i � � . i _ , yvhrcr. m.�utres a pFrmii to o.ainrc al et'. �€m;.rcve, '� . . � L__.— .-_-' :,; v_�.......... ......,-.....-r---...._-.::�..__ .._,... . ..c . _ ., .. lj21t10riS{Ir.6X I'EjlQli tlllj"S1Y'.1Ct1:7P.-DP20Y tG(t3��L;.^ttIINLC; �- � ' .. . i iJN:J�RStAB�'S70RK . . :� . �. . ...... . _ •:�'..• , .� .�... . ..... . .. � -!1[5 PCGil�F25 Zi1C..uf�Y'lICOYft f07�kCr°3 j}CYtMFF :O j[{f:G. - - '":.,:.. . ,,._ . , .-. ...�- � ==u ;�.. '_._ .�� ... ..._ . aOUGFiCONCUIT -'. .- ' .� ,�-. . � 5ign$d St¢fe�fi�Ht fita."-hC PS� Ca-.S^SI(lursu+7;5{.rp:.the � , ��-� ' . ' ,--. � ' �-_ pro is ares cf' he Ca�trcc,c.s L:.,ense Lex (L'haprer 4 - wir�uG ` . � F (carramQncisrq-w[ S ricn 7t1'JC�/-.6ji7rtsror 3�7the�. _ ._ � FixTUR�s . _ . � - �� � Busrrz..s3 ast�:,Proie acans C deJ or that Ne 's.e empr�. `.: ��', � , , tr2re,{^em�na h �cis-for�nz alizge�e.�emarl+�r r,Y�-. . ..._, .... .-. .POWER-AUTHORi2ED . : , -..:, ���:, � Pi�J�6 iOrt 0¢J2C.So..7�.3.1.J by rzrty¢pp.r_ant,orcPermiz UTIIiN CO NO7fFItD �=�' , - s+sbJP rs the a�plic¢rrt:e-a� t[ye:ref v eJ nat ne e�kar ._ . . . . . �� - , .: � fiv2 marrired dol ars/SSOv� .. .�. . _ , . ��� . . ,�,. ...., ._... .- .,.r: - :. _. _ : . - FINAL �'aL�7 6v° l'.�2� �� , �.:' - � - C7% 2s owtt0s bi tTxe��iovet y i+dzi�o t}ie wock.xn1 .: .... _ _- . . . .. ,,. . . . ` .:�-- .. , . ' . ._:. ,...,Yhe s�uctu�.e=is-n4c u�ten�e�o of.e;eki for SaJg�..,_ . � � - Noc�F_S : .�.' . ... � . . ..� .-,,.. .::.:jSra 3C:14,.&tesi»ass.qr.d Pro,ersions Codo:---T�e Co:�- � . . .... . . � - � � -.!racicr•'s-�lice;:se L�.w-u+ce.,ra�t.n�ipl� ta-an okuer,p; � ��.-. :..:.�. �_��r:.� ' ,._.-: .-.. - �...�__�_ __.__..��,.:--._....� - : .,r,roperrY:'wh�.'r,ueids vr impr.7�es t&ereon,anC x�ho dces . . -. , - - . . . .. . :... . . . _ ��, � .....: .. ; . .,� .� '�. � ,. ':., . .� :- . . . . . .... . suci: work-�hi-rnse>f..prorid2�-shat such irr.�rovaments �. - �,_: .:-.-. . � -_1, . :-� ._, . ..:- --.-- .�...-.:,.� _ . .:.:,,.,.<-a.--�_,:are not rrre�ded er-_�atfered for�-saie.-If,.nawever.�rti?. ,. - - _ . _._-� �.-.w�, . . -.> .�� ..�. e _,�:_,,.F,-�. _,�-_=.a �.,a� . � .� ' _.�.._' � . . � . ..'._ . . � -' . . .. . � ..buitdin� o;-tmpr�vemert ra saiF.wirhin one;:Year`gf-�- _ . . ...- . . . � . . _ , .. .� .. � ..._... ..._... _ :«..__._ _ ,:.._.�_ . _._.. _. ..:_ -.._. .. . , _ .-ompte en,`1na owner-5uilder wiF! hare ,Y� burden_ �. .:_ . . __...._ .. ,._;_ ..�.__...�. .._.�....� .. ..�. ;_ .�.: ., �: .. -.c.-.... . , -. ..:._., . : " . . ._� , ...: � -:. . . - . . ,-�o#��ravzr.g;t%urt he did�.na�-.baild.or e.�r.prov�.;or rtie -. .., . . ._ . _.. .._-�-- ---- .._.__.._ . .._.>_��. . ��- ..____.:__�__,..�,w.�.1.- -�� _�_.,,_;y�r�ose.o�'scle.t - . - " .._,� . ` ___-- _�_ ;._ --- _ - _,.- . ... :-: t am exempi�andes SEc. _ - — . � :_;,. r,. ..<,, .,._. ,-,. ,. ,,�,.-: 3 c�'€�.�.€oe:hPs re�caei _,_� , .._ .. ..u. , , ...: >. _._�.._�� _. � _v.,..' _.���;..�..,�,:�..- �.F�. �� ___ �__.�_ - �° :�;� e . ,-�. .__ ; -. _ ,-- ., _ _:_.__ . :_::._. . ._,;_._.�. _.,_ ...:_�,,.�;:_: ,.,�.�,. .,,�a��;�, w >_ _� . _ ,. � d._ ��- ___:.� -�< � _ _ �a€e-� ___, , _ _.._.. .,. ___ . ___. _._,,. .__, .._w_: .._..w:_ - �. -- - -�-,�.,.�,4 _. v �., _..... ,. .,> ,� ..Y,..,. (}s�'�ez . — . .. . ....,._.�. _,.-.z . ., ...: .,.:_ _ �. �,: : .,�.L _. .- ..sE _ _�.. . �`�- _�..v..,.....,�:.»�..�-�:w.w�_mv,.:�,-�.��.__.,�...;:;�._..,.z;m.,�...�. .�..�,,..ti.;.;�_._.,�.�..�,,.�,.;�.,.�..�,.�..,n� �,..;: _ � _-- �.� _y— __ _:.._. _ ._ _ . .- v �r �. _.__, '�� .-�`,1. -- ._ . ,..___: _ .._,. ,._ _ . .:.- �a . a s r.�_--_ . _ -�_- � - >= , _._ _.� __.�� .� _��_ _. _�. ,5,_ .,_ �,. ��;__ .,... .-, ,...�.:f ; _ ---- --- �_ S . � - . -. .. . _. . .._.._ . �..... . -:'�.-- ' .�:., ., .�:> x :��_3_.�t 3.-;:�_ .._ „_.� ., - .., .. - . �� � _ r� • ' - . .. . �__ � . . . .:. . ... -,. :J�. '�.i�.. '. v. . ... .... ..... . .._:_ .._ ...._. .,:.... �..... ._ ... .._. .. _. .... '. - � . . ' .. . . . � n�- � . . rJ�','�'�_ST'__—___.— . , __...-._ a.._.,.._.., <. _,..:., �_ ,�._._........ve..._..>..v.,v._.:__.. .._..,....,,.,,-.. t..-.... v.... - . . .. . . .«»:.....=Ve..-ss�at..,..c...;..: � � -av�•v..�..w:s ..Y.4nR�'��:Nr.a'�ia'&s'."�i'�..'....+;.-w-a.�..r ,.n...r�.._..r.r, .b.ai-....v.<...r....... . _ _ _ __. '--_.- .._._ . ' _—.� .., c-.. .<-; .w"�� r,`...<..l�'"."'[ Pk?"...3,@1J.y.k�".'-t �.a fl?3 v-•_ -_ . . _._ . . - . _ . _ . .$"n:...-� ` . . _ ...._ ,.. .......... .. .... —, . ...,-- ......� :•. .�.,. ... -:.:. . ._�o-'.::-' -- .�'-`-.-. . . _.. ..+t