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HomeMy WebLinkAbout1348A _ �..._ _ _ ._ 9' _ � WORKERS'COMPENS.C71"ON D�ECLA12Xl`IOIJ."� �: .,,��.�'.::. .,.... � ��PLICf"4T��Itl ��►,/IC �L6J����� ����IT �lv� �`, I h eby c� r^ t�a��i ha e a<er!�6c��e ot consem to seif 76A667A � . -��- ��- - � ��- ' ' �"�' . .. . .,: .. ......... ....._ . . - .... su e or�a cert ficate of Workers'Compen50f�ort I�surOnce, (E B17(REV YO/811 ' . . or a Certified eopv�he"r�of ISec:�-38a0,lab.C.1 �� � ,...... ..,...... ... ...,<... ... :.:.... . ...._..,_ _.. _ ;; COUNTY OF LO�ARG�tE�`.. � BUILD�NG AND SAFELY �POoI ty No � Company . ' - _ . :..:.... ..:,'._. :. �,J� . �..i .'. .... ,..... _ . ..� ....a.4._ - . ....,... .. .. Cernfied copy is hereb�fumished. ��� � ��F• �� � � • � 4�Ay��,�.: . e. . .. . . ,a,... ,.:� �. . . .�. . .... ....' . FCR AP7LICANT 70 FIIL IN(PRINT OR�VPE1 _ BUILDING L?^t1 ]�_ I CA I Cert fied copy is filed with!he county building inspeo- AODRESS O Pj� ! W�'( Ja L. ...-. ,... ... ..., , epariment. NUMBER FIXTURE OR ITEM C� FEE OCALITY r on d ` (�/HMPr�� �A+2. WATER GOSF.7 � ..�Date . .'` �� �Appl mnl . .. . . . .. NEAREST� 1 ... . . ` .. ",.. BA7H TUB � CRO55 ST. S A/J A J 2G �hN OR%' CERTIFICAiE'�F EXEMPTIOIJ'FROM WOR�CEI2S'`"���� . -- �-�- � � �� COMPENSATiON INSURANCf. SHOWER OwNER �jr� ;� J,�� �(This cecfion need noebe complefed tf ehe werk involvpd by MA��i / the permlf ic For one hondred dollors(SI00)oi less.} LAVAiORV qpokE55 � � G+/) '��I certify thot�n ihe performance of rhe work for which this - � � pe*m 1 is issued,�Shoil not employ any person- a y anner SINK . . CIlY t���M�µp � 7EL NO���2�� � �sa as�o become subjecr o rhe W rkers' ens �i ws. . � �� �� .. DISHWASHER -"� ' "' ��� �-� --� . . rOt�TRACIOR��W�t � . ���Dofe � App�cant� ` � CLOTHES WASHER � qDDRE55 � NOTICE"TO�APPlICANY:lf;`�afier making is CertiFlcote of � � ����•--�- - SWIMMING PbOI RECEPT6R������������ �� `�Exemption, you should betome subject ta�the Workers' CRY � � 7EL NO. ��.���Compensaflon provisions of ihe Lvbor�Code,yoo must fonh- taWNSPRINKLF.R5V57EM ��������-� . wi�h tomply �th suth provisions or !his permii sholl 6a STATE � . _ LIC. W !ICENSE NO � . ..ClASS .__. .'-deemed�Cvoked. - WATER HEATER� � � LICF.NSED CDNTRACTORS DECLARATI�fJ� ��� � � i Di57RICT NQ �'������ PROCESSED BY- GAS$YSTEM� OUTLETS �/� K� ��� .��I hereby offi�m thpf I om licensed under prowsions of Chap�er 9 4;� C� `� ``` , (commencing with Section 7000)of Drvision 3.of�he Business OUiLETS�OVER��. . ..._. � - -��' � " � c and Professions Code,dnd my I cense s in full force and effecL 5 PER SYSiFM _ . ...._. FINAI �� � ° DATE VALIDATtON , � l cense Number lia.Class � � � � � � FINAL C1. .:_ . ... . . . � ..��,Contrauor.: .. � ��� Do�e ....... BY a ; .�. ❑ I am e empt under Sec -� � .�.--� � ` , '1 aq p/�.� �F �� B BP.0 far th.s reasan ���1�� ����-e `' " I W Plan check fee � ' N . , .. Dore:��.. . PLUMBING�PERMR fSSUfN-G�FEE$... ..... ��, .Q� � . . . .. �Signature . _ . . . _...... . .. ..,.. . , ....,... ,. .-.,.�......:u:. _ �- � TOTAI FEE � ' � . .'` .:. '�.- , ..:..... ..i�,. Plan check applicani � . . ��-SINGIE FAM.�IY ._. . ... . ..__.. . .. .�..., ..� . .,. HOME ONA�YER BY71Cf5�R'D''c'CLAffXYICS� _ "•••: `�� Name .,. .,_ ., '� I�hereby affirm�ha�I om exempt from Ihe Conrroctor's License qddress ��� .5�,R F1 .., ' low for ihe following reoson(Secfion 7031.5,�B�siness and � �� �- � � . , City � � Tel No. �Pro{essions Codel: �e o a o e 5 .❑ I,os owne of the property, II do the o k and 7he . . . � �� �� • � � . . . �� � ��� � � sfrucibre s nol�intended or offered for wle Sect o . � � 6 � r���i� ' 7044,�Bos ness and Profrssions Code). �,i{�.,� �`�n,\ �\ , ,, ,- . .. . ,:._., :� , �_�5 0!� � ONSTRUCTIbN L�N6T.�IG AGENC�' '���' . ��� � , . . �I hereby nff that there s o m�nstrua on lend� a agency for � ` `�. � n OO V,x,�••..��'� ��ihe performance of rhe wo k for wh ch this perm�7 is issued �, � l"`���„�.k�.�l_U.,, �-� {^��y� � ��.(Sec 3D�J7,�C�'C.)� . . s„-,.2_.-'�'�.`�-*"i-� `_'�wf�,.l .�. . . . . ���-Lender's�Nome ... .. .. �`..��'�.3��:� `'�'`.3 �'`� . . . . . Lender's Add ess � � - - -�--- } � -_ �.�,.�. .. � I ce}"ry ihot I hove-�reod Ihis appl�mnon ond stat¢thaf�he ('y �y.5'� !��7 a.�„_ "'�.J . �a6�ve inforrn�r o� s correa.I agree�o<ompiy wrt6 0ll County �y-.+�� +"���' �+� - 'o d�nances'ar.d State laws regulatina PI�m6�ng,�and F.ereby ��� � + ' a�thorize re ese taY e of�ni Counry to enter upor� the . �1��� � obove- � ne pr p y.fo� ,soecfon pu�r,oses. � ` � �� SEE REVERSE FO PLA ATORY LA4lGU GE �`�'-� , ��- - Si ature of Permitiee �ate �� � - -���� -� � �.�,,..:. .. . ..,„; ... .:-,. .�ws"',..w:::���"M..+�...,,:�..�.:�,��nw,�,�"�°'�t.:.a=-: ��,.+s r���,YW�•'',"�+ �4h�`."��y, i..,��i'n..'�,�'v . . :rz� tt �. �. �.;-: . - . .;N... .: ,...:- � 'S:� '.:.: ' '. . � . � � e,_„�„�,.,,_ , _. �iNSPECTOR$�}0���� � � " AFPROVALi DA�NSa��T�R55GNATUkE . �... .,. ,. _. .:.. � � C�NI�.rR :. �� . .. r�UILS C l Inti ------r I hereo f m IFo �om t f o - C'� 1 . UNDER S_AB V�OR�C T�;��f1'� 1��-q� -- . -_��-- - L,c nse t fo �i- f os .,, un i.� r 031�. . RO� ri P�i,N,91NG �js✓� .� .�fv�. :��.� , . :�. . ... .. ..d nes c.d f' fes o Caaa: A �c ry er oi � �-.h.. 3 GAS ?rJ; . __ -�, � ...-y- .�... .....•. —_._-- ..,... ; ... , ia,,., �..s, . ,requires a permi�to..o�s'u:t,alter impro c o �.,'�. �""i"- .—' �`— . ..... .'."..."`T . . . �..� �:. . . ��� :.or mpoir any str�coure, nr'or to rts issua o rc- �AS VEN7 i ' ... .. . , -- ------ � � fi,�s �s �1-� r�urr qui es t appLmnt bpe +to "e a d ��HC'WA7'cR:-eATCR _�:) �_ ...,. n , .. . .. . . .. . menf�+FFi h s I¢e f d ucr ua 'o (p o �r�rs ot..c �rL� 611�^,F X'�RF '. .I . .. . -- . Co.'rcc o s�cense�o� .C r, i. Y.c�m ��-�'�I� � _. e � .. .... ...� -.�.u�u+«uaxn.arn� A.'lv+r-�t.-vr- . .. .. - . . GAS r 51 . � 5 cfon 7000j of Di sron �- -i�he�usine�s rd Pr F�s- �UT���RY CO.�:C71f � " , -� � �� � � •- . . � sio s�odE n��h 9 h ot fh e7rom . t b . �-- _�.—}- ..,,.. , ....-:�. m�••:-..� .... . � `� ,-for ihe allcgedaex , u'cnmAryPviolo• a dr�cee o � � — _ ..., � -- -:— .. r � ��flrn 7U3i.5 y any apphcani for a permit su5;e is'h�a pin ��hA� �'��- �. t'y>( �n �rn�tt ... . „ ccnT!o o�iyi!penalty of not mnre Ihan rrve nundren —_—_— _' ....,.:� ,...,_ . �«��..,ww+�,���..,,, .. .C(SS00).: ... , .._w......._.-.�:a,.�.w..,,.. .,w�.,,.;a.a. .��do ors � . .. .., . � . .,.. �.,�..s owne;.c,'the nropc.::y o.�ll do tl�e a,ork and ..—.___�'_.--_ . .iNDU i�i-i � � �. — _,, — . - .�.„,� .,.,�-.«,....:•�;�.»� •••�^ra�,•,-,xy�,:++;,:�Ine siructure is ndf intended cr offered for sale. __.... .._.,_. . >N�s e a.�caovc,. . . .. .� ,�,���_��a_�_,,,_,,;. . . . . .. .. ., _..._. ,;,.<.., ,. ,,,., ,._,(Sec.7044,BusinessondProfossionsCode� 7hoContmr, - - -� - . ....- , .��,���,....�,�,„,„...t��„,.y..�... <.a.. w.+or's License L6w does noi app11•ro an owner of property ..,. „w„. ...., . � - . ��� � - � who 6uilds or impro�ies !hereon, nnd who does such . . . . . ... . .. , .-- .. .- ..:.,..:,, �.,.._.._. .,.,,,„.„,.„a.,..,,,.,..m�....,.„�.._ ....,:�_,,,:.,a,...:... wotk 6imsel3 provided thof such improvemenfs ore not . . ... :...., � . . " .. . _.. .� . � - . .. � ��� � �-- � . � � - � -�� � � ��� - - . irttertdod or off_red far sale.If,bowever,ihe bvilding or . :. �.': ,„__:,,,,,,._ .. �..:�:�..:^,^^:. improvement is sold wifhrn one year of�conpletion.Ihe . ........._ _._.__:...-._ ...___.. > . . .; .. . , , . .. .. . .... . , , . � .__. .� :., . ..�� owner-bullder will have fhe burden,of provir.g fnot be did .. ..,. �..�:. . . -- ,. ..:...._.,,„ „..w,...y,.,:...�a.,rr.,My:..�•�.:�.wm�'o-.,�a.-:.::,,<a;.,._r�'ot�6uildorimproveforfRepurpos=ofsalo.; ... . .. .. .. � ... ....._..,..._..._ ...-.�.,.,.n �- . ... -� „a�se=,.. .. ����:a;..,. .� '. .. .� . _,.�_ -- ._ . ... . . . I am exempf`under Sec._ —,. ..... .. .,�.,.� .�.s.�an+..,x.a�nw�r.a«.w'�b-bav..,w;d:a�� w,.:e,..».�.��..µ..�.. . ..,.. .:t._. �,n:� .iw : .:� ,.,...-��rn - .. . _ . .� .:�. ,.._ . .. . . . . , ..-. ..... . �. �B E�P.C�for t�iis reasor _ — . . �:,-, �" . . . .. . .. ..:.............;..._„ .e..:�.:n,�,..�,.�,.........�._..�.i,�.�.�:..., .. ... .,....� .. . : - , �,.. . . ... .. . ... _. ._ . .... . , . . . ,_.. _ . . . . .. ,. -:� . � . .. �� ..:._. .�..._«..vW.....w ��..,.,...,.�. .�c.«�•.=..n�:�.��� �fia.rst±ilifs w- � ., .�....,............��. - .. ,�ssc�..wa.„.,.+x..,i.; � _ . . .3�rA_s�s�u---�.....yi-=::� �:.:: , .. .. . . ....._ � �� .... . : .,.,:: �..,_ _ ` Dnte— — .---_:�.... ..,...., � .. ..,. .,,:,-........,.,,,....,.,�,.�a�.�..:.��..�.::a;-:..,.,.,..w»,��.::.,.:.-g»�...�.-.,.,.,.�..,.:::...�-z.:,z-`�,,....._:;,��..,_.,..<..,;..:., . �.,�,_.:.,..�,...:>,,: a_w.o..�-,ar,-..�,, +;:�.a�. 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