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HomeMy WebLinkAbout1648A � � � ��, -n� --�,.-�--- �� ,. - -���,,-�-.��-�`� � ��'�'�i,"���,t��`�sb.�'`,p y��5`'��.�,� � �.`ry�'�y,' ek'a»��'�,2��'r2 z�b-..,�.� .�.:-�' k .�f�.�+a"�. (`�-a�ti;�pa,ygi %' � Cp.�.�-,� c . ;z�� WO�RK�RS COMPEN�A�,�ffON DE�CAT2AT�I�ON� . ,_ -.Y..:. .-.,.._,����,��A 1�O YlYlYal��. "� �•N�, �+�. Yt`. r�,.,f. v+Y <..- €- ' I he�e6y�a{firm ihof 1 ho e a certif cote'of ronse 1'to selP 76A667A � � �� � insuie,or a certificare of Workers'Compensotion Insurance, CE 617;REV 10/e+.; w: ot�i ce i fied;4opy thereof jSec.'3800 Lab.C.'j COUNTY OF COS AN�'aEIES BUiLDING AND�AFETY � c.'a a :' [l ' Pol cy N � �� Co p y__13d.�`F'Y!��1� . _ ...-... LJ Cert�f ed copy i he eby f n�shed � � � .� - �� � - - �--• FOR APPL�CANT TO FlLL M(vR!NT OR TY�E) BUIL�ING �1 � Certified copy s filed +K ihe co nty�buil�iing nspec- l � ADDRESS �`"�� �� f NUMBER FIXTUREORITFh1 C� FEE �*.g?s�,£��fo dep i e t LOfAlliv ��V�S�Apol-, n WAiERCLOSET ' , Dafe NEAREST -�-�.w�t,r CRO55 ST. ^�"`Lx� CE�TrFIC',�TE OF EXE�3IA�T N FROM WORK „ ,, BATr!TUB �r ^" .�'� C6IJ�PENSA71bN IN�SURA'NC� OWNER � �,..::,fS.s :•:�v�.i€y, . .,.: P . �- , , � SHOWER '� (This section eed noP ba complefed i0 the woek�nvolved�by�• s ehe srmi�is for one hundred dollare 5100 or less. ��A�� p ( � � LAVATORY AODRESS ��-'I�ce iify that-n�me'perfo ance'or�-+he work�4or which�rhis� {��peftn 1 5 issued I Sholl not employ any person in any manner SINK CITY �� � TEL NO. 'a �so a3 io become 5 b�ect to ihe Workers Compensaf on Laws. D�SHWASNER � '.�.�ya�..�`k-���k�-`��t��''`�w'� '��,K,...', 9�'�`^��;na�" ,"'�a .��.d$;i•,: ccNTRacroR �+ Date Appl a i , CLOTHES WASHER �ADDRE55 � �:�JOY�CE TO A"Pl�'�A�IT: If after mak ng th s��Ce t f cate of �� S r :+���zempiion, �you shoul�} betome sub'�ec1 10 ihe Workers' SWIMMINGPOOIREGEPTCR , ;,�'�"�'�Compensation provisions of fhe Labor Code,you mu51 forfh- LA�NN SPRINKLER SVS7EM ' CITY Y- TEL NO. �',� ",',"�."�U9ith comply with such provisions or ihis permit sholl be S7ATE `��� .�. ' LiC. ^� _:�deemed re oKetl .. . . _ _�„ � WATER HEATER ,,,� LICENSE NO. tJ'"7 C1A55 J � � ���CEN�D CONTRAC'f�5 DECLARATIOIV � DIS7RIC7 NO, PROCE Y �'t `�"�`� �'- "�' -- ' "'� '"'� ' GASSYSTEM OUTLETS �^y I�here6y aff m ihat 1 dm I£censed unde p ovis ons of Chapter 9 a (commenc g w th Secfion 7000)af D 3 of the Business OUTLETS OVER �'� � y�R ond Profess on Code d my license s n f II fo ce,and eNect 5 aER SVSTEM � FINA� ;I V14LI TION ,+ry, ��A``(a.:��k?�c,e��S,� z.t,.^�:i�.�µ�...:.;.�,.•.-. . . _/i�7/,� _...�. DATE �'��� �+ � � n � t�� um�er�L c Class 13�L � � y�L cense N _ .�. ..,... .. .�...... : . ,...� ...__.,..._ { �Qj,� FINAI �9 T'��o t� ll Date��I—_ BY `�`q;, �d �y❑ yI am e*empt unde Sec �y � B��'€�t �.� s�.. M k �-s"°�.., � -�� 'X, ,�y ., o th s reaso . .�'� � ,��.r�'.��r����a �,�r�s�"��'��„s�X33'�" �,��;. Plan check fee � � Date ��.,a 5y,-�" r,�,y�,. ,� � ;, '��.�- � PLUMBING PERMIT ISSUING FfE$ �� �5 gnat re ^ s��� -� ta.y�1 ;.r�,y�? #^�. ,i.y s..s r , -r TOTAL FEE b -k` + �h i t' .Y !f.*: h f � ',.S' �.y�� �� f��'�� ��I1�GCE�P:P(ILY � . ' � ,.�.- : Plan check appiicant 5'4;k",� 1iO7J��OWNER BU1IDER DECLAIFl1TION Nome � I he eby df4irm tho�I�am exempr from rhe ContraUor s L cense� Address ,��"La fo the following reason (Seciion 7031.5, Business and �'�:Professi�ons Code): City iei.No. Ly ❑ I as owne of the prope ty II do�he o k a d the ���v�s ructu e s no1 ntended o offered fo sale (Sect on ",r� 7044�Bus ess�ana P o�ess on Code) ��� -.. .,���C�I�STR�C�'IONTENb'�GAGENCY `- r�,,� .�:.� x.� . �+ .� ,sr � 6 �- - +--.£� w^- . . . . e m �..e`. ..,. .,.. .,�; . _. ...,.,.. .. ..._ ..�. - -: . . .�,.� _..,_...�.�- . ., �:.... ...:......... ....x .,�.. ,z. ., ,.,�. . ..,,._.,...�_M.. . . . _,,. � -� I hereby affirm ihat t�iere is a construcf on lending agency for� G.fhe�performance of Ihe work for which this permit is issoed , _,_ . . � i = ' 9 G.�U s-(Sec 3tl97 C C� � - . . . � . y.� > / -....... . ���_4 y� z v � scs i� . . �,.r.-:, �:_ : � x>x.�e .�y;-= �.-1'ts.i * i x.a_.,V�� G�. -a�`�,�ik'r�r.�..�...'�.� a ��''� .'�s�'°.,. ,�,z; ,a»�s.. s?� "k�'�-.."Y.rt ,��u?n�'.. . ..x�-..:��,'�,..- -�, .vv:�.',. h,+"'f'-s.e.*�s.z.'�:�. :a`�3s:.:we..z,. x°Y,xy .r.'�r�,? . C� �- � � ��� �`l,'e 5 �-�Lende s Name , . . . � . �. - �^-� �� ' we.^ -�k� `v F R � va-�. ._ ,�..�. ,a � . . � � w` ,�,.§f!,w 3.a:.i`;�3:.,� v-;_;:�: ..-��.�..s.="'r�:Y'k:�..,. �.s$..�c�s#; .. .�s:f�,'�+� ;�s.`#. �e�.G� �`�.�.., p �sic-. �4.o�f-'..._.�"4. r- ..,.r.a,.=k " v*xz. ...,.+1,. F� ..�...a..- '�c.�..!s.. �t: F ���Le der Add ss , . . ... . . ._.. � , . .. �� . .. - � . . , .. � . . . .t. '� erify t1�ot I haJe read ihis applicaf on and�state that the �� _. �".;,,above mformotion is correct.I agree to comply with all County _ , �j���';'ordinanc.es ond��5t6te�,laws�regu�ahing Plombing,and hereby �� oJfho �ep fa�rves of�hls County to enter upon the �„e�# men(ioned prope�y for inspecttsson purposes. " ��� - �---� �� -�-� - � � � � -- - � yfr��°� �,,, f --�'��a�� SEE REVERSE FOR EXPLANATORY LANGUAGE ������ � � � � ``5;�;;:��'�•, /S /p�. V ,.,..;,. gnawre of P rmi � Da e ,:.,,y ., . . ... . . -... �,. :.�.' '>.;.- .�,,.. .. - -, -. ... _ �..., ., aJ .:: �-..;.. � . . :� ., �. , . ._. �. . c x'; '_, . .. , . ... : . ..,. .., .- :.,-: . ��- q� . .. �� - . �-'� � .. � ' ' T.�:ri��k t� h 3r :F J � . . , . � . Y �i ,. . . . : � . . . . ,. . . . a. : , ' .' . ..... '. �.. � .. , . . � - ' ' ' , .' � ..'.' . , ' F n�FRO'v��5 �oa.'IE��NSPECiOR'SSIGNA7URE � ��NSPECTOR'SNOTES� � �� � � - _ - OVJ'V�R BUfLDFR DECLARATION� � UNDER SLAB WORK I hereby a`firm Phq:I �m exema�from}ne Coniro.to%s � ROUGH PLUht81N�G�"`" � �� � � " � . � ' � ' ' ' � "' License Low for +he fuilowing reason (SecPion 70i1.5. GAS PiP:NG Susiness cnd Fr�tessions Codej:alny ci9y or.-ounly wfrich � ....'_. ._..._....,......._._....... ....... requires a p�rm�t to consfruct,aleer.improve,demolish. GA$VEM or repalr ony sfructure, priar to ifs issuance, arso r_- HO7 WATER HE.4TER - � � - - � � ' ��ppire5 7he npplican!for suo5 permit Po file 6 signad sfr.te- PiUM81NG FIXTURES I � meni thnt f�e is litenssd pursuar.f fo tne provisians u?tiie� GAS TEST ��� - � - -�-'- � ��-� - � ' Conirac}ar's License Law(Chop9er 9(commercing w:in UTIIINCO.NCTIFIED � Settion 7400)of Givision 3 of th8 Busincss ond Profes- _ , sions Code)or7hat he is ozampt therafrom 6nd+he bosis [� - for fhe aflegad examptioo. Any violation of Section FWAI� (rcj¢r on �ronf � � �� 703I.5 by any applicant for a permR su6jects the appli- . . _ . tunt ta a alvil penalfy of not more ihan 11ve hundred _ � dollars($500J.: � iNDUS7RIAl �� - � � ' ❑I,as owner of the aroperry wiil do ihe work,and WASTE APPROVAL o ;he strucfuro is not intended or of4ered for sa!e. . . , . � � - � � - � (Ssa 7944,Business cnd Professions Cade: ihe CoMroo '�,�' , . . _ � . , for's License!aw daes nol opply fo an owr,er of property �...-.._. . ..�.:,�. ,.�:.. : � :'�.-. ::".._ '.... .. . . .. . . . ..... ..... ; ,. . . . _,. ., . ,�. �. '- � '.-� ^�'�:.� . � . '�Wha bulfds cr improves ihereon, and who does such � � ,,, ,,,. _ . „ . � -�work himseNprovided that soob improrements a�e not ' � - �, '� �� - ��`�� � infendedorofferedforsa(e.lf,howe�rer,thebui!dingor - � ., � . ' . ., .._ , • impra4e:vreni Is sold wifhin one yeor of complefion.1he ��- . :.... , . .�,�: _'_�.�`��"��(�: ; . .�: ., . �`_ �.. .' ' .:'; " . athad,d _ . .. . ,. ,: . . . r� owhar-buifderwilfhavetheburdenofprovingfh ' � :.: . �' .'.' ��. ...'. � . .-'�.^ ..� �.- . , - � .. - or improre for iFe purpose ot safe.J : ..',�.:�.^.. .„ ; . - , .,.... � ..�.. . : ,,.-.�.. �� ����-- '�'��-�not 6urld .-.. � �. � -� , . - -� .'�: . ,. .... . �.� ' . _ . _ _.:._,... .. .; -.: � .:. ,...... . .. ,. ' ' ,° - . �I am exempi under 5ec.� T •. ., . _ _ , . �.. , , _ ...,. � . . � . .. .-.. . . .: B�$P.C.fOf�t�'i15 f@OSOf1v. ' � . . . . .. -,,. .., . .. .r. . . .. .. ' .. : . . , . . . . . . . .. .. . . . . . . " . . . � ` . . . . .. ...: � : . ": :� ,�. , . ... .. ,.. . . . . ._.. .... .. . : . .' , . � : � . .. ..; : ' ' � ' .. .� Dare� . . . . , .�.,:,:... , :., ,. ,, . ., . .,. �: --,..,.: .� �''-: .. . . � . . . . . . T. .. � �... '�..�.. . ......__: -... ,. .� ` .. � � ,. Owner � . .. . - ..: . . . , INSPEC70R'S NOYES . . . .. , _ _ _, .. - ,� " ,,... ;. .., ,... _. � . �._.... - -... .. . � .. . . , . . . . , . .� ^-,wrn+�.-a .-�rtm�... �r,�+r . , . . . ... . . ..:.. :. � '. ,:; . �'� u:-'..,,.- -.:�r, -: . . . .. � . .� ,,. . . . - � ..: • . . . �. ' ' . . ' ' . . . . � � . ' � ' ,,' , .