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HomeMy WebLinkAbout1445A (8) . WQRKER5 CCS7o�PEW5AvY�fO`N�'�`A"(F�'(��-.�".``��°r ..,�.��,.i:;4m- a.*�,i'�. .�»..,.,„�,d.,,at.v�z `� �a' � :.vy�iw�a�im�-- �,�,��w �.�_�w ::�. - I,he eby affi m thar I ha e a certificate of consent to self 76A66iA ����'�����'^ ��•d�• ��►�/� � r��/y`'� 'insu e or o'rerbfmfe of Worke�s'Compgnsatlon Insurooce.; �E�g{ry`7Rp����pjgy�,` �` .^' ••rn,^� � �-°' � � or b ce ti ied copy�thereof Sec 38W,Lab..C,)-� � �� � �� � � , . ._�-��°BUILbiI�"Ci�7CNCS"S'� � Policy No�/�"���mp�y ,�"Y"f�'1_'�„�-^C.°,� IEOUNTY 6F'LO5 dl�'G�I�S �� ,..,,,. �,,. _,,.��.. w.. ❑ , w.. ,.�. .. _.. ..._ �_ . _�N �{'� ' ertified copy is fiereby fUmished . - � � ���,�� � _, ,..:,.. . . ._ ...� ,_.,t�a,�s..;:.� GerPified copy rs filed with the-county building mspee- � F4RAPPLICAM70FlLL�N PRINYO� PE;" "�' BU�LDING � � �- �� t on d art 1:- � NUMBEk FIxTUREi7R�fTEM'��`"� ADORESS. ;. � { [ �+ �p . ,_. ..C� fEE . ... _ . .. ,Date--���Appl cant L V l.��L��.. WATER CL0.Sff. ... .. -� IOCALITY d� v . � . I�/'�..r �,a ._ .. . .... � NEAREST� ' � ' `�"'"�"""' Tbis sectioo need�nol be com leted�if ihe work invotved b� BAtH Tu8 � - � �y�'�� Ceo55 Si:- '� �� ' �� � CERYi�f(�Af�'GF "'" `(,+he ermit is:for one hundred cfolla �� 4� �� ��. � SHOWER � �... " . �..� � �. OWNER. . '._... PY . .. .. , . ;,. � � ..�... ,. P rs(SIOOy or less.) �� LAVaTORY .- MAIL � .'` ' ... ....., . . ... ^�-I�ce tify'.thoF in theperformance'tlf ihe work�for which iFis �����-�� ��.�-- �G'� A�DRESS�� � � �" - � 'pe md is issued �shpll not empfoy qhy person m Uny manner SIhK�� . � r� -. 5o qs tq become sub�ect to fhe Worke s Compe�lsat on Lo s. � "' " o. /� . : CITY - ��—..>..« TE 6`f�(I ' ,�..� :�: ,. y . DISH,Lti�ASHER ,� r+-� CONTRAC70R � 'Dare � APPI tant � ClOTHES WASHFR."' . . � .. Com ensatioo UroV'�ios� �tLLW Y� �. . ,n g�°"``'tICE l0!1}'fPCfC"A'I�T If, bfter mak�ng this Cert frmte of � .�� � �. ADDRE55 �.--; ��n n rti'tion, ' �becpme sub�ect to ihe Workers' SWINMING PObt RECEPTOR � �qC U . p p .of fhe Labor Code,you musf forih � -� ` CIT`f ��� '.�- �" �.� ��I� � wiih comply with such provis pns�o th s perm t shal� be IAWNSPRWKIERSY5YETA � f� r�eemed revoked � `"'"'�""" �- UCENSE N�b. - STA7E � LIC, C �. . " '� u' sa�wz..,.....-:�:.„`� WATER�HEATER...�_ >_ . . ' . L9Cx�N5Eb`�ON)`R'�$`�7"O�5'��A`���1, . ., „�; �� ,$ 'ss S7RICT"NO�,_..� ,, CLR55 . . �I hereby a�firm fhqt I pm licensed under provis ons of Chapter 9 . GAS SYS7EM � OUTtETS" � OCESSED BY�-� -- (commennn with Section 70pp)of�Diyision 3 of the-.Business� - � " ""-"" � � OUTLETS OVEk' -.. antl Prafessrons Code dnd-my Lcense is m tull force and effect. 5 PER�SVSTEM �� � ................... '�� :v. ..r�_ - � .,,� . , . ,., fINAL � . . _ Lieense Number °�t��� � � .... , _ .. /.:.. . VALIDATION�... ,,, ,,.�„ , L�a Closs DATE � �J �. tC `D �J r� O . �Gf�1��afe O�/ � FINAL .. . �, � - � C�o-7nt octor BY � � .V. � L,J I am exempt u der Sec__,,.,,_,,,_ . . - - O B$P C �or th s eason ' - - U "" Piqn check fee W ;' � _.� ISate ' �� � � � - ....� .� .._. _,,- a 5"ignarure ,. . � _ .... PLUMBIN(`�r p�Rh1h`"f�SUl'I�.�Z",'�'�`E�$'"'"`�"" � . . . � � TOTAL'FEE�� � � � � ���� � SINGLE XAN(ll'V' ."`.``'.. �.. �Plan check applicorrt � .�'..��(�Y A . t HOME 01NNER$UfIbER DECLA12AYIC3IN...`"�., `...� . Nome� �a " � a e 5.. ��eby aff rm�that I am exempt from the Coniractor s Licen;e�� � .. � �..w for the following reason:(Section 7031 5,Bosiness and Addcess � � . .� � a..7�y.O Profess ons Code}. �- � - - -•.--_ .� � � . , � City � Tel.No � c � a%�..�j r�:`. �' � I,os owne of the property,`will do the work ond Ihe � � ��..,cz.4e (Secrron _ � Q41 �}"87 struciore`a not�ntended ar offe ed fo sal , 7044 Busmess and Profess ons Code `� '� ��`:�r,�, ..,,=as:s + � .�,3a>.:�.a.�A<a.G<...,�,eo....ara'za^�d � heeperforfmanblVSTR�CS`C`flb'�3L�N�1�'���G�tJCY _�, .. �:�...,. ���. ..w.<_,. .. . . . . .. . . . � y that fhere is tt consiNction lending ogency for � � '-�� �� - � -�- - ' ' .. e o4 ihe work fP�wh.ich this permii is iss��d �. ... . ... .. . ... ..' . . .. .. . . . . . ..... ... ... .� . ` �(Sec 3097,Civ:�C.). ....- . . . - . . ' ` . -�; , ,. . .. . . ..; - ,- . -.: .. , .. . _ : .. _. . . .; ,. . - .i ,... .` . " ` ,:r , ..� . . ,>, - : . ._ � ..; :-_.:. ..t..�:� . , _. .. ...., �,�. a . _ :., . . ,. *.,`�_ < -,:� ,. '. .- - -_: .� lender's Name�. . ...... ".... . . . . . .. �. �' , . . , . _. , „ ,. �.. . _ ,-. '' ,. . ,,_ �.., �,. ;� -,,:�...., �.s�. �,_ a - i. Cender`s Address � , .. �.� `:� .v,,,r.,�� � .�.:...�w -�nau,.rw.�.:�mc.��:�.,.�v..e.�r,.c�.�ca� ��x� '�..s��,�..,v.dw ��w,..�..�..e> -...,. ...< .' r a.0 - �,.a.,�-.... I ce t fy'ihat'I hove read+his app6catlon and state that the�� � � - above,nformoJion is mrrect.I agree to�m ply w th all Couniy � . � . � orcjino e and State lows requlating Plumb ng,�ond hereby- - .,," author e p,sentofives of fhr County fo e��er`opon'��he . - . � . . _ . . 4,bove m tio d p rt for pec^io�purposes: ' ... . .. .� .. :�� � ::.. W.�_ F ,, � ._...,.: i SEE REVER3���iTf p7�C'I�Kd�`�'"�I ��� � �� � � , _ . ,� .� �_�.. a�. ,r..... .�.��.. �.� � Siqnature of Perm ttee . �_. . ... ., .., _ , ., � . _ ., , �„ _.. ...._ .... ._. . Date�" ._..,. ...,.e,..,..,.. �,.�.,_,.:,.>,.�,,,.....,...........�...,�.....�...,:..,.,.....�.............w�_,.,..». ' �*��"�''� .n�� � -,���'�,�s�z»-� -�-;� ���� _. __ � .. . r, d � . . � . . .. .. � .. �.. .... �. . � � . .,..�::_ _,�sx,s.�sr-�� �._.,s�=>s�'..;�z�tx.���`"'O�Fi�vEPBVICDc2.,'� 4RFT�10'u _ .. .. . .:.� . _. . . .:IUS?�ECTOR'S�NOYES �� :: :. .. ,�,��.«;,a.�.�j�SP ... 'v'S 'GNATURE .��. ,, .� _ ..- � APPROVAL v � .. . , ' �' . ..' -..� ..� _.. � � v.� u�fey a`dE'rmof�a I .empt{o-�:}' CO 1 �..�.o��. UNDER SLAB WORK �� L cense ta fo iFe� follow ng ea on (S t n OJf i. �. kOUGH 7L�.MBING � 9 ._ � Bu ne P fes ion Ced� Any city o co ty } h Cq5 PiPING�—����� . . —��"� �re p to construct okers Issun c n�lso re� . _. ..— .—...,,..,,.�....� ,:��'�"s'��. .��,_°,.'nw 9 ._ ---- :... �,. � � - or repair dny sf'ructo e, prior to t ..._,, e GASVENT '.^:..' " -•.: � . .. . �.. � '- "` " ' �: res the v I mnt for such t to file o s gr.ed sic.te- NOT VJr4TER NEA76R � � -""�+^'�" , . mu'r pp� pe�m -�� � _ � , . . .�_ . �.�� . .,_ _'�..... ....,_.._.:.- ,;, . eDt:fhaf he�.is licansed pursuont lo the provlsions of fh= � -� .'.'�. .', .° �` '� ''..�� ' � ConFrociers Llcen e Law IChapter 9(com e c y,^ :h PLIIN�BIN^vFl%*URES ,•' .� , - �- " . . »�„a.- ,.,.e�s....v. ,-.._ _ GaSTEST � T�—„^r.Ct" �� ' �� � Section�7000)Noi�Dvsion�3�ofl6e,BusinPsondF'.Fo�es-. ,., tJTiLRY CO h0�FIrD � e ,,. ..- � .. ,..___ � 3rs�w.�f-�xd..,"� r�a '�.- a=� oe�getl�e . . A .. sions- o f Ae is exem fberefrem and ihe�bosis �, -� c--} ��' ° .,�ti� `��._., - 7031 Seoy.any appl cant 1or a pe m�f'�su6�ects tAe a rpU-. i �nAt �`: � °�'�n.�nr on jroacE � ' ' � �� � �� �� can£-to a"crvi(penalty of no!�more than frve.hundred .,.. � . . ... .,q . '�_ .�� '� . .. i..- � �... __.. do.lars $500).:. . _. r< _.; � _ ,_.rz�._ _...,. r �,`,- ` ...�,„ ,,,...:. ..' . -. .. ...-... � .-.f ...� : . .❑I,as�ownsr,c`.ihe prop�rty ovill do ihe wark,aad " ' �'" " "'` -`�' � '�" ��`� ' � -� � he s ructure is�not mte ed�o�offered fo-sale "� ..lNDUSTRIAi�,r . .- :'- ' - . '' a ,.-�.. . � � �d , . _ . .. .� W:a57c AflFwC3UAL� .,, . � 1 � '. � . � �.: � � :� .'f .. .. , .M, . , . . �...= . �._ ;.�.___. •- . (Sec.7094 8usinessandProfesslonsCode TheC� � " ` � "` . � . - ";. ��� . ,��� �.��f:� .�.��� ."� � �� � 'who�17cense Law does not"appty ro an owner of properiy ,_. . �-- . , ".,.. . . .� ..�.-F . .,_ ..,. . - . , ,. . � �buflda or_improJes ihere.on,�ond who does such . � .�": , � . ! �. , •� , .. :,:., - wotk hlms¢(f rovided thptsuch improvsments�am no1 _ - , r.� ,-..�.. :s . � � -:. . .= � *����� � ' � "' ' . "d � �� m � s . infended or of ered for sa1e.!f,however,the 6uilding or ,. , . '.. y ... . � , - ._�_. , ,"._h ,_,�,�. ,�c,,,x„�.,� ,_�:-F;;,ry,4impiovement.'rs sold wifhtn oqe yeo�of completian,+he , � � ' � ..� _ _� �� "�" -�,,.� � ,. �.:.� � .: . , owner-buifderwillbavetheburdenofprovingthothedid . ....'� ,.,.. . . � � � .�.—.-- .:_.....__;_..-,.-.;�:,.:�, ._r,,-:,.z.�.: ....,,«„ ;^�^x,.�_.., �.."�'S.„....�: .'.` nof�6uild ar improve far the purpoie of sale.) . . ,.. � ,-. . , ,.,.. ._. ;, . ,._.� t .. .. . _. . �:�.. � ._..:_ ' '.,: _.,' .. - ... . , . . . : �. . _K.,.__ , .•�am e�t'emp''under$ec.� .�,. , .. :: , ,,.,�., . ,�.. .. .. . -:. .. . - ���.. . .. . �..,. .. . . _.:.__ . - B&�-P.C.'�ar this reason.;; . .,.�: ..�- ; �, . . . . , . .. .,.. ....... . .. . . . . : ��� �,�. � ..,,___. . � >�,.. , .,�. , � � . ., - .' '-,,�::,? ,ti,� .. ... , .� . . �. �� . . . ... ��rs, _ �" Date - � . . - . . �-.�:: ...:.:., �r�;�w.,e..�...-,.�+-,a�.�:wa_�,,.,..�;ia�«- ...�..w„cp.�s�.w... w..,...,:..�,.d.,.,. ,. �..ns ,.,W�...r��,.» 1,.,»_„�:;>,.:e��..u.�.��..`�:,...�,�,,,.,...�.'. . . . . . .r.,. . . . � . ' .. � �; . .._ .... .. Owner . .. ... .,. ..w,::«;�.a�accrt�..�'a�'ua,�'£.a _. _.. ,......._.�_... ,.z:. . ,_ . - . , ._ � � . . . � �Mz_�..�,.::�f,�.�*3 k,'�tk',ri..�`'�='�'���'�-C��.M 4 �.;�c. �. .,�i�. . . :�.. � .. . .... .. .�. r....�i ��.�.: -' ... 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