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1449A (8)
.., w . , "� A ��{�� �a�!'1��� ����' � ��+'�/a.'h r�' ����°'`��"�`:. �'� ....t��d' v. '�+�a�K#+�+P:,'.�Y. - WO�YKERS COMPEIVSATIONDECL,�ARA�N� w�, a t �; ����v � L�l�� �. ._�VIC LU����OJ �G�M�T , , , . ..�, ��,.�,�. ._ .��< ,.� -�w� ...� ...,., �� � I�he eby affvm that I hove a ce�ttfimte of conse�t to self 7xA567A ' � �. ; . ���� �� � insure,or d cert t mte of Wa kers'6ompenspt on(nsuronce, CE 877.GREV 10/81)- , � - .� � �� i� o'r o ce(r��irie�il c'opy @ihe�ec�s G�ec 38tid,�ab C),r!�`!� �/ COU TY C}F L S ANG LES � "Bl1blDlNl±AlVb SAf TY 7olicy No/_S��L,.J_�gompany . ��/ /'-�Ja�99. .. . ,., . .. � � ,�,.,M.......,..'..-�, r!�'/� . '❑ _ �... �7�� I � �= Cernfied wpy�s here6y fumished '"'' '- ""'� "'""^"`°�^""""'"""�*°'�"d""�"'"""`'� BUILDING- / �^/ /�--±-�- , ;, . '"�' ' FCR APP4ICANT TO Fllt IN(pRINT OR TYPEj qDDRE55� •��� �✓���-�` C� �Certified copy rs filed with the.cpupry�6uilding nspec- �� . �.. �-- . � � � - /'� �� '- � "'""'� tio � epa Ime � � NUM ER FI%TURE OR IFEM ��� LOCALITY; ��J�_ � FEE Y �l�G���� _�,„ ,� . ATER CLOSEj �� . NEAREST�' �„�..».4��rr�������A� r..r..,�.,.a.,.Fa,o Dafe_�y��Appl cant . ..,.. : ; . ,_ CRbS5 ST: � i '�. �CERTIFICATE OF'EXEMPTION FRqM WORKERS � ; �.- BATH�TUR � •��� • : � �:, COb/l7E'N�d71��151+ISl�f�A.NC� - "�`�' . ."_, OW NER ��, ,.: � �.a� �*� � .s,.,,. sNOWE� � .- . .,. _ �,.-.�... �. (Thia soat on,need no1 i�e completed if tFe work nvoCved by . � . � " .. '�" . `""'":�`-`..` """""'°"`"� -- MAIL , }ha perm�t rs for ope hurodred�ollqrs($100)or:Iess f ' lAVk70RV � �. ADDRE55� s - � ;� i;certify rhai'in the pe'rfarmqn<e of.ihe work�for wh ch ih s � "�"` """ ""'"'" , � - [��JC[(� � _�-.....,...,., SiNK �"_'. CITY '��� C3• ry .'p�rm 1 s'ssued 1 shall ot employ ony person in qny manne� � . . �. so as to becorr�e sub�ect.to ihe Wo�ker; Compensot on Laws�., r DISHWASHER - CONTRACiOR �� � �y � . '. ' �. �� { ., . . . ` Dafa � Applimnf ' CLOTHES WASH�R � � '�" �°.'7Q, . . ., MDRESS �� � � e a�� ��fI�E 'fO�iPPII�LA�J7:�If after making ihis Certficate of � - SWIMMING?OOLRECEPTOR ,u � ",.'�`�. .,""`"'�� "�. '�1'Jj ; mphon, "you"sho�id,become„sub�ect fo'}he Workers; ,�0.3�w,a � Gitv � ' ��E,7�.,a , ��ompeAsdflon provisiohs of the Labo Gade;you must forth-, lAWNSPRiNKLER5V5TEM .��,. � .. � �. � � 'y✓iih comply ih such provis ons,or th s perm t shall be . . STATE � � LIC - , ... ""." ? LICENSE NO �N � ��� � � �deemed revpked � WATERH@A`�ER , ... , . � .<.-,....._,....-. c ., z ,.... . 'DISTRICT O. . .. PRYSC�SSE6 8Y."..'.• _ ... .: LiC�t�5�7 L'O�I�TR�F4CTO�R�DECL,4RA`�'rZ?N � ����'-' l � •. . ,r . � .���'� '�'.`�'*'`-� GASBVSTEM �- OUT4ET$ °�"' 1 f,hereby o�F�m that I om Ilcensed ur�der pro srorrs o�Chopter 9�HI . � �`� L� � (commenang wifh Seclidn 7009)of DrviS on 3 of,the Bu9�ness - � OUTLEf$OVER -� "�� �� �- �� --- � - `�"-���� 5 AEk SYST�M ' f , "and Professions Code a d my I cense�s in fuli fo+ce dnd effe4t„, . , . -- ��------�-�- . - DA EL ��' k7� V/��{ /�1TI4N � . [,� . ;. �p��'�r"�:.J :; .,,. .,..� ,�. - . ..... . .. . Cicense yumber � Lic Class_..��l_.�, -� ��-� �����- � , f •.:-p�py- �ry m" FIN O w�,�«.�..,.«�,� .. �i�CI�F 4 � l��r��. - . . . BYA` � �. Cont aci`or . . .u, Dare �„„ ass . ._ .,..,. , . ... . . . . . O _� �g �r"�� 1 am exempt unde Sec . .�-� � � � � (~j B 8P C for this reason � �� � � �� "� -�� � � � 0�..' i ,� -���� Plan check.f�e ,_ _M_ tn ,:' *,«a;�pie �.*,*s *� �ri: PLUMBING PERM171SSUING FEE$� ' Q ., � � �. Signar e �s . ,.. .. ..._.... . ... . . G�i �l LI.�{� _ �, • _, - , �, . . '- . k ^'^"^" - '^". � TOTAL.FE�._ � ' # Plan check applicaM . -�Y �..��� . ..:;� . . �� � �.°F� � .,- �':�: SINGLEFAMILY 'x � � .�. ». � .. �� . . ,.�,.� HOME OWNER BU,IC„D�R bECLARAYION -" Nome --�- , . f ��J Ct Jr O � � � . �- m�foi the��follow narn�exempt from the Cont d„dor s L ce,n e, -. .� """""'"""` �"". �`�""�" �. . . � - .. . . • g�-eason ($ection 7031 S,A,Busirress an��Y , Address . . „_ �� . � � „� � �'7a;5�-'- . �.�.Profess ons Code -. ..:. - `�' Ciry .... ..�� �Tel No ry ;�.����y .���� � ��, 1 b��7 . ....❑ �_. ._. �.,... , ..... .. �, .. . � . � . ' I,ps owner of the. ro n will da rhe work,and_tFie "` � ���' .�'�����'x��{�-����4������� .��ryx . . . .. � � _ P Pe Y, . ... ,... �. , , , .... � ' strocfure is no,t inlended o�r,.�o„ffe ed for.�;wle (Sect�qn ,,, -: � � . . ' - � ,..,�,« .._, ., ,:.,� .,,. _. .,.:. - 7044,�Bus ness and Pro�ess ons Co� � �� �� ' . _s . .�y �. ; �. .-- :. 'r F :� � - � � �NSTkUCTION LENDIN�AGENCY " � � � " '� � f � � -�� ��� - � � ' � � r, . . . . ��>Q�..�.�„�-m.„..++«.,,��».�w.�.,�,,,...-,,.,�...�.�.,a.,�,�...�,ti.�...,:��.,..,,.,-,�,..�. .�..n._w, «�-,, . . . 1 hereby affirm fhot tfiere s a constiu<t on lendi,ng agency�or -. `'�',k�,.".`„`"'� '�m�.-...'.� '..��-": `�"`"'fhe perfarmonce-of.?he ork for which this perm't 5 issued . _ ' - .�(Sec 3097 C v C). .. . . . . . .. ��. -. �. ;. ' ��- �� -. ��� w ,'�. ;. � �. �� : �: , : lende s Name r, 7 �z�,�r, "�, er.a a F'+3R�p"'"Qa+,wa�'ar���^`�^�PrFr9�"'����F��•,.,....�.»,.�w.v+ e���.,e'• ' .. � *�rc� -�-�-�,. ,„-v&��um�` �Lende sA,d,dess � • . . y i w fr' s ., '*'���..�.+-t �,�.w.� � �3�<� ., ,� " a . .. . . � . . . . � l reriify thoi I hct�e read,tJ�s,app(ication an ��state ot�n,e _ ` � , �� � . . <. . ., , � . : ��above��formanon s cor ec� I agree Yq comply w ih oll Cpvnly .. � � - . � . .. . .- '�ordina �sand State�faws regulating Pl�mbing,aod hereby� . , � � � . � . � �. �'abo e i e nep 'santotive of'th s�County to'errter �pon the ,., _ .�. , , , �o d or i spectFon purposes. $EE REVERSE FOR EXPIANATORY LANGUAGE , , ' ��� _.._ _ �S gnature of Perrprttee,..,_. ,, .....,,. �Dafe � � ' . : ' .. � . -,. .. . .... . �, , ,... , , . �'_�.'. .. ,9.�„ma$ .-�.- , ,-. ..z. . . . . ., .. - � _�_ . ._ � � .;��Y.,��,�"�.;����,�.� �.��.�,_m —�� .,;� - . .. �� . .. , ,INSPECTOR'SIvOTES _. ___,._.- __.,_ I cQ,r by a � t,ar I x�emp f om��A •��. ,:.�,.. ' APFRCIALS � T� iNSP�T GNA7URE C /`�E?Bl)ILD 2`J aRATIC�I , . � UNDER SIfiB WORK Co 1 ��r; .. ROUCN PLUM8ING ,,,111��� � GAS PING - ��, _ . . � � sP I �s for + e folloroi.g enson (5 /0 7031.5, � � , �s n,��s a�d F'r��fe sron Code� An�cify c ty wh ch � GAS VENi"� �� = � � � -- reqair=s o permit to con t urt,ch r rmpro �. c' mo!ish, _ u . __ ' ' NOP WATeR�FiEATER �� � ��_ � -�' - ,„, ,,,��„y o,�4r. y„rePOr any�sfructure,'prior to{ts rss�uance, also r2- ` '-'�� �" � � �� � � �'� � ' ��� � '�� quires ihe appli6oni�for such pe mit 1o.,iife a signed str.fe- - �PCUMBINGFlMURES '� � , . �.. '� .' .:. , '�.. .. meni fhot h s licen5ed p�rsuan{fo fhe prov�s�ons of!hE GASTES' .� .'_.i .�.:. --' ..� ' . .. .,. .,:_.,.._. ��,�� � ` „ onir<tor L�cense Law(Chcptor 9(commencinq v,-irh UiILiTYCO:'�Ot�fIE� �� ._;. , . �__„_� , , ,,y,_�r,,,�,Sgci�on,.7000�ot Oivision 3 of the Business ond.Profes- ��� � � ,.�.' � � � �-� ;� � sions�Code)or thoi he is axempt therefrom cnd the bosis . . . ... „Y.. + '- �- u. � � - � - � � `� .� for tlie„alleged ex�m.ptlon..Ar.y vfololion cf Sec9ior, � fIhNF ,t.��.:' x '. r c7 . . ".. � .. „ C,n1 r on _J�.,rorcl „ .. . .- � . . . . . . :;� 703P:5�by any applicant�for a.permi/subjecfs the appli-. . r �., _ y : �, . � f to a crv�f penaliy of nof more than f h�ndred �� dolf INDJSI'klAt � " '- /50p ' .WASYe APPROVAL ,..T � �� ..; � . "'. ��-. .:- . _-' .pL�IaoS OWileF of tfte}�rope�"y`.vill Co h fj�K,'�and � ..eiaa....�..n�,,.... . ��" ' ��" ' `��� `��'- � -- � - - � � - -'� � the sfructure is not r+ended�or offered for sale ��"'�� � �,':. ;. - .i . : �- �'�`';" ' .. , . `� : - � � � ��,,,;�;,�„(Seg.7044,Busfness andRrofessions Code: The Cc �:� ' . . ' "� V •� .. .� { � �.� , _�...��. ..�.. . � , buildc or�1improvestiherPon�andwwho doe��ueh . �" :� ' ' ...: _ .. ...��" ' � ' A� � : - � fors ,,,» ..whp... _.. ._.._. , ,„_, . ' work himseff proylded tha�sucR improvemenfs ore not � ' � �"'� `- -� �-�-. �: �- (ntended or of/ered for sale,If,however,fhe building or . � . � .. . .. , . . �,.,.,��«�.,�._.W-vu,�.., ,...-.,.�-�...e.,. ,._.,.,.... � �� � - -� -��� �-� -�� - � r� �--�-��' � improvement is sofd witbin�ane y=or�oi completion,the . ..-_ ,. ... .. . . , - ; ' � � - �� - .., �,�� �-. , : : �,,,,µ,m,,�.owner bui(der,wi(1 have ihe burden olproving fhat he did � � "��*( � �� � --� ' � �� � - � � � not build or improve(or t6e purpose of sale.) � . . . . � . . ..... ..�..�.. . ._ ..... . . � �; �,rl : . _< .,.,.. :..h... - �; . . . ^ .. -.,---+ wmwa.eaa.�.t.m.ww.. .+cz�-...�.._.u<�..,�:_....i.r. , :. . � � � ... ." ..:__ �.:_ ' � . (�. J am exemp4 under Sec._ ..� . .� ....... � . � : �. �. ��.- . _ . `" � . B&P.0 for this�reason...�.. � ...: . .:. - � . . '.- � � � . a _.. _. ..�_ «.,�....�....-a»u.���-:._...:,,I ... . . . ; -�., ' , ; . . . .,; . . �. _ . .. _ .. . � �. . �. , . . ....: 4 . `... �..; ,�.: :._, ,:�..;M.,�,.�Date,, .... . . . . ,... �.�,, �. . . �. .. :.... . ,`:�.,..... . _..::: , ..� .�.. -:�� �� � � . .. . .. � - . � ... , """.�.. Owner,_ . ., ,,...„.«.� � , . ._.. . � �,wM�.��. --� �:�.. ..,.M,..,. . ,_ _ �.. s_..�„ �� . iNSPPCTbR'S N67E5 �.,_:..,—__�� . , ,:, _. _: _<... .. ..:���._... ... , . <: .w . . . � , . �.._. . a.,.z-�-� -,� �,�R. �.' �.. ,�er,�a : _. , .,�: •d.,:•-•�•. aua.�nc:itit.5zw��ua,ra�z,ce��:�xH..u..a+�.;..:, .� -_ ' � os. ' � . .. . .,. . '."".___ . . ._ .w... .�, .r.�,.. .. . . .. - - . ... .. . . '.._.�. ..�;�_ ,���:._ �. � .::.�. ����;v�:�::.r . � _..;. ,-, . ._ _ _ - , .�_:: _�, ,...�_. s.w��. �'''�"� ra'" ,.,,�. � � . . . _ . ��>�.�...;,«.,;.,. . �,,,«.,tc:- � ��--- . . 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