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1451A (8)
WbRKER5 C6MPENSATrbh1 D��ARATfON � `�° ^� /��p� 1 ■�y�](� y/���1�"' �y^���� ��-x .�r a v ; , � RRPr�L�Vn,/Ax�IVAV ��1� 1'� [Y1'B . W,� , I 6e eby affirm tha+ I have a ce`itif cate of consent ro self� . 76Ak67A ,"nsure tlr 0�Ceri f�mte of Workers Compensation Insurpnce�, CE 817(REV IOi81 J� �,�� �� � � � or�ce���r�f ed�opy ihe�eo{„r�c 3�(5�6.C.) � COUNTYA�L�$/kIJGEl�S .M"�'ILD�IJ�`�f��5i4FET'Yk " �7oliry No��CompanY... F '�� ,.:..,:..-. ..,.. __._ _ _.. ._ X� s!.�.��.. . , Y'�� .� .:�.� �rtified copy�s hereby fumished 1 �T �� �'' .:�❑ . � � .�. . ..�. ._ _. . . . � _..... - - FORAPPLICANTTOFILLfN(PRINTORTVpE) � ' ��"' BUtCDING ' ..- , Certified copy.is filed wifh 1he"county buildjng�nspec, � � � - � ADDRESS-.� � ����T" � ',�_ 1 on deparlmenY. � � �NU R � fIX7UREOQiTEM � EE . - - .-, � ' ���� � . . � IOCAUTv �j. ��.� . Date�APPlitanf ��- �— WATERCLOSeT . . . -Y .. . .. � - NEAREST�'� " ' . CEkiIKiCAtE"OF"EREMT�Y�`¢N F�"f�t 1'�b12�t5"'""" eArN ru6 ,� caoss sr. ' , � Nw �' a CbMPEN'5ATI(5N'If�t�ll'RA�fVCE �� , sNOwER ' x.. .. . . OWNER - n . . ,»,:. . . � (This secr on�.need no4 be compiefed if 4he work�involved by - ��� nnAit � . the permh is for one hundred tlollars(s100)or less) � LAVATORP ' ��� -� � ADDRE55�� �- � - - 1-cerhfy ihat��in the�performnnce of��the work for wh ch tliis � � � �� � : permil is is5ued,1 sholl�noi employ any person in�.any manner�� ' r SINK�"� � .� � ' �" C17Y�` , ; sb os to be[ome sub�e<t to fhe Workers Compensoi o L ws. � DISHWASHER, :�, � '�- �n ` '. �l �' ��. �� .` - CONTRliCTOR � ���� �. � . ' , , y . ... . '�.. Date � Appl cpnt - � ��� . CtOTHES WAS,HER-.�. � � ADDRESS �'"'���� ,� ��� , ,...... �.,� .,.�.,.-.,-. �. ' . ,�"'^�TfC�`"TO"71`�f7L�A'"�+1T."l�a�er mpk ng fh's'Cert fimte of��"� - rhpiion, 'qou�should-�become sub�ect to�.the Workers' SWIMMINGPOOLRECEPTOR' - ' .-: . ,�.� ..�.�:ompensation prov"�s�on5�of ihe labor Code you must forih- � � .. . . �CITY" i��( ��,7 _Q'� with9 p Y p perm t shall be LAWNSPRINKLERBYSTEM '-e r c m I wifh such rov s ons or th s T - .�. . ��7 ., - - � /+ 7 deemed evaked - WATER HEATER ' � : � �� .T SCENSE N9. ���? �J -ClASS \ .7�� ;,; LI��NS�D�ONT(2h.Cfib��19EC`L�RfCTI�N ,u,. _ , �� _ � oI57RICT NO. PROCESSEo ev..... . . .._.. ... t .a. . .�a��_��.�r . i� � I hereby qFfirm Yhof I am�I i.censed under provisions of Chapter 9 � GA$SVSTEM � OU��`TS -^-"'�- �� - � i d Prrofess�o s Code and m��license is in f�ll fo�an�ffect OP�RETS OVER`""� " '"�' "'� �, . ' . y SYSTEA4 � FINAL �// VALIDATION � �- DAiE �i � ti� ..,.. _. cense Nvmfie��_.�?_�Lic.Class� - O -� , ,,�.f� nl� .. ,��. a.- fINAL-��. . U. Cqn�ractor ��y�'"J e'�7 �,Date� � BY ' � � � I am exempt under Sec � � � � - - � � - � � - � O � .. k«rx.�, .�.� �,., .s.ur a .;a»�� ^aE %��^ sz � �. . ... F- r. . � � B&P C"for th s reason ���� � � � .. � � . � � � W ..�� - u. � <� *. Plan check fe� � pa 'Y , r� �, a. . . 'Date " .. . � . � PLUM�ING P�RlvCIT�.f5SUING FEE$' .� . � � �..S gnat�te � � . �. ; � � TOiAL FEE : �.� 4�.� a_ . ��` a. - � r ` p.µ7 . Plan�checkapPlimni . . . .. �. ' SIIYG'CE FA/J�1LV "� � . . . ; �m m �c.� o ti . �P of s6 onseCqdlel 1martr a on SeU o����ION„ �.``."" Name � � � �. . �. - - . . - HOME 01yJt,�pa�(JIC��R Ci� y � p .the Ca tractor s License '� - . . � m e���,-rJ� . 9 g ( n 7031 5,-9us"ne'sS&nd � Address _._.,-. . ��._ .... . , ..._ � �� . � . . . Cit� . . ..- ¢, ce i+���J'�i�z.` .. . • ' '^' . � Y . Tel No. - - - !,❑ I,as owner af the properry,wil I do the work and the �� �: �� �� � � �Q.`�„'j �-.8'� � r? , sfructure s not ntended or offered for sqle (Secton -� �� � �"� � "� "-� � ��- � � � ���� - "-� � , , ., < . 7044 Busmess and�Professwns Code) � � . n - .�, �v�. � - � 'CONSTRUC`YI�N C'E�N`I51i��`bZ,°�NCY�,..a,..�. �.., . � �..,,:�..: �,,...�.; ,� _. ,.�..m ., ,..... E...a. ._.�. r. . . . ". � . . .., . �.�. . ., ... ... ,.. �,..,.. . _ ,_.. ..�.., � a,- ,. . . ....... . . ._.. . . -`,;�I hereby aff rm rhot ihere��is a eonstrucf on le ding agency for �� � - � � � � � -- ��� �� ���� - ' � � .�.ihe erfofmance of the work Yor wli�icli this �.,. - . . . .. . �. .�.. � . . P ..... ...., ,... .-Pevmit is issued. .�... . . (Sec 3097 Civ C) - .' '� . a° '� .. trt ,y . . , , �-� , : .. ,_`: . . - , . ; , - �. - ... �. �, ,.,.r� . .. , . , .. a . . � ::� ,.,;�-. , .. ..Lender's Name _ ..._. , . , .. � .. ... . . .:�, ..�.. ., . .. . ., .____.._ . . ! ';y .', .y r -; -� : r y . -_ .,.« � ���:.� .. r � z� . _.: ,. ', .- . ;Le de ts Add�ess - � ,,,.. ,. ,._.� ,__.,..,,. .„.„.�, _.. ...., .._�._. _.. �_ ,.�._.-_. I _ - ._ , ,... -r, . , _ .� .. . ,... , . . _�_ __._...._. ._.__,F_�_...,__...... .,. . . . _,. .. . . . I�ce trfy thai I heye ead Ihis opplicahon and slate tha�1he . - � - �-qbo e nformotion a conect I ag ee.to mmp�y wiih alf Counfy � . �� � �,ord n es qn�d State losvs regulating PIum6 rrg,-'and.hereby � � - � - � � . rii repre�entorives-of th s Courry to enter,upon the ��- ��� � �- - � ��'� „a.ulh . . . . . �abo e entio ed proper for s e<f on p��rpo}s,e�5{.�� . . . , ,. . .. . . -. ... ..........v.�._.�.. ...,.....�..,,.. _...._�__......».,....�...:...:... . �.........,...-..... �,.�. .�. � � C�/ .+� ! '..�. , � .�. . . . . , ,�, SE�IEEV�RS�1=(SR�E7fVlANNAYQlt'V"17175CC1AGE'..:•.. _ .__ . S gnature af Rerm�ifee �- pat� � �, , .. . ... . .,. .� . ._ .... - - -. , , . .: . . , ,� ,, , ,., � .,. . -�. , . . ,. ' -. . ,. �,-. ..' _ . -� s_m _,.� e ,�- � . . .. ,-,. _ , � ., -� :, � .. �. . . ...�:,.. _. :.v. � ...: _. .. , , �!^. . �. ..� . . � ke _". •e . _ a. . . . . �- » ... Y"3 M??..�^�fii ..- n . �y� �,,, �.S � � � � „ �,, A.,��.� ,a ,.� ,� ° _ .� r, � . r �<< , . � , , � , �.o ..�. _,,. =,ti - � �� ,. , � � � � .e..��_... �� >, � �. � ���'�{�lsaecroR•S�"tvoiF��_..�.... <�,..«w+«:,.w�,...�a....,�.,.K.��, n:a..��..�`.,.""`7�n.�U�,CI"���'..�R�A�c)'� .: .., '. _. � ..�_" � . ._. - APPROVALS ....-.,, D ?E INSP� ' RE � . . . „M.... sr..,......_...,_ , ., ..,. __ ..' __'T- . . . . � uNDER StAe WORK � 1 � ' heroby offirm ihat I am zxe*ipt fro-m�Ih C .t�cinr; . � ���_ , .,.- ' . . .. ROUGH PlUM81NG '�" , " �� '"� """"` """ ` "A' "" 'Llcense L r.for�tha Followirg reoson (5e 70'1.5. . ..� ...,_ _. .. . �. c ;�� , ;," — �. �� � . . . . Busine.,s and Profess o,s,Code)�Any city o counfy wh%ch GAS FIPING... ,- `'..:. � ... . . .. .. . .... . ... ;_-.. -- -- . - -. -..... . Nn--.--_..,,,w,--�.:...--»...>.. .�».,,.�„w:w��.o-».e�.w.��-��,�.»� requires a permlt to constryct alte mpr ve,d^molis.S, GFSVENT. . LL'�s� . �� �' .....�. . . ''..: ..�. . � �° ' or-:rePair brty str�cture, pri.>r sd 4ts:sivattce: alsa re- .��".. . ' � � �. HOi WAr�R HEATER � �.`.... - . �� -.-.'.- «.M..v::=*..� aw.-..,;�.-.�nws-..��,=.��,.,.�.;.F..�q�ires�fhe applreen/fot such permit to file v signed sinte- P_JM,BINGFIXTURfS ,;,;��. -^,.� � .;: --y,;;y.'�.; =r:'.:' ' � . `' � � :' ment that he is_licen,edpurwan'to t e proNsions o e s n F rr. . � r., . .. � -.— "�.� .. _.___ . ..,.,,,aw ,..,���,.,�,�.a. ..-, =:,� Conrractor's Lsense Law(Chapter 9(com ennng�•,r'rh _� _ �GAS 7EST� � � j/'i? ,(7- � Section%000)of Drvisipn 3 of Yhe.9usiness_a,r.d Pro£es- . UTILITYGO:�NOTIFED ���� . . . �,. ,:�,�- ,- .--.�: v^ -.-��..� �°�,.�m.^•� ^+-�-.��°':�.^" 5ionsCade)-or+hafhe�isexemp}iherefromond!nebcsis... .,.,..-, . �.�:� ,. .- .. .-� ,,;:,:` ` . .' . � :•. .. � . for ihe olleged.exernption.�Any viofc�ion oi SecPion .�. �'� . ..�..,.�M,.�.�.a.W..�,o.�,. ...,t,,.�; � . . . KINA� ' ' ' a� c-� ^ � --aT- � �� . _. ' � 703i.5 by ony.opplicont fo�-o permit sub�ects the appli- � {�nP r o"n _1`ron� " � � . . _ _ ._. , ��a�p to a tivil penalfy af not more Vhan five hundred � � �� -: s � ,-- r,c 't ^�'wg SR _ _._. �,..,��,..�..s,:.a�,«� ^^,.� doflars($500).: � 'VDUSTRIk��.� :�: . �" - ��� „>�� - ' P� ...,.��I,os owner o`th= repert�vAll do�he work,..cnd � �VAS E A�P20VAt ' ��,� � � � � �- '�' .�" ihe s ruc4ure is�not nte�ded or o°ered for sale. �""-, ' „ ,.. � -.�... - �,.;.� . ,,..- , , --.- _ ,. .. .., .. b .. ,. Sec.�7044,9u;FnessondProfessionsCo�e. i6eCc c- _. ' �� �. , ..,� ��,, � � ., " . -^ `��r�w:x w�.��•-M--��T���•�'.-��'+-"{br's Licertse Law.does no�opply fo an owner ol properYy.� ....._. � , n 4�?. , . ,., .., . , , � ' :i�.� .- y ,..y_. - - , - who buifds or��improves ihereon, ond wfio doos such � " ' " o«:�- �---�- � � . � � � �� , ,..-, . - "Gt+ork.h'rmsetf provided that sUch improvements dre nat ., . <.. ����., .:�.: . _.,. . .... . . . .>. . . � � . - . , .; ;_ .:�.... .. �- -._, . .., , .,._: . � . . ,. _ ; . - , ","'� . ' � :.;: ., . . �. , )nteeded or offered for sale.:1f,howeq=r,the b Iding or . , . . . , : � .. .. ... _ . . . . ...... -.. - - . . ...., . .�..,..� ,. .. . ,,..� ,r�-. -.„,-��-� :-r_w...�^^s,�,�*��•^�x��=°���j��t�a-�-�'+�'^ improvement is sold wifhin one ycar of tompleTiort, ihe ��� - �--���� ' � -���� -�� � � �~ � �- - � ' ��� ` �� � �owner-builderwi7l have the 6urden.of proving tha>he did � �- a-;., . .; .. .. ." , ..�"+'""" . . �.:""'"'^�'�` .R""'""""`*'"'"�"""`" 1Yo1 l�uJd or imptove for t6e pur�ose of sale.J - � __. ,-, ,_ - . . ., ,..�,wk-n�«:���n �.-��� ., � ._ �� � � � t'�am e�xe p!unaer Sec.n,.«..�.».>..,. ..,.�.m,.,M..,,. , _.._ , _� � _ = s �. r ��� ' .' � . . � .' - _� .,. �. ,.,,.wv_ ..�.�...�.._,_ u,.,�,. '....-.y...-�+-a�...M=:=,^�'�--'- �.-w,.�.,..R,-«wa�w�.�s�� � _ ....„.w.,�.,, ,�__ .� . . . ,-.� .. ' ..o-,.o-.�;;: _.. -�. ..�-- . � : .� , .'. » -� B&R G.for.this reason...�.. .. . . . _: „., ..; .w.,-,..,.:z. ,.,.,n�.......,W....v..�. �..-..�...w.�....,e=.��mm.s.«, .,,w�. ,r.x..� ... �., . _ . . M1� �:.. , -�. � � :,. , ' ' � . . . `, - . :i , .r � . - '-'.' .. . ° � Date . . '_.. . ... ._ _.- . .... .�... . . . . .._...� >,-�-., ..�..,..-...�,�:,«...«„�+..,.� �.,, . _.� _.__ _ ._ . . _ . ..� . . . �.� ..,,, - .. � ...,w....»:,w_ . , .,..,,wN.<,-;.. . .. - ' - � . � � '.� ' ._ :. - .. � . � . . . . ). x:;;_ . _ .. . . ' ^ . . . . _ .�. ..,,„,.-.u.,-K_+-��,rz�«....,.�,-.,.�w.�..�.-�MS)wner _.. . � < . ... .. . . _._,_.. .. �. . .�: ,,.....,._.a.,. .w:.q�.,-.:u:.;�.t,w ,s.,,,��....�:v ,:,�......�a«� 9p,�.«.,.;..� ;�4.;.�,;� .:,,,.a""'�' - ... _. . ... . .. . ... ... . . �>.�ti. lNSPECTOR`S NOTES .;. w. :::.., . . � a, � v.�. �.,:,,�,,�_,,,.�,�„w:.......,��,F�o-�..,.�.�.��.:.�.M.��r��a�w,w�i x,_a^�,��Y�� : �x..x��z��:.��.������+� , . : �.�.�. `. �..,:. �,... , .,.... ,..,.:. . . .... ,:�.. ,a...a...�m..�,�.,.« �_:,,..-.�s..e r..�_:.,d�u.tan3a,.:�'k`�. :sti�L,.,u-.ASY��fi`'�'�-�Iv�AS,..�w�^4`.x ..,,�'kn.. *c�^.r.,x . . . . � . a, . . � . .,� ��, .,, ..,. �. � .. . . .. _ _ _.,y- _ _�.�,r. ; -,�zw. �,+s��r..�+�+�,s�.n.nsa�Rw�-<..�m^+,a;r.+z+a�mm^..tt.,�:;,n .+�.q�_�„-� � � , . . «,..,,.�-.,�s�+w,,.,w. �:�sn+��en aK�.<astca..-..e;. � , � � . � . .�. ��. .,...>w-.,., �,...,�r�.�.+.M,w.-�«+,..Y«,w,�-,�a,.w+,w:,.N:w,.,,o-,.raM..�..- .»�..�n,.r.;...,r,w*r�rax:�r�u:,�.,..w,�v:��«.r�,�,�n..a��r.«...,�;.�:,, . . , . . .. r ... . .:- a . .. . . ----- . . .. .;;; .�.,,..:'. .. :,,.. »,_ _�...,....��,. -...`�.�„�..�.��.qyy„�., .. � � . .. . : . � . � .� z, . . , ,:; ... ,- .v,.„ - . ,..,,a.a�,:...�:,.��,.�.^.R.,-.�,.r:w,�,����5��±�M��u�+s�wb�s�`,`-..�r�" wrz��.��,;:�r��.�.,m.::,-. . . �: - � � �. ,. . .,. . . - . . . . . ._ _ „�_.,�. �.w+-.,.:._, � ,.. ._.�...,,,.»,.�w.».�..;..�,.,..:�..��. „ . . .: . . � .�r�:.. . . . .. ,h. - . �. .. .. .' . •;�' . ' . � . �_ . . . ._ . > . ..� ., - - ,. ..... ., ��. ..� a�b " . _ "�:�."F 's"".�'�""+�- — _ . _.. , ..�. .,�....,. k,., _,.,.,.. .�.�..,,�,*.�., ' . u �.. �.� ,. ..,�, . .. '.. . . ......_ •.•---a. . .. :..:.. .. .�,,..�. s.k.,,�s_��. .: _ �..� . �.Y.-;ec..:e�.t^'a*asn��^'*�^h*.':'Exi ....�'^�+xxaF'�"tW�^�P+!&�r*krL.,.. .�;,, ._ ,"?'�4aYC1+W^�55'"�?k: