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HomeMy WebLinkAbout0818A (4) --- _ __.. _. ... _. ..._ _._�..�_..,_ . __. _ .... ---------.,_,._.._ .____ _ _. ---- � WORKERS'COMPENSATIOMQECIAR�tT10N A�pPI.#.GAT�O:1�1 ��JR-PI.UMBII�t�PEF�MIT 2�/ � I hmeby aRirm ihe�I ilove o ee�HFrare ot consent ro re1S �y�A � : inawe,or a certlflmta af W ksfs'Wmpemorro�Uu�.m�ce, c[6i7 pREv.tadt 1 - � ��'��°a'��'���.�°°: b.�.> cou�vr�cnFcos.nn��e�s BUILDING��fNh$AFET.Y �o ry N3 �o�,��y .. �.- � . - ����� . _ _ .. . : . _ -�. - -,��- � � �a CO[Ni�pd qppy is hOre6r fumisbed. - - �{��p�Fp; �- �. ..F!]R ACA�fqM 7U FIIL IN fPRINT OR FYlf) � RF3S �M+"� F R �', cqpy is fi16d wirh ihe munry bu+Wtnq trnpec- N qx���� � '� - - , ��anileP[�m+enr /f f� �ioouin - �. Du�b����APRtkvof�fl��...!'� . � "lYA7E7�1 . t�� .� _ . " . CERTIFI(!�4TF�p¢RIPt10N�EgOM V1f?R1�' �.��� BATH T1JB � '�'i0S5 SS, _ . ._ � G97M 'hON iNSbRANf`� .�. �� 09V1�R . , s -, � , •� (Tht�t�iiiort�n�rd Roe•pr�u�spT�Ui[8�h� prk taKeW�d 6y ��; v'.. �h��p�nmlt�ls 13�pn�iiory8�nd d'ol�ert(;1UO�er b�r,y �yyA�. � I cenHy�Rar ixsrhe�0�mance ot rhe wak ia Wfifrh rhis _ . . , parm7t il.i4fued bhtl �10�e�nploy wfY person in amr monnar � '��'�' i�l.Na.��� ' so us ro besoma�uhjeD b 11m Wo�ken'Compensnti�u,Lowa. �W�R _ . COIY �, Date . .a^pY�mnt r1oT+�EsdlVasHER .��Cp �� - -- � �TO APPtIC�14NT: tF. ARer rrmRin thra Cer�Bhoro of ion, yrn*�kwfd bemme w6ien ro rhm Wo.ken' awuwwi��sao►itEeeP[e�a - .. . - - ��wc.penealWn pGvLtionLof IM�kabor Eode,'Mu mut�fo+th- �f CITY �.., -__ w�1b calfql�k t�tflb iYrh Fp.wuioru w this qDrmi/ahal) be '�""� IAYM SPRINKSER 6YSlFM STATE - LLC. - � UCENSE N� . QASS . . deemedrmnoked, waT�r MEnfEre '1� UCEh1�D GOdTKAC7.GR5 OECIARA�IDN DI57¢�7 NC. � . - - PROLESSW6Y ` i herehr aA�rm rt�rmmbsn�f.onder�a�ot c.�a�e.v aru srs�nn our�ers Q i �,, pA (wmtrteruCinQ wifb ffRtpon 7QQ�)of dYroion 3-of rhp�uaineu p��7 g R }' . �` and Profatsiam doite:rntd m 1� ��n full 4Qrce oed efien. R�R F�NAL V/4L ATION 4 //•��.,•w.y/�� �� V I�` li enaeN,a�lb � - �� Lic.Clqff,.L..�..i,{f. oC �t } �/I����� .._ _' Ooie�� � . B�WAI V � C W �y �� � 1 om ezemR7 under Sac. �� H E � B.B�.G for�hia reqson . � � , Plon check fee � ome: ; ; vwnnsuap vewwr rssu�rec;Fg� �0 8 1.8 A � � Signovu�e % �� TOIALFEE . .. � #.• • •.•.�� Plan ehse4 applimnt I �l swc�Fatwiv I •2 2�5 0 � HOME OWNER-9kJ�LQ�R DEp�1RAilON Name � � ��eby aHivm rlror I am exemptfram�he Gonvacwr i licerue �. •�•2 2 b'5�c� �� ,/Per thp foflutivrery rof9mn(SeeMon xIXl1.5.Bwinlfr ond �ddrea ' � o'1Saa�enS�iadeh tiry Tai.No. . . D���S''�8 J� Y1 I,ns owimr of�he propeny,wili do rhe wwk and fhe � � . srruaurs is no�infOndOtl'or offerDd ior wle(Sxtian � � , 70ae.8usi�s and Aofesfioro Cade). � CONSTRIlCJ.GON fENDING AGENCY !eby aNlrm�lr�t�her�ia p eownrunion bnding apency fa. �� oerformnnee aF�he wa.k ta�wtucA this permir is iaaued . .. . �os'r.G..c�. ` �'�¢�I�d� �i?� I �r's•1.�w, ,r �Y aa�. �-. .;9dtlr���.�''���e f..ddC:, , Ql�Q�� Ey�hai f hqfe ro�l ais OpptfootWn ond�e�li���he � . '� ��nfureoonon is eorreen I optha�o mmply wNh afl Counry . � neea a 8t4lte lasvs•epytC��np PtumbinQ,and�heraby 'ze f�H a1 thia Coun/y ro enter uP�me � � � � �� . W�ea. . me aM��mpecncn 3E�B€4ER��'FQIf`�lCPtA�IATpRY IANGUAX:E ��a.�"7_.^.� oi ermitlee pote ' 1L1 __ � APpRpVALS �A7E �Msr�cr s anrae INSPECTOR'$NOTES O'JJNER-BUILDER DKLARATION . , � � � .� ' . � UNDER SLAB WORK ���.� ' � I�hereby affirm that I am ezcmpt from tho Contraclor's ' ROIJGHPWMeING - (� �/ P"d—' . License. Law for ihe following rcason (Secfion 7071.5, - GAS PIPING � Business ond Prolesslons Code)�Any cfty or rounly whi<h ' GAS VEN7 � i . requlres a perm�i�o co�sfruct,ol�or,lmprove,domolish, H07 WATER HEATER � � � or rapafr any_slruclure, prlor to ils Issuance, afso re� . . � �� •�quires fhe oppiiconi lo�such permll lo flle a signed sfale� �� PLUMBING FIXTURES ' menl fhet he I5 Ilcensed punuaM to fho provislons of Ihc GASTEST y7 ,j , � _ CoNroctor's License Low(Chapfer 9(commencln�wilh UTIIIN CO.NOTIFlED - � , Secfion 7000)of Divlsion 3 of Iha Bus7ness�and Pro(es- � , . , . � � , slons Coda)or fhat he�s exampt�fierelrom ond�he basis i � � � � (or ihe olleged ezempflon. Any viofo�ion af Seclion FINAI �yfer on �ron1 '� - � 7031.5 by any oppllconi for o permH subjecfs fhe oppli- �, � canf fo a tivil penafly o(nof more ihon five h�ndred douar5�ssoo�.: ! MDUSTRIAL � � ❑I;as owner of Ihe property will do thc work,and ', NIASTE APPROVAI . . � � ` � ihe slrocture is no�intended or offercd for sale. �� `7 �(Sec.70M.Buslnoss andProfessiuns Code: The C �*<- � /j��../����•U.'.��C ��� L/ .. . .. ror's Licensv Law does not apply�o on ownor ol p�operty Y � _ , , who bvilds or�mproves fhereon, and who does soch � . . . . . wo�k hfmself provided thof soch Improvemenfs arc nof I � � � Infended or oNered for sole.If,however,ihe bWfding or IImprovement Is sold w7fhfn one year of complation,fhc , owner-bvUder vi(If hava ihe 6urden o(proving}haf ha did _ � � not butld or lmprove lor Iho purposo o/sale.J i ! - I am exempf under Sec.� , ' � � . 6&P.C.for this reason ` I Date Owner INSPECTOR'S NOTES �` � � ` , i