Loading...
HomeMy WebLinkAbout1438A (8) ' woRKeas•coMa�NsanoNOE�,aaarioN' APP�.IC�ITI�N FdR P'LUIrI�BINf�s P��IT � x , I here6y affirm tMt I have a cenlHcpte of consmr to self �y�bp7p � iosure,w a cerrifiwre of Wprken'�ompenserion Imurance, �.8T7(REV.1Oi81) � . . . . � or a Sp�,fiNed y�hereo►(Sx. o Wtr.c.) CQUNiY b�'LQS ANGEL�S , BUILDINGJiND�SAFE7Y Y � �, Paolicy Nm � oMpan . � � _ .� . _ _.. . . __ CeniHed eopy la hereby furnifhed. --� +� / (j � Cenified rnpy Is filed with the eouny 4uifdlnp inspec• �RaPYUCAN7'YbPGL�ta(PIItMOR7YPFij q��p�Eu�FO J'c��o �4��7�,IC �19 Ijf . tion depanman�. ^N^'�� ���� � � LpeqtrtY 7—!S-YS w��Q�o�, 4ar�o . Dme_, °PP��Wnt� . . ��—� � . . . ,���'a"t. 'SS Ud . � GERTIFICATE OF EX - FRC)M � RKERS' � ��+rvB � . . f7DMVFNSAflON NSURANCE ��. �� uwNFA :. .i ._ . � � (This s�cNon bNd not bceompl�fid iFf6i'work Inv0lv�d 6y � / p- - � th�pormte i�For on�h�ndr�d dollao(SI00)or hu,) UVA7OQY pppRESS�J b A�Cb !t � � I ceni(y rhot in fhe perfOrmo�ee W ihe work for wbich tM1is . �ryK . . ��, --� ��.� - . � permi�ii iswed,I shalt not employ Ory�PdriOt+tnCny�manner . � _ � '� '�-� ' so as ro become cubject+o�he Workeo'4bmpenaa�ton ta.vy. �y�yq�ER . -� � � � � �g�� - � CONfRACTOR �a . GO f �G(' I Ga+e�.�.:APpticant � � - � � tl4THFsw0.5HF�t o�D�RESS ....r �.fkA70r1•. E�•_.. ' NOTICE TO ADRICANT:If,aofter akt q this CerCHwte of .. ���R�� - � _ �- �'. Ezemptio�, yov chould bbean aub(et� to fha Workeri . '�y p A .- �,ryp,��3�� a Compenaorion pro�isinna of'fhe lalfoe CGde,yov fnaie Iyrth- �rpyyM*„y�1NIclER SYSIEM O . . with canPly witA avch prmisions tu lhu permlt ahall be 5rA1E ,p -�UL. �^ deemedrnvokad.� ��. WntERHEAtER - uC�15E:N0. � �5-�1� d.ASSW7 � tICEN$ED 60NiRA�RS DECIL�RRTION . OIStttICf'NO. � 8V . I hereby afftrm thor 1 om�lkeo�d�nder prov4�tons ofLhaptx 9 � `���M aT�t5 � (cammencing wirh Sedion 7C�Opa of D�visipn 3 of�the Rusiness ovER �D J . � y � o�av.orou+w,:Code iCerf»Iainfuillorcsand�ffea. lPER FINAI VALID/S71OPF 6 � � oatE 5�-�-csiG v license Numbe� � � ic.CYass - IA �( FINAI . � Coetractor!Lc`�'��'{ ��iri'�r..Date _ � � . . gY G . � I am eaemp�under Sae. _ � � ,, d aar.c.+«en�:reo�o� .Plan cheek fee � pute: piUMBINGpERM1T ISSUING FEE S .,� (`�� . SignaNre � . fOTALfEE . .. '. - ?lon eheek qppliwrn . .. siNGtE F.nnnnv �1 4 3 8 A HOME OWNER•BUILDER OEGIARATION �� � tJame � � - . , . I hero6y aNlrm tha�1 am e:pmpt from 1he Contronor f licenae �� - � �#• • • •.•5 Low for�he following reoson�Section 7031.5,Businesn ond - . Rrofessions Code): � � �;ry � �e4.No. 1 •r Q$,5� ❑ I,as owner of the propery.wtll de the work ard the - . ���' � ; strunure ia no��nrended a offdred for sa�e(SeeMen � , •2 2�.J a� � 7044.Busines�ond Profsuiona Coda�. . � �, . . � CpNSTRUCi10N IENDING AGENCY . . . . . . . . O 7,1 B—H Jr '� 1 heroby affl/m�hoi thers ix a wnstrudion fending agency fnr � the pe�formuace of the work fa whtcb�hb permi��s issusd . . . . . . . (Sec.3097.Civ.C.). � . . . � lendx i Nnme - - - ' � lender'a A�dress � � . . . � � i cerrify iho�i ho�e reod th�s apphmt�nn and smrs thpf�h� _ � _ � . . _ .� . . . � a6ove informotion is corr9ct.I pgee to cnmply witM all QaUN{� � adinaacea and Stofe Imvs repub�inq Dlumb�ny,tlnd kerehy . authw�ze ropresenmrrved of�Ais touriry te en�er upon ths � - . �� ab v an�ioned properry for inspenfon purposas . � �YI�,`�� SE�IREyE(!36 FQR EXF[J(NA7QRY kANGUAGE � qnoror f Permit ee DaYe - . .. . ,. . � ; I s�oN s,ao��asNi ' � �� �aump , . . a�op � uosoa�siy�ao�•yd g g • •�ag aapun jdwaxa wo� " (�e�os�o asod�nd ay��o�eno�dw�lo ppnq�ou � � ' p�p a y�oy�6u�no�d�o uaP�nq ay�anoy�pM�ep��nq•�aumo ay��uopardwo��o�oeA auo u�y{�n+pJns s��uaweno�dw� . - , �0 6u!Pffn9 ay7,•�enaMoy•;��a�os aof Pa�o}{a�o papua�u� . . . , �ou o�c s�uawano�dw�y�ns�oy�paprnwd pacw�y��om � , -, � �� , " � y�ns saop oym puo •uoa�ay�sano�dw��o spr��q oyw� ,. � . . . .p�ado�d�o�aumo uo o�,(�ddo�ou saop n�o�aauwl7 s�o; � ' � � � � � � � -�wjuo��yl :epo)suo�ssa�o�d puo sseu�sng'Wp�•oegJ � , , •o�os�o}pa�a�}o�o papuaivi 1ou s�c�n�ortiis ay1 - ., lvnOtlddV 31SVM puo'�iom oy�op���m l��ado�d ny�}a�aumo so'�� 1bI81Sf10Nl � �'(OOSS)r�opop . . . -. pe�puny ent�ucyl a�ow�ou}0 6��ouad pnro n o��ua� � _ � -qddo ey�sy�alqns{�w�ad o�o��ua���ddo duo 6q S'ICOC ' • �uw� v �a�u� �bNii uop�ag io uoqo�o�n .(uy ��uo��dwaxa pa8a��o ay� �o� � - - , ,� s�soq ey�puo wo�laray��d�uaxa s�ey�oy;�a(apo)suots -Sd)OJd P�D SSBLI�S�O ay+�o F uo�s�n�p io(�pp�uo��]as , 431iIlON'pJA11711f1 � , y�im 6upuewwo�)6�a�doy�)MD�BfUiJf�SJO/DOJ�UO� � 1S31SV°J oy�}o suois�no�d ayy o��vonvndpewc��r s�ay�oy��uaw s3znixid�wewme -o�o�s peu6rs o e�!}o���w�ed y�ns�o��uo���ddo�y�sailnb � � � � -e�es�o 'o�uonrs�s��o��o��d•a�n��n��s.(uo��oda��0 831V3H N31VM10H 'ys��oweP•ono�dw�•�o��o'y�n��suo�o)a�w�ad o sa��nba� � � 1N3A S'd�J qorym,(�uno>>o A+p Auy:(epo�suo�ssaEo�d puo ueu�sng ; - `JNIdId SV9 'S�1£CL uoi��as) uosoa� 6wmo��o} ey� io} mo� osuaoi� �N10W(11dH900t1 siopmiuo7 ay�woi}�dwax�wo��oyi w�iyjo Aq3�ay� �a0MeV1S830Hf1 NOIlb41b'1J30 213011f19-2J3NM0 5310N S.eO1J3dSNl 3anivm:�+S s.a0l�adSNi � � 31vo s�dnoaaav �