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� WORKERS'COMPENSATION���CLAReAYIb1V:�� .�.��'.� "�::.. ��� .,��H.:�. �� .. . , ... ..: . .[[[��� I hereby pffrm�thnl I have a ce�trf4mte of cunsent to selh J�" � �„�,,,,,�,,.:�,�,�.,,,.,,z,..,,r.�,„„�„ ,.� �>-..r.. ...�� _ -.�,.-� , T - M.,,�,�,. ins�re or a cerjificate of Workers'Compensahon Ins�rance, -�" ' " ��p�,��,p������R ��M��NA��V� �'������ PA�i �lpi��� or a,cerhfred cpo�p,�yf�Ihereof(Sec 3800 Lab.(G.) 76++z9e '- -� _ �� � �� � CR�r� Policy No�C7'�t"l1S��mpany ��C� �� cEs�s 3/8cl ,.. . . . ,,,..� � ��. +.*r=:, f ...' :� ��� '«' . � COUN7S�ZJF`C(���`A`NC,'EL� � BU1LA NG,ANb 5AFET`� ,u „ ���Certi�ied mpy s hereby fu n shed. , - . " � � -�-t-� .... . .-. . . ..�. -.,.�, , _ __ . ..., _. ..._. , .. . �.. ..,_ .,.. . .. ..�-.,.; . . ..,.s> . .� ,. ... . . �-+�w , . . , 'm`�:. sa.,.,.aa..w. �«+.t�...x,..=e.'�� ��'Certified copy s f led with the counly bu�ltl� g�,nspeQQQ FOR APP�I�.'f�(J��(O��ILI�IN - qD R SS �[�5 �f,/J �E�'�. hon deporfinent ���(7y� jjj BUILtlING"'"'�� � � � .Do.le ^��-�� APPlimnr �YCRH-"�� AODRESS � L.,�` ��1 � ,{`f� �i�� � . LOCALITV .�JtiIA � .., . , ..:.:.., . ... _, _ ._.,..�. ..�✓�Jln`T+.C.t� '. . _.. . �.._ NEAREST '� � �- .. . "- . CERnFfCi�T�`t�K'ER��a cirv zir ,___. �_..,�, : . :.. ceoss sT � �,i �,� � SIZE OF � ,- � 'COMP�NS.dTIb`N,I�JS`iTRANC�� ��•...�� .. �• � (�-�� LOT � LOT NO �ASSESSOR � TRACi�. �., .MAP BbOK ..�." � PAGE' PARCEL .. ._:...._.�.� Thts secTion need nof be eomplefed if fhe psrmit is Eor ona � �..�� �o. � �t�� USE ZONe op" hundred dollars'(S�DO)or'�less.) - - . � �\�.� . ; . � � � �- owNeR c — � saaslf t`ha��n ihe � . ` ... ----�,. y performance of ihe work for wh'ch ihis � �� �SPECIAL � permrt is issued,I shal)not empioy any person n any mbnneY�� ADDRESS�'� S� . .g,r,��� .y CONDRIONS,�. .- - _.-.,.w:..,«..-m.3,..�.:.�. �.+s�^,; io become.sub�eCf fo fhe Workers'Compen5alion Laws'. '. ` 4 �� � � � � � � DISTRSCi $TATISTICAI CtASS � -'- TVFE -P ES ED BV� � ., �' .-..'. :.. . . CITY �!W�i\NL.I . ..... ,.ZIP..,_.,,.. ,. , . .;�.,. CONST. � . Date— � APP��tanf � .. . .., ARCHITECT bR'.`�"��` .. TEL' . �' . CLASS NO.�� . „H..�: -..�_ ...__ FNG,NEER,. �C� .t� : . . � �, NOTICE�TO"APl�'L`�C"A`h�T'i�"'ofrer making th'is Certificate of� � -- �� .....-. .-.,�.. - . .u-�.,.:.-.„ ��` � Exemption, you��sFould�becbMe^subject to the��Workers' qDCRESS' � VAlUAT10N� � �'������ Compertsdtion prvvisions ot�he Lobo�Code,vou.must foHh- �_�... „_„. „_ �: .,, ��. - � �." . wi!h camply with such prov sions.or'this permit�Shoil be'� -� ��"7EL q��� � �y �s � � � VACI�ATION .... 'deemed revokecl'. CONTRACTpR� .. �(,�^ Qfa �.NO 1. �p Q a �. .. ..... '� - a;-,m „5.�.... ......� �-� LICENS�D CONTRACTORS bECYfiRqTION�� ��� /�,{� ��� LiE � � � f hereb affirm ihot��m licensed under ADDRESS`���� Q d V�C�C],{��SfV�Q. ryp�� ('l'��� s � y prows ons of Chap�er 9 . . . .,(commencmg with Sectit,n 7000)of Divis�on 3 of tbe Busness ��Ty�� �� ��� .�.. � .�A�.- '� . and Professions Code,a��y�ense is-in,fu�l force and effect� p��RiPT��rY OF�dRi�,�.�; FINAL - F}a � 3 _�. .❑,. Licedse Numb� "K LG-� � L c Class. SWiMMING POOL � � P � `� ` .,.�„ o�re � D � , r �'�ps..�k c�.�l`A.� ' _�{2f sa.a �-i. F[�txa+C� �C .�... a .Con}ro«or Dpre�. �-� � � FINAL - � �l��^'.F �� Q � . .... , .,_. .� .. SQ ft. .. Q � �I am exempf u der Sec.— , ... _, � SIZE � �:��i.` , .. l G- - DY � �� 9,6_.� 'z .. U ......,.. . .. ...'...., .a.:�.�< , ° . ... .. a'. ..�8&P C for ihis reoson� � -^- ' �-r EIECTRICAI � � �. ..�� �.. .. . . . . � �-J: � �R f2 O f1 .�. — � Date � . . � .. .�W 5 nature �� . Steel&Condu��Bonding �\`� �G,y� g. '�K{;�_ �� d � g � ' Conduds,Conductors,Eqoipment . ���4 �f �� � U7 �� � SINGLEFAN�ILY �� .�� � . .. - - . -� � � u:c��i Cl`.'�.p�.� .. �.� � � � . :.� ..�. _....,...�. _ .� �� HOME OWNER BUILDER DECLARATION PLUMBING - �. � ' � I hereby offvm tho11 om exempt from iHe Contractor's license ., � . . .. , � . Low for ihe foliow ng renson (Sect on'7031 5. Business and P-Trap � � �- � Protessrons Code)� Gas$ysle,m .-.,. ., ���-�� - � I os owner of ihe property,will do rhe plomks'fpg pnd Anh-Syphon '� _ . . L� - � � ..�.,eleCf�icahwork.I,or my ersYp'loyees wifh wages�3 their . ,:, ._....._._,,,,__.,........_. .. �Sole compensation,or a Ilcensed contrador will do all MECHANICAL � �-�� � � � - � �other work and�he siructure r3;not intended o/pffered� � � -for sale(Sedion?044�B&P Codej. � � � � �-� ' --- � , � * Swimming Pool Heater� . . . � � . . � '.CONS7RUCT1�6N"'C'E'17�.f�i�G`�C"�' """. '" ' . . . . . .. � . I hereby 4f m thoi there is o�consfruct on le d ng dgency for. APP���M� �-� ��� t ` ��" ��_ � � the.pe fo mance�of the wnrk fo which;fh s permrt-is�ssued� ._'t` � �j� `�•��� (Sec.3097,Crv.C.1 " (PRIMI��{— Q ,, .p,`op�o. E � .� .. LendersName �!`Yri�1ft_.�C�'`�� � .�L � 1 M . . . -..�•..•".:.... . �. AOORE55 ^ ..C.T�r IY{Ll C4,W � ��Lender'sAddress - � , , ��-�� ,� , � � . - ' �' P C Fee S . 9e�mr Fee. � � I certify rhai I have reod this applicotion and stpte ihol the� � � �.abovz mformation-is'corle'd.I-agre�Ao comply�with oll founiy � � �� � � � � �/D S�� � � � � � ordiaances and State lows .�eloting to �uildinq, elecirimi, ...,..,;: issuonceiee / , � .mecha,nical.ond plum6 ng construction,�and_hereby autho�ize�. Inveshguuon.Fee . - � ' - �� �, � - �. represeni�tives of th Couniv to enter upon the abo�e- _ , . TorolFee� �� � y'� me io d propert f r inspe 1 on pvrposes. . , .. . � -- � --. � � . �, �i`. � . (��[� () f l! '� �'^' ..". - �.. w�eM��d=�k�h..a.=::�:.a'#sa.Rh_.A .o+..N}'�..e�+k�iN.'-::C=ti-+an.N.Nv r,.::<3.rsYm«c�Yra::...'�.a.,��,.� a . ;g�owre of Appl�mm o.Ageor � baie � SEE REVER�E F'C�N"�A�L�E -� � � � ,�ra� ,-�.;, � r�`"��b�m.�a�e���w��� ^� i��"«�trr�";�sx"+j��.�'=s�&j�"s i n�.�' �,«« �,,� ���.. .� _ ... �- '"�°"°�p�PLAN�t0 APPLICAN7,:"" ` .":'. '""" � � .�'."""'""".""INSPECTOR'S N4TFS ..' . �-��. OWNER-BUILD DECLARATION �. � . ER . To: � ..Returned � - � � �y , hereby affirm thoi I�om e empi from ih C�atractor's . Approved �L cense Loui� f the�.follo ng reasbn (Se< 7D31,5J� � .. � . �.� 8u3iness ond Profess ons Gode A y ci}y or rounty which �No. ...,�..: Date .-... No. -� �at�_. . ... . . .. � "... . ' '. .' . . . .., �..:..' � � requires a p�ermit to construcL olter.��improve,demolish. , � �.,::�". ..._ .:,.,�....�.:. . . ".. . .,..,., . . . _.,.,..... ,._,...,,:� �. .«� �grrepair anystruciwe, prior io its issuaue, olsa re- . . -� . � � . ' . ' .�...,:.. ,���� r� . . . . . . . . .. ... _ _._ . .. , . . � ,. , . :. .� � qulres,theapplicanlforsuchpermil/olile�asignedstafe- � � �" "''"` " " ""`°x- "^�t"" "-^` --+..'. � &cr.. -���� :v,mentThai he is I c nsed pursuaM to the pro�isions'of 1he .._._ ._ ., ._, . . _ ._.. . _ . .__..�� , . � - � � . . - :„ . Confracfors LrcenSelaw(Chapfer 9F(commencing wlfh . �..-.-. ���-�: .-. •` ' � . - � ' .. . �- . --.----,.o •-...---.-:��.�,-..---w�. ,;,;Secfron 7000)of Division 3 0l ihv 6usiness pnd Profes- _. L - -sions Codej or fhat he Is exemp!therafrom and Yhe basls � -�-� — - -�-�- - —- - < for the alleged ezemptio A y vio(alon of Section INSPECTyON - DATE"� .J INSPECTOR�A �� �"�'' " 703f 5 by a�ny appliwn�for a perm�(sub�ects fhe oppli- t.� .. ., _ y t-� ..�. . ^� . eant fo p civil penalty o{nof more lhon ffve fiundred � IOCATIUN__.. , ! g�g . f\`Y.l. , . r ( , . do(for❑s(5500).). . � � . .. .. ..,,�. .,.� . . . . ... . �. .... ........«.. � �- . , , r- " :.:, a nrr�3,�. ..f,as owner.of the Froperty,.or my employees with 57EEL 8 F6RM'o ' � � '""-' ' ` � . wages as iheir sole<ompensation,will do ihe work,and , ,. . - .�. , .. '' ` �� �A� � , ' � � � . .�. �%^.� the siructure_is.not intended r ffered for s I_Sec.70q4) . �l'GHT CONpUITQ��L . '. -- . .,... � _. °x ,�ia.p} ' . �' " ��� Bus(ness ond Pro/essions Cod 7he Co lrpctqr's Licen,se � BONDING � � � - �. � � "� ' '��- �r-' �- :,;�.L.awdoesnotapplytoan.ownerofpropertywhobuilds,o� - � ,-,,..,�, ,,;_„�_. : - � --� �, �� -� `improves-fFiereon,andwhd�does.sucM��vqrkhimselfor _: .._..___ - . . ... ,� . � .,� . .�*.. .°.-...-. - .��n.,,�,-�y,..�r�-,.- :�„y.,,..,, -7hrougfi fiis`own emgloyees, provtded ttiaY such �. .�: � ; . . . . �m- �� . .... �. . -, ,,� � � � � � ' �` ��_ ` provements�6re�nat intended or offered�for sole. !f, - r.�-'p„�`«,+�w+q�:qr.�y< w .�..,yr ��,y.�: however,Ihe bu Iding or improvement s soldw�thin one �COwDuli �it(, �'�j.�� ��lk - - � ` " . e•� " ~ �<..yeor�di cbriip�eton. tlie ownvr-builder ill have tfie � �p � .... �- .,.,,:,i ,_ ..�;` r� �-''-- � burden o/provmg that he did not bui(d or�rmprova tor the cAs tIME 'Y� i��13 , t.+"v��., . .._..,..,„ �... . ... _.:. .. : _ _.,pu'rpbse of�3d1e1' � �. _ . .-.. . . ._. ,� . . . � _. . ,; . . .. . ...- ..,.,:,: .,,.., ,�,�:`., ;;,�,. as owner of tke property,�om exdusively con- ❑I .., WATfR t179f .�. . . . ��._.'". �'.: , c_. . , � :_ �. dac �g wrth 7i,cnFed onl�acbrs to�mnskucf'the prajec� � . . .., ... , . . . � � � � � +. . , � ��� >��-'�- - ��..,�;-w ,�.�,:;;, , y,��SeC 57044)8us n ss ndProfessiQns Sode T6a Controc- � .'SEYd6R .��� �- ' � . .. �.�' . -.. `� .� .tars CicenceY6w does not aPPly to an owner o1 properfy . ,. � .... . . -.�� . ��. .. . .. �... `�., :,.� surn bro ec sr'witFraVeontra�tor.so+d who contracfs.for y � � O censed pursuant lo ,.., 3 r w , -the Co treclor License Law ANTI.SYPT70N�VALVE �.�. .. . �. + ... , � ' ' - • :�.: _. ❑1 om pt d Sec ,B 8 P.C.for this -ELECTRIC WIRES ��- � �� rea o - .__ � . ..... . . ..,...„�..,., .. „ ,S.a ' . -�FENCE(IIEIGHT) � Dat� Owne 1�....: . . . ..... ......... .�._,.. �.«.�..m ' . . ;�: -� i . SEiF-CLOSING .,.,���� � .I GATE¢ �SELF.IATCHING� �. - .. .._ � �.,_-,.. .. ...,." -.:. .�.ie�3PECYbR'S"NOYE�s', ..,,, ._ _. '--- --�— _ ., • � - .� ,. � . �,�..:. � � � _ � * i � _ ,, . ,,,f. > _ �i rr� – . �a,. . .. n, - ., � ROUGN WIRING .,..;' ' • -_ '- d �f1�ELEC7RIC ' � � , . � . , _._ �-. _ � ..:.. .... ',--.....—.-. -..._ . . .. ,..._�..� v R,......� '. ^z �..+a ,. "-_�a . �_ . - e.x. r .... „�...:"i � `�:�. :� .. ;�. ,,.....�..,.�:.. .�,�..s, c��. i ..�„- � •v.. , :) ��H�R(LOCATION 8 VEkT) . , .., �� ., � � �.:�� � .� � _ . . GA511NE TFS7 . .. .... . • .. ... ..... — . � .. .�P�OlORAtNAGE � ' . . � . " —f'..° , , � � � . ` ... .. .. .. . .. .. .. ., '., , .� '- � _ A.TRAP . . . . . . . . . .. . . � � ,._ . ., ,. �_«: a�... ,.4,r,E, �..,sP'b..a.'�y}�UkN: . . ,�....... ........... .� ..'.t: ^i�.m...;•�'; ' . _ ' . ._..... . ...�._ ,... .4.�.�. ..Y.u::.a:n��.,.d ..� . . ... . .n. . � ��.. . .... . . , .. ,..