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1408A (7)
�. ; ... .., .: . .. � � ....� . � . � WORKERS'COMPENSATION���CLARAYIb1V��� [[[��� I hereby aff rm�thol I have a ce�trftmre of c�nsent to selh �����������r��� ����� � .yv..M.,w�„..:� . ._M _.«, ,�� , r. - �.«�»�'�,�.�.a«>,u...�-,sK.,,v.z.� �� ins�re or a cerjificate of Workers'Compensahon Ins�rance, -�" " �Al'"r�IV S�'IN�Il�`I�(;�PQOL PERMIT or a ce t fied ml�p,�yf�ihereof(Sec 3800 Lab iC.) �gAyq� -� -- ,� Policy No��J'�t"l1S��mpany ��C� �� cEs�s 3/8c1. ..... . .. _..:�.,,,..�., � .a„�..��. +.*r=� f `'� .. . .« : COUN7Y bF`CO�ANC;E� BUILA NG AfHb SAFETY ���Ce tified mpy s hereby fu n shed � ��.��_„�� «�.�.r,�,�., _ .._ .. ,. . ... �..-..,.; ... .. . ...._. ,. ' -... ' . "."y' . ... BUIIDING .. , ���Certified copy s f led w th ihe counly bu�ltli g�nspe4 FD)2 APP�I�.'f�(J��(O��ILL��IN . qDoaESS ��5 ��f,/J �E�'�. tion deporfinc�ent �iI7y;� � 1,�,,�/A1�,,t�` BUILtlING.'.:"''.� " � . . . .Do.le ^��-�O ApPlicanr�`�"v- AODRESS L.,���1 � ,{`f� �'i�� � ... LOCALITY .�Jf.�,�llt,,,� � . /- , .,._, . ..:,.:.:� . ... _.; _ ._.,..�. .�✓�J4�+`��C.t� ; . . _.. . ._ NEAREST �� � �- .. . cERnFfC�T7E`C��'ER�h7Ca c�ry . Z1P _... �_..,� . , ... ceoss sT � �,i �� � SIZE OF � �... ,- �� 'COMP�NS:dTYb`jJiI�JS'�i�RANC�����•...�� ..... • � (��-�� LOT � LOT NO: �ASSESSOR � TRACi�. .� �., MAP BbOK ..�.� ..,.._., PAGE' PARCEI (Thts secTion need no}be eomple}ed if The permif is Eor ona �.�� � �O ry' USE ZONE AMP� p red dollars'(5�00)or�less.) -- . OwNER i l��Q � f��. NO "� � `� �- soaslf �hat in the � work for wh'ch ihis � � � `� Y--���� n��d y performance"of ihe �� �SCECIAL � erm t is issued,i shai)not empioy any person n any monneY�� ADDRESS�'� S` .g,r,�� .y CONDRIONS„_. ,_:.,.w:_. ._...,3.�..,.:.�. »�.,-�sa��s�^,; io become.sub�eCf fo fhe Workers'Compen5alion Lpws'. '. ` 4 �� �� � � � � � DISTR4Ci $TATISTICA7 CLASS -'- TVPE -P ES ED BV� � ., :, :.. :�. . . CITY �!�....I�i\Nl.l . .... ,.ZIP..,_.,.. ,. ., . .;;�.,. CONST. � . Date— � ApPl�itanf � .. . .., ARCHITECT bR'.`�M�` .. TEL' . �' . CLASS NO.�� . �H..�: .-..�... ..._ PNG,NEER � NO710E�TO AP�VL�C"A`h�"T'�1�;ofr�r making this Cartificate of - � �� ...-. �-......�� . ,v�.,.,__-„ ��` .�� �� Exemption, you��sFould�becOMe"subjeci to the Workers' qDCRESS' � � -� � VAlUAT10N� " ��������� � Compertsd+ionpeovisions of Ihe Lobor Code,vo�o.must foNh- ._._..,,_„. „_„.�. . -�� ���. wi!h camply with such prov sions.or'this permit�Shoil be� -� "7EL q��� � �y �s ^ � � � VACIbATION .... ... 'deemed revoked'. . ' CONTRACTpR� .. �(q^ Q(a �.NO I. �p (/a �. .. . . �-� LICENS�D CONiRACTORS bECY�dRA'1'16N��r���� "������ ��� /�{� ��� LiE � � � � � f hereb affirm thot�om licensed under ADDRESS`���� Q d V�C�C],{��SfV�Q. � ('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,and my I cense isin fu�l force and effect� - . �--- >�. . � -_ � . �}p /` ' �ESCRIVTIdrY OF A'dRiS.�...T,�, .:.❑.. FINAL (�/.� � LicenseNumber�`K-L����p Lc.Class. � :'. SWIMMINGPOOL .�...{� �.�. . DATE � (� . , Q ��Ei..1{'.V C�.�- � '� ^E� SPA ,..�� V°1C 4�..-. -� .Coniro«or Da�e�. SQ� '� �..-. �• � FINAL ... . � �l�C F �� Q ._ . .. , :,_. .� .. � Q � _I om exempt u der Sec.— . .. , � SIZE ����i` , l G- - 8Y � �� 9,6 � 'z , U ......,.. . .� t , . .. ....'..... .a. �.�< o . �� ...�8.&P C for ihu reoson� � -^- ' n'-r EIECTRICAI �� � �. ..�� ��.. . . . . . � �-t m� �R f2 O f1 .�. � Daie � . . v W 5 nature �� . Steel&Condu��Bonding �\`� �G,y� g. �K{;�_ �� d � g � ' Conduds,Conductors,Eqoipment . ���4 �f �� � (A . .__._ ., . .. . �.� � SINGLE FAtNILY '- - . v:�.C C��:�.�, .. ..� � .. . ,.- ..�. __..,.... � _ � �� HOME OWNER BUILDER DE'CLARATION PLUMBING - �. � ' � I hereby offvm tho11 om exempt from iHe Contraciofs license ., � . . .. , Low for ihe foliow ng reason (Sect on'7031 5. Business and P-Trap � � - �- � Protessrons Code)� Gas$ysle,m ., ���-�� . � I os owner of ihe properiy,will do�he plomlrfpg pnd Anh-Syphon '� _ . . L� - � � ..�.,eleCf�icahwork.I,or my ersYp'loyees wifh wages�S'their .. ,:, ._._..__,,,,__.,..... ..._.... �Sole compensation,or a Ilcensed contrador will do all MECHANICAL � �-�� � � � - � �other work and�he siructure�s;not intended o/pffered� � � -for sale(Sechon?044�B&P Code}, � � � � �-- �� -��� �G'7'I� � , � Swimming Pool Heater� . . . ��� � . . � '.CONS7RUCT1�6N"'C'E'17�.f�i�G`�C"�' """. '.�" ' . . . . . .. � . I hereby 1f rm thot ihere is o�consiruct on le d ng dgency for. APP���M� ��-� ��� t ` y` � � � � the.pe fo mance�of the work fo which;fh s permit-is�ssued� (pR���._'t`�—���j��`��.��. `yc�'��� � � � � (Sec.3097 Crv.�C.1 � . v 4 a� . b l . , .. Lenders Name �!`Yri_1ft_.�.-va'`�� � .�L � 1 M . . . -. •'.•�`:'�` � �. AOORES$ C.T�r IY Kl «•�-cl � ��Lender'sAddress - � , ���-�� ,� , � � . - ' � �'�' P C Fee S . Pe�ml�Fee. � � I certify rhat-1 have reod this applicotion and stpte ihol the� � � �.abovs mformation-is'corle'd.I-ogre�.to comply�with oll founiy � � ��� �� � � � O S�� � �- � � � ordiaances and Stote lows relot ng to buildinq, elecinmi, ... Issuonce ice , � .mechan col.ond plum6 ng constr ction,�and hereby autho�.�ze�. Inveshguron.Fee - � �� - �� �, � - �. represeni�tives of th Coaniv �o enter upon the above- _ , . 7orolFee� � � y'� me io d propert f r inspe 1 on pvrposes. .. � -- -. . � . � k,�`C� "�' �` :��, ��:;���_�r.�,�,....���.�n��r.������,��.�...� � ;g�owre of Appl�mm o.Ageor � baie � SEE REVER$E�F'C�N"A�Li�E r -� � � � . . . - ,,�#a� ��.a � _ r�"w-c��b'wde,�m�e,s,.�a�w�'="�+�r;4� ^� i�'�'"w�trr�,.`,roxx%n=a.�.,��«�.��,..,«�.. .:,_,.� ... �- '"�°"°�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�O!ORAtNAGE ' . . � . " —f'..' , , � � � . ` ... .. .. .. . .. .. .. ., '., , .� '- � _ A.TRAP . . . . . . . . . .. . . � � ,._ . ., ,. �_«: a�... ,.4,r,E, �..,sP'b..a.'�y}�UkN: . . ,�....... ........... .� ..'.t: ^i�.m...;•�'; ' . _ ' . ._..... . ...�._ ,... .4.�.�. ..Y.u::.a:n��.,.d ..� . . ... . .n. . � ��.. . .... . . , .. . ,..