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3� - �� - WORKERS'COMPENSATION DFCIARATION � � �P��������� ��R P"�dJfV1BIN� PER�IT 6�S . ' - I nereby�afnrm-rnai i have a ceriir`imie ot conseni ro seii � 76A6G7A T - . �.R�_:: � insure,or p cerfificate of Workers'Compensation insurance, -� CE Fi7(REV.10'81)� � . � o�a certified copy thereof(Sec 3800,( h (.) ����;y{]p.CQ5 AP-!C'sEEES ; S!liL�1NCe APdQ SAPETY : �� � .��r�! �� . ; � Policv N _. . �Comoa�y -.... .. _ - . . a Certified copy is hereoy fumishe . - � BUIiDING � � � FOR A?PLICANT TO FILL IN�PRINT OR iYPEI_ _ qppRESS ,'1� / � _ �ertiiied copy is filed w ih the:ounty bo�lding inspec -- k' � .. �ion deparimeni. � NUMBER FIXTURE OR ITEM C fEE � �� � '�� LGCALITY �d���� Dafe qppp�p�� WFaTiRCiG5E7 i�" NEARE57 } �� CERTIPICATE OF EXEMPTION PROM O �CERS' �, BATh+tUe - ��,_,., CRO55 SL � r.r� - COMPfNSATiON INSURANCE f ---- �-"--- -�� OWNER � � �� " (This secti6n naad nat 6e com�alePed[f Phe work involred by _ p SyowER �. _ Z , ' MAiL p � . fhe permit is for one hundred aloliwrs(5106)or less.) invqlORv � �� qppRE55��7 ' � :i F �- I certify that�ln ihe performance of the work ior which this � ��}p � y� yj � permif is�ssued,I;hnit not employ any persorr�n any manner -. r 5!NK ._„r �.�- CITY �, 4�f1�a/ TE.N0.�7�'7f�G90 �,� �V�tio .,��, Y so as to bamme sub�ect to ihe Workers'Compe:sation Laws. 0 DfSHWASHER �_. ' - B _�_� CONTRACTO ��f Y�j�.x�,"� �� �Dota Aoplimnt CL6TH;5`NASHER � ? �. NOTICE TO APPLICANT.If,.:a{} mak�ng�,this.C..rlificate of �. � ADDRF55 ��j,7�� ;��. 5�tJiM,�YING POOL RECEPTOR �,,(� ��-,y y Exernptron�'"yo� shc�7d beccvne sub{eB to�iF.e Worke�s � 'air ���Y�/�1'7'� 7e�.t�O.�rJ6'�7.vr++� -H�� � � npensarian provisions of the Lnbor Code,you musi torin � � �� ; 9� com ! vdith such rovisioas or tfiis tAWNSPRINKIERSYSTFM _ C..�._,.-. . pY P Permit�shal) be : ____�. �_ . STATE uJ,sg LI p c_ s�_.�,� ��emed ravoked. � wr,TER H�ATFR y .t LiCEhSE NO.'§�r�'�7�"`►" aass 4 . . IiCENSED C'pNlRAC JXS DECrqRA?ION - ����- - '°—�- - �tsrR�C7 NO. �PR ESSeD BY "� ` . i hereby arf m lhnt 1 am I�censed� d r provis�ons of Cfiapier 9 � �AS Svj7EM '�OUTLETS �,,.-� ,- : S ' (camme xmg w�fn Seciron 7QOD)cf Divssioa 3 of the Susness OUTLCiS OVER —� -c�nd Prefessions Code,c.nd�my licen;e�s in full force and effect. �5 PER SYSiEM 4 i~ �F�NA� � r�����/�s �'�� �at� �/� `� �ALItl3ATiQN �� ; License Numher������_iic.Cl��ss��_ . � � �'�,� 5� �y: q,v � f INAi � - � �� Contractor '�" ,�Date -��d'd�° _ B'! .�,�., ' ^�.,� z .��. Q I am exempl un er Sec. � . n k*�� r +� � : � B.&P.C.for th9s reason 1 ' -�� a. . : Plan check fee �_� � � � + C � : Date: � " } PLUAflBING PERMIT ISSU9NG PEE.$ ��lY � � ! � Signqi�reLl� - � � � �� - � � � T07Ai�EE � � �� _ ,�d�P.p�'�PT � U PF i,� ��s � �--- _ � � �� - � Plc�n cfieck applicant � � . -. �_ - SING.f.PAhh11.Y � `' � - � HOME OWNER-BUILDER DECLARATIflN - Namc . - - � . � �` � �.�-. i hereby affirm;hat i am e.xernpl frorn the Caniractor's Lfcense-. - <. . . . . -���: q �_._. ' �..for ihe fvllov✓ing reason(Sectian 7037.5, Business and - ��dress . � � �� � ;; - �ssions Code): Ciry TeL No. - - ._„�� � 1,as owner of the property,will do the work ond the � � '�; � � . str�ct�rc is no?iniendad or offsred for sale {Sedion � � � � �, � } 70d4,$us nsss�nd Ptofessians Code). � . .� � . CONSTNUC710N IENDING AGENCY - � - � _ i hereby affirm thczl•#iare.s a cons'�ud'on lending«.gency(or � . � -. i� . ihe performance of the work for which this permit is issved � - -�_,���:. (Sec_3097,Civ.C.). - :�= � Le der's Name . - - ', -Lender's Address � � - - *s - ' I certify ihat I have read this applimiion ond stote�that the �� � � - "�..,; � above mformotion is cerrect I agree to comply wiih all Counfy .� � � _�,� � ordinances and S!ate laws reyufatirtg Plumbing,and hereby � . ,� � outhoriza representatives of rhis County to enier upon the , ; . , . � ab e- enf' ned property for irepection purposes. , - '"r SEE REVERSE POR£XPLANATORY LANGUAGE :� I _}_ ,�. 4��-���" � s.�•� . _ . s p , �,. }.i Slgn ,ure of Permiftee � Date � � .. .. .. . ,,�: ,G , �, �, �°a o � � � o � � c� A � c � o � . . . - '�p � � �` 2 p � � G DW A ,s"'„� O � � � m � O .,- �s ��� Z � � a � �, �j n� o s�o � � � " 9 O , � ' . .�" ���� '.. ��. _`��. 1...� q � .. ° . � m`�"� .�� � . � O S i t�, N vt,_i q � � � � LA� � � U � . � �,� v'. �qt v r� � .7 � tV G z. `_ . � �, ' m , , � c ' � , 1 1 �` 1 �} `� � � � ;, .` `y , , i � �1 O 1 ' N �. ,,, o � , � � t � � � 4 ' " � �- - ti w N (1 3 c� �� �ro w o � s n �o o �� � ' �, � , � '�? 0 7 4. u� O ta S��, � � ¢ Q '� � i� � I 3`� .�.� �s,a m � �.n @ o ,.t o ° ct o-rs c.� �z � ��'O � 7+' �,s^�G���K Q t�0 4n c�9�K � '19 p �`�t � � `•. 4 ,,..�(,.4.� 9 S1.?•r�.. � '�'C_ � � � c0 C+ = u* in �.� ?"":.. � C`J �' " � `kx� C t�9 O..^� � 'P fl o[_�f° �' o � —e � � Q 0� 6L en 9 (4 CJ � C� N � p "p X �-a.� o m'`" �.� N o� : �� °_fl c?� � 9=�° ;'" C. 0 o r- � `, �f� ID � �rt� ° n � � w v � k< ° N u ° � O � "� � GD .�.+ � � C5 N e�f � � 0.. 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