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HomeMy WebLinkAbout0976A 4�.� �...��*,,.�` 'r ,:._ _.._.- i� ,�,,�1' � ,�y"�`� � ��/ .�- � w� E-..< �. �.. . .; � .�T .. ;. .�' �. WURKERS COMPEhLSATION�UECIAR£4TiOtV � a�:. �� �`l1���LP�1-�7�Q1�.LO����l1FlB�\����l�I-L. -. x �,. '� h kereby aif rm ihaf 1 hdv�'�a cer�Rftcote-_of ca senf:to lh �;76AG67A, _�' `s� �. ���� irtstrre;-or mcwkl`"rcate of W�rkera'Campensaporc-kns�rance gt7=k�V'70 St � � �� Y ��' ��� i f .�;m � s ;;. `y -,�. a{"� � ora�cer t¢ecF�aFythe e�{Ser380J,�. b �) - ��".: � s�' -� � � .� ` - .� �a��xi.,�v:�a�':.� �"�l�r��#��d�=�n������ -sF�f€�t�a�`t��scrsAfe�Y ; g"�'-'� I�y::^,--��.amr ,y �.��. _�..�. �--:.:�� . �-.., -_ . ._�..�1c��, �/�..�` .,...:. :�..; � ,,:, �Certrf�ed;copy is-hereb�fumishe ',� ' -. � � �'�.'__ _ _ ,�'�."�' ��: gg - t : �� fOR APPI CANT TO FlLt IN(P41NT OR TYPEI BUILDING� /I-� �� ,g.��� g -. CertrHedFcopytsfale�w;ththeT-cour+fy,�bwl3tM�}-:inspec � --- -- ADCRESS �� ��-�� R � , . � ;� �.'f[ondepariment -..M-� ` ;- NUMBER�� -RXTUREOR-Ite`M FEE LOCAtITY � ��' � � ¢ ..,,... __.._ ,/� �_:- . � - % r� �+ - // r �� -J".!""l7� � ��.�'.. .S� - �.. 'sJAI'FRCtOSET . . ��- -��.A..._� _�_: e;. ..-�: � pate A�pTcdnt • - - - � NEAREST � -`�� ` ��,:�_ __ . ... _. ,. . . � �ROSS SL .- -: � � �;•S �- - LE�iFICATE'QF FXENii�TION KI�OM��WORK RS' �- �BATH TUB � - J� -� - 5_.-__, - f'OMAENS9Tl6�lNSURANCE `- /- - - - ---1�..�..,D�VIVER _� � - - _�` �; f �- SIIOWER -. ; (This sactfon�aed nof 6e cumpi�ted iF the work imoived by� -�� � MAIL / � �'-" � :` �the permii is for ane fiundred dolfan(5100}or less.) � tnVnipev� � qDDRE55 {� � �-�-�c ��� / � - � , .�I certify tn�t-in the performance-of Ihe work fvr which th s - - permit is issued,I shal)not empiny any person in any manner 51NK � �- �CIiV 7ELt. O����p� 'so-as to become subject to ihe Workers'Compensation Laws. oiSF�WnS�teR ✓! I _ � ,'CONTRACTOR - f � � Date �ApDlicant � � � �: d C�O'4FS WASHER , --�' ����--� ��� � - ADDRESS ��j��s ;� � -.. .�NOiiCf 1C�APFLlCR,lT�. If, ca£ter mak�5 th-s Certific�re of '.�. --�-- , _� _ T�`•� �'�7LL�Q.� ,,.. � -' � fxemption, you should became subiect to�the WorkP�' SWihAMING FOOL RECEPTOR • ,... � - •.-npensation provisions of the Louor Code,you must farth .,�,. ���- ��� -��— -C�7Y� iE1-NO.q�`�,�f „'r �t�WN SPRSNKtER SYSiEM � :nc �omply wifh sucF provisions or 'his permif shall be S7ATE �/ .�J L�G � l . ,=�,�: � deemed*wvoked. - � WATE�HEATEI2 ! , !ICENSE NO. 1��j� C�ASS .r��� � � _ ��LICeN5E4 C�N7RAGTORS DfG!ARRTtON� - ��� — &y [�tSTRt MO. . `PROCfS�FD BY ?"' . GASSYSTFM OUTLEIS � I hereby affir�m th�t I om licensed�nder peovisians of Chaoter 9 - � � � '° - � .- �.{commenc.2g wiih SecYiun 7R�0)of 6ivision 3 of ihe 8�+sinees OUi�F50VER � ��'��r��r�� ��_j�_ �.-and Professiens�Code;and my license is�in tuii force and e`f=_U 5 Pe�SYS;Ehh "�5 ,{ ,q�� ---i-�- ��=wAL������ v,�c�o�►�Eor� ;���, � �-.l.icense Number_�✓ Lic Class�� � .�— __' DATE ����. fp F!NAL �$,�� � . y �r$ � �'�e7� — -- 8Y . .. ���Contractor �"^"� [ iloie { ¢�' �,� ❑ tx.: . I om exempi va r Sec.� ��� � B.&P.C.Por this reoson�_::— Plon check fee � 7 ;- A�=;� � � -- _._._...__�Uore:. PLUMBING FER(JdT ISSU{NG FEF$ ° - . �� '-�:! � D ^ . „ -.. :Signaiur�----' -- ----- � . . �:��. *.` .-�'s�'. {i � � - TOTAi FEE aG' ' :� 7 �- - - Plan check applicanl - ��:�'`� ' ,'� � ' . 51NGiE FANiiLY � - . ��-� j _ -� � HOME OWNER-8111LDER DECLRRATION �� iVame �� ^ � ,.� � 1 here6y affirm that I am exempt frem ihe Coniracto%;ticense � � . . � � :- - �v for the fotiowing reason (Section 7031.5, Business and �� Addre.s � � � � e� � = fesslor,s Code): - - �ity Tel.No. � - �-""'''. � . . �. 1,�s owner of ihe property,wi�l do Ihe work and Ihe _. ���. j shucrure is not intended or offered`or sale (Section . �� � - � 7 �� 7044,Business and Proressions Code). � - � - � `'`� CONSTRUC710N LENDiNG AG€NCY � � -- - � i_ . . . . .. . . . �' ' � I hereby oftirm thai there is a construaiun lending ogen,y{er = � -. _ � _ the performance o4 the work for which this permit is issued. _ � . - � p . (Sec 3097,Civ.C.). � - '� � ,1�. ! �� �- i.ender's Name_— � . �- � � - -.tender's Address - - - - � �-- � t certify that I hove�ead thls appfica�ion-ond state that ihe - � �-� �� above information is correct.i agree to comply with all County ` - � � �. ; �-�- '-�-ordinances and State laws regulating Plwnbing,ond hereby � ��� . - � �` �(-::� _ au� orize representatives of this County ta enter uoor ihe,` � � , � `..�.�:� � o mei oned properry f r�nspection purposes. S�E REVERSE POR EXPLANRTORY LANGUAGE � ' + -.�-�' � r�-�"'�'� - . . � � � _ Si ature of Permitle-----l��� �ate � . - #. . , . .. . q�, # ': \ . �� Q v � y'� G O c➢/> � C,9 A _.,�-`� - -n -' �, -�. S, m =e��� � �o ...._..,_ 2 ;. J+ a' ` s 2 r' ➢ �' . . �Zy 6 T. < � Z q� ' Gf � �c o - N C. Cl L��"q. , sp F x' `Z X ➢ 2 "``r � 'v� s \O G G7 � . �+ '� "� m � O ��`� U' T ` ; o �` , ��'+ . , � . , �, ' `��m ° R ` , � 1 '�; c \ 1 g 1 � '� �N m � ' ` ��`o �. 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