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HomeMy WebLinkAbout0975A �.� •' =.�- �-�"-�"� �:�z �� -� F � � t� �e� �#..,C-�:�`� ��i w��� �A""' ,i"'�����A���-�( . .. �.-,.._., 4� ��M/QRK�RS`iCQMPEf�SP,T10N��ECIARATION b. s.d a�.:� ��s�.�;��-�°.�����"L4A��-�,�F.�V����,lY�4R��PC,R�IGS�T V`here6y�affirm tkat I`have'q•�certificate�,of-consent.;to seit�r��76A667n F�'� � - - °,:. _ �� � '- - ?'� ': ^3`-- s �_", �� insure,-:or.a cerNficate of Workers'Compensation InsVra�+ce "•-��CE 8V(REV�iOlsT) * � � rt > .: �� �' � � ��� � � '�a'{ � *� . �''� � � or a cerHfie4dwc�ap��j!t�he�/reof(Sec.3800,l b;'C.) a s` .. . -�CO��IttTY.'OF,lOS"ANfa`�lES:�_ ,. � y_BUILDING�AND SAFE_Y p'' �'"k ::� ��"'�:, �' .,... ��,-:` Poi�cy4,NoQ�`_�L-Company f!� � —��,�F.' rt �.r.�., F� �� � p.:a�.x �• _ j,�� � � ����..�� ��,..#,.:: y� �,-f Ce�lified topy'is heteby fumishe . BUIL�ING�-- `j� � �f , ..� _. � -�� � �� : '� � FOR APPLICANT TO FIL�IN(PRiNT 6R TYPE)= �.-�; ADDRE55 -� B a ��-* � �- :Certtfied�eopy-s�f4lec�wxththe�co�inipbuildmg.>Inspec � � - -- -� � -. ... _ . .. --'. ,;.�.�.afiort.d ar.tnienf�. NUMBER� - �-FIXTURE-0R ITEM. . (� �-FE£ - �,_.,g�r ��.; � . eP t . ;���..b-��'�`?Y-#._�� �,f r, -�ss.�s. �� � . LQCRIITY �.�''�'�; � , _._ ___� . �� WA�ekCidSeT - - � - .�� � '' Date� �-.�AppiicanY �i `� rs �._ ��- �. _ ..r, -NEA(TtST `.� .;� +c,� , _� � + ��CRO''aS ST - ` f � .CERTtFlCA7E.OF EX£A4�SFQI�G f,R4Rh:`�J KERt �" "�' , � BAm tUH i� .� ���"'... �"'^""(_'O1�A'PEt�SSATtON"ttJSURki�fC�^" �w� .r'r��. _ ::�e N�,,� ;� € ,,,e,�":�OWNER � . . *e`' �� �� �;.� .__.�_ _e_. . . _ . _ _.- �d 7_�v,��.SHOWER :� > _ � _ ..:4,-r . :;.� -_ ' (T�ie secf�on ne�d-no4 be cainp(eted if the�work involv�d�by �� ' ` ' ' ��.Nq¢ � �" ' � �- -#be perm+f'r fOr ene hundred_dallars.(S10D)gr less.) y ,� LAVkTORY -- - �.:} .�� ---+ .A�DR€S� . � - ��`- E �.. _� � -, 1 cert�fy that irt the psrformnt4ce of fFe work fo wtiich th�s , , _e - permttisassuecl,4 sholt-nai-employ-any perso��n any_manner %�. � - S�Nr .— �i r 'Ciiv . iEC O.���.�� � �- � .. ---— . " . �. smarto�becemas�ks�ec-�7o-t1�e�=WoFkers'Compensa#�a[zLaws..- -�p(5HWF�SHER ��� ��--- ,�-^'-` �CnlJTRACTOR Y �- y �� � � �. � _ _ _ : _ __m:.__._./`e.�m �� �. /' � ' � b�te �� Applicant � � 1 CLOTh£5 WASNER � � �j� d� � �ADDBESS��LY}�i I � - �`.�`s'� -tiIOTICE TO APPLiCANT- If; after mokin� thr; Cer!ifico�e of -.� �------ � --.--_ -. � � F emption, you Shouid become sub�ec? to fhe Workers' S'J�MMINGPOOI.kECEPTOR � � ��TY. � � TfL.NO �^ �- & m ensatwn pra�isions of ihe Labo�Code, ou must forrh- �� �a����� � � , �. p Y - LAWN SPR�NKLER SYSTEM y ; ih �omaly wdh such provivons.or ihrs permrt shall be STATe y/' UC. /� / deemec�re4oked. � �� WATER HEATER ! ..^- lICcN�F i�0. €6ib' � C3A55 "�''��f% �� ? � - JCENSED COMRFlC70R$DECLAFATION � -- �� DIS?RiC PROCESSED RY �� } g � - � GASSYSIEM �CUTLETS . � � -"" � -1 herebp of(rm thnt!am licensed vnd�r prov�s�ons of Chapter 4 ___ j�,.�,7.yL,lyyN• ;im �: x _"�.._.. a..,t: g� -IC�mmenang w�tn 5ection 7000)o¢D vision 3 of`hs&isiness OU7!E{g QyER -- - � ---�nd Frofessions Code,and my(icense isin full fo ce and effect. 5 PER SYSTEM � �iNa,i �`.�,�„ V�RLfDATIt?N '� ` -�-- DATE "'�'� � �-L'censeN��mbe*_������ LicClass�� - �-_�� ' � . �a Gule�/��r9� �-� . ' BY AL ��Y� �,�,g '� -Contractor � ' � ��', � �am exempi uiider Sec�.._� � �� �..�❑. 8.8P.C.fo•this reason� - �:- Plan check fe2 _'._ �--~.. � , b : - �.�'i� i ' zi d` � � _,.._ Date: PIUMBIN6 PEh'INiT ISSUING FE£$ (a � � - �� � ° � � � �` l' � � - - -Signatur�_�._ � _�OTAL E€E � . - - - �. _�� !& ---- --"— " 1 t -, � � . _ �� Plc n check�pplicant ___ "_ J * 3 SINGLE FAMiLY � - � - HOME OWNER-BUIIDER UECLARATIOtJ � N��r�' - - - _ � � "t `� a : --._ v � '�he�eby atfirm thai I om ezempt from ihe Coniractor's License � Address - u f' v -� � �v ior ihe fo�lo�.ving renson (Section 709L5, Business and _ � � �- :�� � ��essiorsCodr}: City Tel.No. ' - �� � � � � 1,as owner of the praperry,K�il1 do The work and the �� - _ ' strudure is not intended or offered for sale (Section l . 7044,2vsines5 and�P*ofessinns Coc�e). �� � � _ ,S 'p CONSTRUCTiON L£N�MG AGENCY � � � u4 -� � . I hereby affirm ihat ihere is o censtrudion Iend�ny ayer y aor ` - . . - �� ' -ihe performance of the wo�k for v✓hich this permi�is issued : . - i -(Sec.3097,Civ.C.). � � � f-_.. . . . . � . � . . " � ;.- Lander's Name — - . � _ . - �� t Lender's Address___ ' � � . � j �� I cariify ifiat i have read fhis applimtion and state that rhe �� � - � � - . � above informqtion is correct.1 agree to mmply with�II County � �:. �_��, - ordinances and State laws regulutiny Plum6ing,and he eby � - - � . � aut' �e representatives o£ihis Couniy to enfer upon ihe , . . � .. a ove- iio d property?or inspection purposes. 1��� .. -. . _. ', f SfE ES€VERSEFOR EXPIANATORY IANGUAGE ' � � '� .�� �^.� �-,r�i6 '� . 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