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;� v . : � s � . ^..� ,. ,.:-.-«-»�_ ... a�.. •.s . �WOfL�SEF�YS'''Cb�f�A`T�`��Y'�'C.'� �` .�� � � W,iw�: a � ��.« a��-�.�-:w `' ..:�;�a-��-:,��. ,. �swe6YA /� �y r y� "'"�/'� C heieby at`}lrm 't�t Y'�,ave�s certi4icate��ns�t�'o se]f ., ce air'jz=eo'j /yg��L1�A 1 ��N �_I�0.,J L � in&ure or����LfiCa1e of Woxkars Compensation Insuiance or " �� " ' `� • . .. . a _.. � � ..,w ,� �. , ...�.-_ � . a ce�,t��ied'oop�y tfibieoi'(5e`.'�6f�'liab C.) .. _ ��" ' °: � . j� ,����yr , ?'�v�o `G c mpan , ^ � � • COU�I'T�b�d:(5��i�(i�l.�"S "`�,� „'B'",111pL��'A��$�FF_�_�,' �" �;:� , , , _. . _ .. .. __�,� � ,�� . a.� � Y ,. . , . { ❑ Cert�fieti copY�s herebY�urnrs}ie .� . . . .: �. � .. �. . � �� ����.,...... S F,OR APPLi�J{pYTYb F1'L�C.1N('6R7P1`'�'�'i`� ' BUII,DING' „ . . .; ,�.� _ Cerftfied copy is fQed��ii%`i{'�tfie eounty buttd�ngih peckion � NUMBER FIXTURE bR;;lYEfv1 � • FEE "' ADDRE$S���� Q'�� y department � i7 � WATEFt`CLOS�T "� �t�.. LOCAUTV" - Date�Applicant � BQ�<� �{..�7 `` `�"�'` �`'"'y'� "�r�'g+t Bq7HTTl6 �C..fj�. CRDSSST:� c�RrixY�ar�'6'�=��i�4`���i�`�ii"�� :� CO�vf'P�FI'S'�A'1'7{�Iv IP�S��� .. � SNOW£R: :. � OWNER � ('rll�s sec}jon nee(�not be�plet��l��ttle Woilc�,riv0�'vC� � LAVAT(71iY MAIL by the;permtt ie;�_for one h�ndred dollazs�$100'�or less} . siNK " '� �'"�p"Aooaes5� ` ��„r� > � a z� �3 .�. � ./��-C7 CITV - ��TEL.Nq�—y��,!'� C5 . . I eertiPy thaY m tkie performance p{Yhe 3vork foc`wliich 2his � Df$HWASH�Ii� '' ' � ' - � perfiTtt ls issu�d T gI1a1(not empioy any person in am'm9ni�er �� �- .�. . - T-d1.�-p SO"2S fo become gub7ect to the VVoxkeF� Compensahon Laws ' ��� � -.-�� , � / � �� - ONTRACTOR' � � �4 � . ., .� CLOTHES W�1�'1=1EFf"� ' �- A�OIiESS �` v .'�'f(j �,-,.�-�L�z �� ,�'" U Date �� APPlicant ; ' . . � . . . � ,�.. .y . �, ,. .: � . SWtMM�IN�`i Pf7't5'C4Fi�`Z"�`PY�"7'�""� �. NO'f'XC��'T'(�"'�P`�'L�A af er Rla�ng t as C ificafe of � � - � J Exem [ion � Q �f � CITY � TE4.NO. �.s p you,should b,ecom subect to �Tfre VP�orkera' - �AWNSp�RIMK�'ER"SiBYE� '� �"��/ '+� Compertsatlon prov'is�ons of the Labor Code,yoa must forth � �STATE ��� y ry LIC � w�th �qmply w�th'such provisiorrg or,4�is permit sfiall�e �� WATER'NEA"`tEli'""� �.LICENSEN�6." �/ ���rrc� "CLQSS, � — deemed:S�'aked ` - . GfCSSYSTENt OUTLET$�� �15TR1CTFf0. �- � - PROCESSED$V �"" �I�EI�SEb C'6N'�fli��'t�"�'t��S""A��i��' ""m ' e�-+'' � � � ;�sar,� ,s�y,w,�� k,,.� . OUTLE7$�O ER T here6y°affum that"T am licensed under�qv�sAons of Chaptee . 5,PEA 5YSTEM � � - 9(comm�nCmp witfi Sect�dn 7bOb)of piu�s�on 3 of`1he Busi . � FINA� � � - n�ss and i+rofess�ons Cade and`roy Lcense is in fuli�ce a`n� pq7e L 5���-��;`� VALI DAT10N effece ' i � y� ' � LicenselVum"Gec 1�+'-Lw.Clae@�� `�.�� . -EINAL . . .. . . �.�.. �" - . ..��. . �� �. q. i � ����;�/ : ... BY .... . . . . Contractor � Date � � � � � � � � . . ,� �.� ...,_ .., �,r . � . . _,:. � ❑.. .:.. ... . :. . .� . ��� . .-. ..�, . ._ _. . . . . I am�e�empt f�nsmg requlrements as-�I am a � P1811 Ch�Ck f08 . . . � licensed aKch�tect or a teg�stered�pro�ssional�ettgirte'e'C ��� ��� � � � '� � . � � � � �ctipg in my pcofesaxbnal'capac"tify($ectio`n Y-p3`1 $us - PLUM91No f��,T�,K/Ii#"'('S'S�Il"P5G"F�E'�`�."..�°"�"'"' tf"7j-� � , . mess art�ProFessions Code)� ' �� � � � � � + � .��. �` �. t S �.- TOTAL FE� � - � � - Lm or Iteg T�o �.: � Date �r Pian cMeck appi,icant � � =�j'79�R. HbTti[F�'°v'�."�Q"�l'SS`�� . �a#w"a" Name . . . . . . . . . , . � i � $ �� - . . . �o- a�a�e ro m;^ . +�. ::�«*Ay+ Aaaress�� ?.�.•a 6�J{) I hereby aCl'um thzt I am"e"xe�pt"�'io�i`t'�ie �"`oa"$xacto,cs � . - License Law for the"�fo�oiving reaso'tY(�ec.Yion�3!`,5�;l�usi-~t� City �. Tel.No. � - Ites9'�nd��rotessron's Code). -. � � � � - .. - , . � a s 3�.� ., {7'a1. � I,as�nwner oPythe¢coperty am exclusively contiactmg � � " � ' �`. � . �. �.._. „ �..� with I�censed contractors�to conetruct ihe project � � � ' ' � � � � � -- (Seciion 7044 Busmes�C 2nd�:Pre�fessio�s�C�ode"'j'"'�� � .-`. .. �.. ..:;, .,:. _�. .., . ,. , - ., ,,. ,. . ..,. .. - � t ..' Cb"1'VSSRTJ`C`1`�S+I'`LE�S�'hICU�A�'C�Y' ��- �� �.' '".,"` .,�° �,. �+ � ,�. �+- �.�..r�,�. �. .a.. -�� Q��' ."..,�,,.,�:��. ' �' ...,, ..._. ,. „u, ...� .... �._ .. ..... ,. ,.. . . � _ , . .. _C . .,,. ,.... ,'� e'1 u I hereby affirm t�i�'at thera is a eonstr�ahon lendang�agency � for'tfie . .. _ ...: . . .._,. . .. . . .,. ..., . _,�... .,. , . ,_. ._ _ . .: _ _._.. ..,.. ,. ., ,. _ .. .. a� parf�ormance ot�f�ie w�ork for�vf�tch ttus par,mit is, _ � � �� ` - tLendersec 3'b49 Crv C}. . "`. ` . �. : .. � . . ". . . xSSue (S �Name � '-..' " ,�.__:_� w. �-.,,,,��. .,.�.,..�.e�. ,. ,... �...,. ,.,. .-...�.�,. �.enders"AcY�ress `` �" '':`-�a �. =. �... .w.; •r ._ � � I certi'�'y that`"�fiave'read this app7ication an�state th�et��he "°�°`�' '��"`�"'�'�`�"`'":� �"„""'.";. ��"".`�� ��'��z.� '�'`.�. . "'-P"„ . ." . . ' above mformahon is corr0ct I a�nee to comply wit�a31 C''ounty ` � � � �� "' '�' . . . - . ` > ..... �.a.. ,.. ,_;,.. .... . �SEE�R�V�7F�"�"F"tfTF"�`�'�'w`t�f'.4"�''�Y2'�"�"t����, � �.�'.""'"„` � brdir��nces and State taws regulatang`��"umKmg;'and�iere5�y'� �� . �e ..� .., ;�, aut6onze,representa'iiyes oP thig Countq��pq en4cr upan the � �� � �� � � �- � . . �. ,_ ' - al�ove menhoned praperty for mspeMion purposes �(1 y - ��� . � ;. �.. � . .� �"�-�'�� �. � �-e G�! ....+,5:rmr �.w.��r.�.a.,.:.�s,�w+r�.z»w�;rwr�.-aw:zr--.�,«.as.�.w.�.�+,ew.��w. a«sw+::...�.aw,�.�.w�,��.-r��ws..��.�w�.»,„..apa�.<.,..�.,..'-:,�k � Signature of permittee Date "' '� " " �" ' " ' `� � ' �����-� _ _ _ �'� "� � " -.�� :=�_ _ _��-._,.��" �� :..'- �INSPECT6F�'S(Tf x' �v �..«.�,w�r u->.. ... .. �z bW�I���'��..IbER���L��.�I`TQN�- � ..t�. ..�.... ..,, ,; _ . ., . , :. �,� . _P.PPROVALS�° RTE SPE ,RSSIGNAT�1FiE .:: ,. ,_....: ,u..«,,.,,.,.�...+-,. »,.e, . .' .a.u„��;�m.�b�on:a�u��' ����'�hf.aaa�8�zr,�+.a�,+,.,t�u '—__ —__ ...^ . ... . ., . _ ..-. uNo€.Rs�ABwaRK'- '<.' :�;_ .� �. � � ,. ;�.rr - ::��.-�. s-° . � . _:Iherebyaffirmxhat��lamexempt.fiomtheCqntsac�or°s., _..,.e': .� RouGti P�uMei��..��......:. .. . � .. . �".."'"`" ".'*`°°'".'""�'"""""°"""'""" ,""�"""`°"�`:^'�`'"^""" �License La�w��fos:the k'ollowing rteason(5ection�703I.'5,.. GAS`PiPrtN,s -� � �- " .°. �' -.� Busineas und-ProPessions CodeJ: Any ciey or'Couhty- . .5 �..:. <��:. ..�, s. s, ��, x. ; ,. . . . . „ . - ` �- � r ,�,,..� �^�..�.v� ,sR�w; � .._ �n-.m.�. ...�,R..A .. 'P�- °�" CDhich re u�res a perihie ta epnstruct, alter,�dmprove, �.. :- . _.. . ... - cAs.�„Enir . r. - 9 , . , .. �r deas�oli.�h,or repair aay structure,�pnor to�it,a��.����suqnep. Hor�?�iR RHEAr�R :�- "`�" � '" " m7sm regulres`�ihe appiicant jor.�speh permet ia ,¢ite�a �un+ietnfG F�x'F`t�a�5 � "� ' ' `� ' .' :�. ���r -w � '�""" ��' '"""signed seatemenr thar�8e is kc�nsed pur,suant�ro the `;�- .., ,_�, .,.. �� ^,.��y"°,�"�,.p .{:, �� ,.:`s^'�^x ��'�""3`"�"�".""""�r.sions of�the Con�rpctor's License Luw(GffaPJer 9 �as�i'�sT - �` - _ , � , - .�/comineneang wit& 5ection 7PPOj oj Dey�sron��.��pj the� . _. '_ ._. . . . .. .. ' . .,_� _, -� uT�Lr;n'C4�$�9T16I,Eo . � � ...- .,..� . , ` � �, ��� ��..: `"`" ""'"°'.'°`"`"'�`�°" �' °"`"Biesen"eS5'and�-Professions Code) or that 3re;is exgnapt ;^- - � �' � �- : i ���� � �`� , h�erefrom and tYe baats for ahe alleged exempeion.kny. F���� ,:,,�� � ��� � � `��io�tioir of SecY�n`7p31.5 by any,app(icont'Jo'r a permit.. , � smb�ecis the upplicpat to a civil pena?1y of not more rhan. �;m:� ' � ' x "`�"�`�"�a': fi've fiz�redredlloiXars"($500} =—"�--�- � t-�� w- '� � ', ❑i as oaner of TNe�pxoperty w�il do the wock,and A STRIP.L '" '. � '� ��. � � 4„�.�..<.w_,.a4 r .._,.... . . IN 8;E AFRAOV�G.L . . .. � ..��. 9ssr..� .�. M,..n.%.�J_�.,-.-,.,_.._.,..............-..-�-o-=�,,.-,-.�,.�.-x .- . � �- 3ec. �7044� Business�an ed or offecea forsa[e.,,. .:, ^.,X i ( -.: Y6esYrucate.-�sno intend Code�' The C tt , '� � ' � '" � �»� o an owner� - _ Profes,�ro�i.f .. __ _ .. _ . . _ ; . ._... � s '�"�`� 41'�" "� `f"�ct!{re Pie`ense�aw r�oes not dAD�l t � oP:�.. �� �.. .,,,. .. , �.�� . - ., �.. � �roperty who b.ralrla or irqproves�hereon and who does a�::� ��. �' ,,_ .� ��; ._ . .-�-� - ., �. . ,r .,,._ ... _z.::.� "wns.,.-, •��,�,..•. '�,�rsuck wo��'htrr,isel`f�pr'ovided�t�iat.such im�rove»iei�'ts�.�. %� -��. �� - -� -�� ��� - �� . �:. pre not entended or offered far.sale. lf,,however,�the�� i,r - - , �� _.��.� . .. �_ ._ �� . .,..., .� .. , _ �.. ........ -,-�«�a���-a..,..,�� �.�+����p p��saleae�'Qwda�a�6u Id tor�mF o�e fo��he� � - .,�,.�a�� ,.,,z...P"p - �: �.,��'�a 4 ��:,.r�'�^+,�a�.�a.i��s�¢ - : ��, :... , ,. .. ..:.. .,.,,,,... .,.�.�--�:: .��.�,. ; �._ = ' I am e`�einp�unde'r�ec . a- _ ;— � . .�,�� - - — "`�" `�`„"`B&P;C:,for thts reason , � �.,��,.�„�.� ,v���. �.,�.: �, �.s-,,w._ _.. .. _ . . . �,�� .�����» �-----r- �.. ���. �-„��. � „ .�.,,, ,.: x.. � .. . . ._ . . .. 3 ,-. . � .< < .., . �_ :�. .. P _ -._' . .�.. . . - , :� -:%� . ..:. , .e �- ._ .. .,-. '�ete .,; -; � � � = _�m :�,:-.,.,�.�. .�..�,���,.�.�, ��r.,.�� ... . � �.�. .,. „..�:,� x,. ..,:. . � � . . , Owner �-,,.,-�:�..-�..� ,.. , , .. ��� o- ��� ��� �� � � . .. ... K ,. s.,. ...., n._ .w,W �' „� ,..;a. .'�,w�.�:.. k .�d�N� e da '�%,�a .0.�ce..r:qt,{-ikT1�,1G ,_r3r.�i ». ' - �4NSPEC?Ok S NOSES � . .' .. �•.,� •' -� y. ; . .. . , � ,....,,. . ,..M�,:����� „ ,,�„�: ,��.a�z��e����a°a . ��` " w�a�q,������ �$�. 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