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HomeMy WebLinkAbout0807A (4) �4VORKER5-COh1PENSATION DE��.AtYATYON � �sseer�w � p �g p�q ry�y�--,y �y � �'p ���/. �y T � I hereby a}�firm that T`�iave a cett�f�cate�ol copsen'f fa�eSf� ^'�es ei�('¢-so� /"1 P r��,4 PS�I V!V �o� r�,�M 9�J�tl V P�!'C���I insure,qr a ceti��eatea#Workers`�CompensahoztTnsu,r`az��e,ar �� '�� � "` � ` ' "�' '"'" � � � ' � ,.. . ,.. ,.. �. . a ce"fi�ed opY thei o���e'��`�$ a�i�C.)., .� . � . - � . � . .� . . ., . .. c J� lr.�rr�� Cl3liN'TY QF,t�Q,S AN,GE4��,_ �.,��1� G AI�.¢SfAFEpTI? ^_, ��y�:� ,.:- CompanY . . . �. ... ��-'�i. !. / � . . _. . _.....,_ ❑ .;_ n . .� , .- , .. , . . ,:� : . . � Cert�fiedcopy�ishereUyfurn�shed � FOkiYPPLICANTTOF)LLIN(PR(NTORTYPE) .BVILDtNG-� y� / ` � � � ,.,. ,.:�,�....,- .. . .� . .ADDflESS CY!-�4 21 .. Ceifified copy is fited with the coqnty bujldi¢g inspeclion' � NUMBER FIXTURE OR I7EM • � FEE � „departmeR• F � 40CALI7Y- ` � ��� ����� ��� WATER-.CLOSET �+) IYaie„�L�,.ApPixcant:. _ T_ .. , ._ �-NEAREST .- ... :.._ . . .._. _.:: � -�� BATH T:UB � GRq$SST.� , , :_ �H1FTaT'ICA�`�¢F"EX$�iP �O,N FJ�bM WOKT�RS �� � ` -" Ci3h?15�SA4TTO�T�SS�2t1NC� �� ' - SHOWEP ..� � OWNER ' � �...�c�.+-�... ('Th�s sectton ne"e"�'riof`6e completed`�'iP�the wox�'invplyed,. -.� �'� �AVA70EtV. � - �/�� P�� � aa.17RESS��� ��J � �u-�-� �� by the;pexmlt �s�for one handxed do(lazs ($100)�tess) -- � -� -� ' � y�� a �� SI N"K r � r �"s � � „ � : ! ,� Ai-ct �cirv �' vi/ T��.roa:�'a-9= /7o C� � I ceet�fy that m flie perlormgrrce o5 t��worh for w�i)cH tn;tg p�SHWASHER - ' �� A� � U . per�ittit is�sued I ghall noJ ex�Sploy an5 pelsun man}�-nrtapner "r�� . ' � � `CONTqACTOR ��_����,_���^�� �?� .� so aB to become sub7ect ta the Wox'kers Compensation Laws - CLOT�ES WASHER_. � ,�.p-�u-1 /� � /� O. 6ate ` �.pplicaRt � �. ' � � - ,.. . � ADORESS -y r s�t Y � �� �� ��..7 c✓�✓�� L=•e;2-��L-/�1 �'/" ,. � 4�� . SWIMM�NG POdL RECEPTO,R�;. � U� N2jT�'�6F�T'�APl��7C'At7'I�,Ff�`af�er ma7cing fhis'Ce�i'�Ycafe o�' - . . .GTY ��TEL NO'�o2.�jP/ �� Lx�rtption ypu 'should �ecome su6�eGt to the 1l�orkers � - LAWN SFRiNKCER��5Y5YEM'��� -� ���� � ��� y� STATE' �✓/� �LIC. J�J� �� Compensatttin p�o�hs�ons of tlie�a6or Code �ou mu'st�forf'h �� � � uGENSE nt0. ��. ,��v0 ���:�OLASS 4�- � wttfi comply �nnth� such provisions or th�s permft shait�ie � WA7Efi NEATER . i G�' � ��� ��- � deem d revo ed � � � - � � DISTRICT NO. � PflOCESSEp BY �r: .� � - . . y+-; G'6.SSYSYEhI'I �J OVTLETS�-� i � �' � ��omLr��Ns3�tS����xnc�53��xsbE��.nt��.�'ror� ouTL�rsev�R _ � � I herEby a#���rm thaY T am licen�S under prorzsions of�7fiaptet � 5 PER$Y5?`�lyl . - - � � mgncm�v�`th Sectton'Y006)ofiTSivis�on 3 of'(he'Bus� � . � � .. . `FiN'4� � VALfDATfON ness'2nd"C�iofessions Co� and"'my Lcense�is xn futl fqroe arnd _� DATE ���.,��-� , . _ . . . � ...� . ., ., .., ._ .. .. ,- �`�. }� !� ,f / �' FINAL �.�.. ��. effect /"} ' . . , „ , . License N�mber"', "�✓�y�� Lic Class�� ""'---.r-� ,,. „ � � � gY - � . r � ..' . / . . . . . . .. Contracfor ��� Date.���� �. - � - ��� : � ;� I'�am exempt`from the licensing reqwcements as�I am a � Plan C1i2Ck'f26 ' � � - � � - � licensed architect or a registered�.p4ofessional,:engineer . .,pWM61tYGPEBMtTt5SUiNG,FEE$,� � � T��. � ,._,, �w.,, ,: . . � achng in itty'��professional�capaaty�(SecUon 9Q'51,`Bus- ,,,, , . . `� �-� � .S - ittess and Pr0£essions Code) .� 7[STAL FEE" .�'. �;��J. � � � - ;^ T ; r , ? . . . , L�c or Reg No � ,�� Dale ' *� Ptan check applicant:- � . . , . ... ..�.,. ✓ 1 � . '4:Y , _,.. � � ' � � . . . . - . . - . �.��FYQME O�Nb'R BTJ,tiDER CYEZ."Y,'�,ARl�TTON � Name . . . ; vz , .� , �. ._ . . I hereby afPrm ffiaF I am ezex[tp"i from thc Coni`nactox s �' Addrass_ � . Lroense Law for tha foRow�ng_season (SecTion�7031.'S,gusi �� Cicy � �� .TeY.Nv.� �� � � � � �-��8�'��� � � - ness�artd�o�ess�ons Code) .. ,. ..:,....... ....::�,......_ .:�!.. ., �_.�.:,..._ _ -:,-, �1�o m e e���n' - � I,as owner of,ihe proparty atu exctps�velY con'txactmg � � � � � . � � with Lcense8,�confractors to cotxstr`uct tke �-"p"r`o7ect �� � . � � � ��o.a.�]`],.S L'. (§ection 7b43,.Buslqess and Professione Lsode) � . -� � - ; i ��v ��-�y - CQN5TRUC,�'ION�,$,NDTNG_A,..GEt7GY - •b y' t�u „ I hexeby aFfirm��iat the�`��"fs'a ro`i�s£ruc{onlending`egeney" - � �i��"��}`,_'��j��.- �� � �. .., _ R�rm1Y ia .'. , ` . .. � , _.. , � r� _. , ussued�Se,c��fU9'f�C4v �f�4he'svork fos wl��ch thra � ` - _ � ., . ,; s� - Y 3 .. ,� Lender's Name '. �. � �� ,-�� t� 5a � 'i �, �` � s.� � �' � r # i - ,. , . i aY ��: tl 7 �. ,� Lender'e A�slsess � _ , ' � " ' [certif� .. M . . � � : � : ' T _ ` � �� A ..J` � ..: a..,.- � . �, . ... . . . ., _ . .. _. y t}"iak 1 have r�ad thvs applicat�on'and state that flie . . . ..., � .�<v�_,-m,.�. � ..,.._ . _...t ,. ..._- „. > . _.. ,. ,-,.. above�nformattod ia cqzract I agrea Yv comply w�tC�aT'�County 3E KEI�ERBE FOR EXNLANqTC)R�C LANGIIA�E � ocdinances and 5(ate LaV�regulatmg Plymbmg an�.,hereby � . � � � - � � _.�t ,..n, ._... �,.�.. ..., .._ . .,�, .,_.,.,.._, ..M- .<v.. �,.. ,..�-,.d,,...._ .... .�. . . . .�. . ._.. ... ... .. authonze represe[itattves oP thAs County"`to enier'U�oai the . .._.x .,�.._�. .__�..�. .,-. .., '� .� :.. .. a ve-mentioned pro erty far'inspectidR PurpoSBs, - � �� ���''�� 4 6. . � . .. . � ��.Signature of Permiitee Date - � . � � � q ... ,,.fs �.�:.,r g , ;,,�,. i .. .... . - . . -. ,: . ..... . .. . ...... � .. .. .. -���iNSPEGTOR`S NOTES hy� 0, 7� � � APPRbV0.LS� UA�� �N..� t RSSIGNAl1�RE� ....•�..�•._ � ,_... �w�?Y�.B�ILD�IL.Q'v�.''-'�d���ON,. . . .. UN�ER SLAB WORK 4�9 � - � ` �� � � ROUGH PLUMBING ,.. ��? � � f.� ,�V. �� tl�heceby affixrn t6a1 S am exempt�ft�m tlie i;oqtcact9r's�� i,ieeise Law�fox the PoYFowing rea5on j5ection�70�1.3, cAs PiauvG�, �� � ,-; y �, `* : $usiness and�Pra essJpns CedeJ: Any cuy or couYtty ca5,',��F,NY � - ,� -„ . .;; � - wh[sh require.s a permiG�tn covsstruc a7ter,i»tpro'�Q, '""� � � � � - � �� demolish,ar�re arr an 'strucrure, rror zo its�.issteattce, HOT :ATEFTHEATEFi � ' ,.� '-� - ':.`� .._.� :" . . .. __ __.:.:, __. . . P Y P ---2�-- ' -�� .;� „, ; , . ;_, ' "- ��� . � � �� -� . - adso requires the applicant jor such permit to j{fe a��� PWhfj6IiVG FiXTkiRES �.." � �: •� .. 1 . . ..� . . . . ���� ' '" �� � ';signed atafemenr that-he is licensed Aursuarzz.;to the �a�esr : ` provdsiona oj'tb�e Conardctor's License Luw�ChaFaer�4 . . ,-' - '�"""°'"."''� - '`," (zomrftehcing.':'with�5ectiors 7Q00)�Gf Dlvision",�'bf fhe� .:. .�. , _..-,.;, -<f,m. �a .,.....-,,.;. _.v r�,�,. UTIL��.��CC}iWOTIF�f3 ... ,.: ,':_"_'-""y� . . ' ,.,: . , _._��___.�.. ... _ ... .�,,_ . . - :- < "-.�.._. _. . ., ...., _.v. ._ :_. ::. . ° �� . �Bustness ¢nd Professions �odeJ o.>-ahat he is exempr. . .�:. 4,,.; ..� �.::. �'� �„.':. . -:' �� '-•-� '"� ` � tharefrom.�and thg basis�for the al/egeb exemption.,iny.. FiNA� . . '�,°se�>t. aes`��.:� � -` - .�.. .� .. - ..- ..� . - . ,,_ :�' � �.. . ��niolnuonajSeetion7031�.�6Yanydpplrcantforapermir e �. . �:.� �.,< ��::+.� `. :y.'�. ,-,. .`,, '.:� - ,,. '. , � : . �su5jecfis She aPPlicant to a crvil penalty of not.tnore dhan '.'` .�; �" ' � . ; jivn hundred��dollars($SOOJ.: �. . . �. � . INbUSTRIqC� ��. - .. � WAS'�E APpRO�L,4k � - - -� O I,as owpet of the propecfy-.ailt do;he'work,and- � � ���t�.e'shrucEure�is taot intei�dcd or o£fered iox saie:-� �t. .. �.; , �; . , . _ * ..,::. ..A . , : . .,._ . . .�. , -:_ . , ..;. � . �,. '.-:_ ',- ` . �_ .,, . �r ._ . .�: ...-., ., �` .��.-5� , . O Li�ae�Lawa ce�r�otSaPPIYCoo an ownerQaf: = fSea. 7 , , , _, . , '"�:� '�� rrucror's , . �_ �. _....__ �_ ,_.. .�.a . „� , � . � , � ,.. , ,.. , ,,_ .. . . , �-- . property;whp.hua7ds o'r,im roves thereore,and„wha:'sioes . '< . " ' . � .. � ....��� , . .:-.. .. . �-,.-- -...,. . , 'such work�himsetf.Prnvided.thpt.�,such rmprovemenrs , ;� . _ are not dutended or.offered for��.sade. Ij, however,�the �_�, . ... ,�,-..>,,�, ,.,.,. �..x.,�. . . , ��� � ,'. �� ���� . ��. � .,._. �� _.�. . .:... . ._.._-.. _.-_ ;. . -- �pPfe ioqr.�Yhe r nvwner-�tde�twe1Z�have Q l e�burden hu , .;, , . ... . .�..._ . : .ce+ . .n �. ..� � _ r . .. . . - - -. ...- - = . --- .- .. • . .�' ... . .. . .of,pravfng,cNat he did�.not build or irqprove�jor the . � " _ . .. Pa4!'AOse oj'stile.) . � �,.,; , �. . -.� . . ; .,� .:. :t.. ��-. < � ... - � `- . -'` --- � ' - . . .. -. - . .. .�, , .�:, - . � �.._ �. � ' ' �� �'I am exempi u�der'�5ec. . �� `' ., :.. _ ,, . _,. __ , . s , B&P.C:fur tl�as,reason .,.. , ,. . ; � -: ' Bate _ _ s , ::: ��.. :.' . . � ��. .�� �..:' .', .__...: .._.. - �� O�vmer- , r,�.. � � - . _.. .._.. .-,_ _,,;.. �.__ .: M_.,.c. . ......s.... „ _ __.., ..,,_a.�,..m, � ... :.�. ._ �_�.. � ,_......�_ _. � iNSPECTOR'SNOTES �- � ` . ^��� . ..�.:� �. ::.� '_... . ��.�. . ..._.a.�e��..�..m..�.'..'... Y .. . .--. , .:. � . .. . .. . ,. Yi