Loading...
HomeMy WebLinkAbout0808A (4) '�:WbIFK�It��xC -,.; � �. .,. ;� ,. �..: , .. . ]6A8@7A /� ; �" �� �y _. I�iereby a�'firm�that [ havz a cert�ficate Af co�se�t to self � ce e�>fs aa� /y�������� - �nsure or�certi��ca�e ot Woikers �mpensation'Insuranra`o'r"` � ""``" 'ti�e copy ttiereof(Sec'3�00 Lab."C.) "" �v� . '� . � . , , ". � f% 3�G O 3 c/��' � ��,�"� COUlV`fV 6P C:i'�S ANGEl6S,, �Y� Ompany � ,� ,µ:��.�� PE _ .. o�� .,I�.�` � B�fi Ll�f i11G`"�i1�'� _�,n.��'�- , ..._r_._ ..w� ..�..,..,.. ��;, ,�....�. . _�; .�...� _.,. � ° ,-• .. . Certif�ed copv�s herebg furmshed .� '" � ' ' �` ' �.� ��j �� FQ R APp'L I"CAfST TO``F��."'�'1 j��'t'�'P�t'il�i`�� ` _. .�ertified copy vs F1ed with t c9unt buiidin ��� � � � � � BVILDIN�" ' -` ��-- - . • "''.^ � .Y 8�nsp tio NUMBER FFXTURE'Of#"Y Aq"`""�"'�` • �fe artmen ,��y,,,�� - - FE . ADDRES$� 1�ate7�Appl�can� C.T' :� WATER'CIOSET '�-� ,.,: .LOCALiTV�iYl. ' : � :. „„-� �_ . : . �,� 0^,t�, .>�t G E CERyI`TF`�'L�A'I�"`O E � i p . . � 6ATH TC7�B �� ". MEAREST� . cYSi4iI��r.rsA"�`o � � �� , eAd caoss sr;: � _...:� � BHOW�I�i ��J� OWfVER '� . . . ' �. � �„� a � �- � �"Y:' �e.�--� (1"h�s"sect�on nee¢not be c6mpleted�f tfie wox�C��mvolyed �AvqTOR'�" ��: �,qq�L �Y fhe pexffitt �s�por o�e hund�� dollars ($1l10��px less.) -q6oRES;'� ��t, `� } . i4 StNK � � :,�, '�€�,`„ � f.t.rJ I certify that ir���e performance af tk��'xbYk for wh�ch this" " �� � perm�t.�s�ss�ed I�shall not elnploy any persdn in'arj�q manner � DISHPYqSH'gp �- _ - CITY` � -�r,t.� �G-�/T EL.Nd.����J so as t`o�¢eaome,,sub,tect to ihe W"orkers Compensa4ion Laq+g, -,� �� � � _ � ` . _ _ .s-9�f'�'� � :. ..,z /, .. ,. . CONTRAC`1'fJ�i . , ��,6�-w�� �. Date ._ � . �. .. ClO7R"E'SWA$71ER-�. J � � O Appi�cant . "T� - �qDDRESS" �� �_�� � Nd'��C`'�`Y�'OO"��,s,,,� ' . eYE�ICA�L,-aft�r tn,aking T�x�s�eifif�cate of SW��MING PObL�'E��'��`j`�'. �� ��� ExempLon,�ybyy:should become sub,teat to the Workers �� � � CITY .�" U 4ad Compexsatioa�rov�sionsbftkelaborCode � LAWN8I�RIA�<"�`�F�°S"�°S'1�'g'I��. ��TE�,NO:��y -��!o d You must forth � `. STA"I"E"'"�" z . w�Eh comp7y wrt�i such f�rdvis�ons 67 �ts perm�t��shatl lie � WATE'p'�'�"q°�°e,. LIC. dsamedrevoked ��� . > .,. . �� �..�,�' LICEN5ENQ � �.CL[t$5 � T.x���fS$sD��0�1'C�RACT��R,S�„llF�q"''(2��` �''`'�"`''�" /� G�+SSVSTE'M „�"OUT�E'1`S� . DISTRIL`7'7J0;"" �� . � n..-a.,�Y« d�-P1�� �� ROCES�SEDBY'�""'.`., L herebv aff�tm tk�at I am licensed under pro fistons of CNa tei OU7LE75 aV p y . �/� 9 (ConlmBnCmg w t'h 5�ction TODO)of LSiv"Ision 3'pf.the Busi �. 5��R��V$'f�A;`"` . �,�,._ . _ . W�r., .,:.... . .:� _.. ..� �, ness§rid professions Code,and.my hcense-is�fuil force and - � -� �FINAL �� � � ���- et'tecR . .. . , . , , �: ,,.:.. � , :� oaTe l� �S�6j VALIDATION _ y }�p� � ., L�cense Number LL�+R��Lie.Class � . �' ` . FINAL . ..- . . . ... ��-�-p����� � ���<-'- Contractor y J!_'_ _"^"'" , . 'BY � Aate � � I am exempt from the uensing requirernepts as�T am a -� PEan CIICGk fC@� -� � - � �_, ; licensed archiLecY os a re'gistered professional engmeer"'' - '� ' �- � � a�ting �,� my jytofessiona,l�-capacity ($ection 7031,�Bus ��-��B�N'GP�`�'ut - . �,Y � ihess an,il Profgss�ons�o"de�• � .. _...� �� . .. . ,.: x �. �, � � . . � Lm or Reg No " '. ' �. .. ,_ . TOTAL FE�6`.�..' . . .. , � . : Date �� pian chack appl cani � � . - � - . 7ibME'O��t`"'���Ig�p�N'^�.�.'�..�',... wame . � . . . . . '�. ..� i ., »' - . I her�by�.af�rm t6at C aro aXerilp{ fro��;"the Contraetor s Address � . . . . - L��,S��A � �.icense,Law for the�foI[a�iirYg'�i�ggsb'fi (Section'7037�5;�usi,`�" '� � � � ❑ess and�Professiorts Code). ' ' � Citv .. . Tal.No,-� �. � �� - . �.�.�."�`G �� . ' . .., , ., . - �, . .�.0 ..� r.� � p P Y, . Y ,. .. ..._ , �,_ � I,as:.ow�F of the ro er; am exctusivel contracting � � ��« .�'7 r,� with I�censed cont}��ctars to cqpstruet the pro�ect � - (Sectwn 7p44 $usmess and Profess�ons Code) � ' � ��� _,�; � :, � ��� x� •� ,. ; �,r s � ��CbNS"1"A�"C ,. � � ���.��a �`'�,��"_v.�: � n -� T'heseby,affy��t thaY there is a.�constru tfo�e d��g agen'cy � � �� � � ` >. .-„ ..�.. .:� ,r,......-,..,,..- ,� ....,-.,.,...». , >..... . . �._... _ .�_ __ __��:. ,..._��_. ,..�� ,��� � _�. for the perforinghc'2���f�tha w,prk.for wfiich ihis peemiY is � � � � .i issued'��c 309`7�rv:� .. '. �. , �- � ' .-_. - . ,'. . .�. . Lendei's�NaMG .� ,•� ,. .'.. . ..,: , . . , . . Lendex s rtiddress � � � ' `I Ct����f �' �'.�Y ,z , sv.,,'�+:.. �+.�as3-w.: �...., ,,.-.z. r. . ��K� t�kr..�.,.,.� . � " :. K ,:� � ��� = y that I haPg_�ead this app[�oatiQn,8�d state Y4�at the �- , above�nPoemahon is ca�rect.I agree,to comply w�th alI Cb,�niy � ` -�� � � ��� � �` °' "�� "��` ' ��- �'" ' ' ` � . _ .. ,. .... , : . 'dxdinances;and State-laws�regulat(ng'plum,bing, arid hereb.y SEE R�G�EiF"�"�`�pt""�Ai,j."�AT R�`����«��.r"`�`.«,�.,u...�.s�,.�x�ssw>-`""`�.-..*�".�"'��:�.�m,���;,�.�.""` .. , .ma,ro�.,,....�3�T..�.,.�»�;-_ <�authpryze>epPe�sentairves of Yhis��CounSy,to��enter upnn rthe � ' � � �����- - � �� ��above me�yt?oned pr arty for inspection purp'6se5 ' "•"" ' "` - l�... . , P � . . . . . ._. _�dGr ��r���� _. e _.a.�,-0 . ...w, .:�. � 9ignatilre of ermitFee, Date- . ."� �"� .". ."�". : .�.s�,,. ""yg���s���.�,�.�'��"^°*��;tr '� :�.a,.�,� �� �" � `� ��t¢..:sv�:�. _. _ . a�*�.���'�.�'�.�.�! ; ;., _. .. _.. -. - . .�•;.". �.��..:� ; , i � .....f. ,.� _. . �. " . �:: ' .�:. . ' N s,.+ , fi� '§ . ,�}��y�yv�yg t�g�gp�y-a�y��+�'y}'p�p.�r q� . �.,-k ! � � S J ^ 43Vi1'MGR DVf�+&)A+Bt I1LCLf4sot\l��l'� , . � ;, �. ,�.�"ts# :'�"` � � NS�P�C`I'`bR�iCt TES �� V . ., . � APPRQVALS . ^ATC (NSR�.. R551GNF�SURE R� �-�: �.`` .��t '"�'f � " s�, ��� UNDE�i.SLAO WORK - r- '.�..- : ..�� �. ' �. . � v � c��at�a"�"�n caettiPt�ro'h th�CarnEYac�3vr s � �� � I ecebv af�sm . , . ,.. . . 4 , x -. : �ce.�se Law�,���e simns C�eJ Aisy re tY�°rrriPra e t o n � ROUGH'-FLLMBINCa � . � idSIdIPSs Qi7 ,, O 9 -. � . GAS�PIP1tvG "'� `"� �� ��n :�� ���� � a --: whecb requcres a pe`renit�:to construct, aPter. . . . . � . � ,.;�-•,x � �,r � � •,a.,y �. •a,<,,,s�.+s a�...� „. � demohsh or reprur any strueture,prior to its tssuance, ... #.: :.:�. . �� .,f .. GAS,��N'�' - '� �° ` "��— - r•� ' ' � � li anr or sttch permit So��,fiilz':a ,.. _ _ - _ alsm� requves„°ahe app C, f ursuanN-.io the Ho�r�iitERHEA''ER - ,� sfgned ataternent tiea� ke as ticenserl p a�Ut�tetNGP�xTSIREs- �� ,q„� 3 .�` ,-""° �,-; "p'rovrs�ons of the Contrdetor's License I,aw(Chapter`9�� , . .�:, E. . -. , � ' � ;: ' " � � � - :- : _ ,-; � zrecen°w+th Sect%n�7000 e D'fv s'io-� of t�ke s� .} u „ (comm 8 sy �as"#r�s'7 '. ' '. .,..._ . ,:; ', ... ...r ... ..:,... ., ,.,.� , �, ,., Y'= :8us�ness,Hrid�A'ofessions'�Codej�orf that�he�is�exempt Uri��Tv eo NOT4FIEb , t�Terejrom qnd the„basis,for ihe alleged exemption..4.ny� u --""� �� F' c �'� �'�v�Q�fia�oj"�ection'�Od]•3 by any dpplicant forRRermit '. �. a a . _ . . ���� ����_.� ?�;�y�'� . _ . su61ecta�t3ze o�s,piicant so d civil penalty ojnot more than ..<, .e ,..��: -- . . . ,_ .::�. � : . ., ._.._ - u drerldoIlars SS00).. ��- � ': ,._� ,�,,,i � , � z_.. .. ,;,.-� . � i� � ;: ..� �` .' .� � . �� .-� . gi��p I,as,otynec of,the��xoPext will do the woik,nnd-'� . - _ ,�-a � Y ' ,_- ' >yw , a,- I �Not�sTRta� . .. ,. � ;- F � � "" "'.the'sYcucwxe is not mtended or offeced foz sale.�. . WASy�qppga�q:� �� /Sec 7044, Busmess and Profsssions Code' The Con-�- � z�'�.y _x, .s `trecror a,�jer.�nse 7.aw�does rtoY appiy�fo"an awn�er�oj � - ,�F , prbperty,who L.�aTds`or�mpro%s`tl�eYeon,and who does � .;, _. . . _ . .; `�' ; , , - � `"� `such work �himsePf pravided t,hat sqch tmpCovements ,. � . et , are na, tniedided a'r offered for:safe !j, however, the��� i��� � *�� � - :��:- ., buiidersg ar zmprov¢meirt is soid w�tn�n one.Yerzr af y;= � "i"' com letigr?, .the,owner-builder ,witl have the�burden� ��-_��g�.r,:,�+ „�,�,�_- ,,.� ;pf proving jhnt he d'id�not build��.or emprovG for rhe� .l . - .. "- . pIAF(70864�SQIPJ �. . ... ,_.S aa j{.�:.r b "."�€�e;� ��.�"ts�'�T#''+y��. if'a'e�-' � ,�-,mxF.znNa�>+d..: �: � .. _ .. . . ,_ _... 6. - 3 BYR�QX��R�£X,�CC ... . �_.,'.... .�s �- , �. , ' . '�. � . _ --3� _ ' 've`r __.. �. ,_ .._.. - � � , �. �. .., m'. ' � �.. 'B&l'C:�or tTiis'rea�o�t,� � -.--N^..,c .--�-r. 'r;;r" "��: .�;�:,,�,� ��^;sSk� x.in�'a.:��, �'ka�'�3�.��.����'., .._ -. . - �: -� �„..-...,;. ,...." ..». �_. � ,� , ...�. .,.�._..._v� . .. . . .. ,;.-.:. ., ' . � . . . .t3 Ws„, ' . .�, _ ..:_ � _:: �-"' ` �; , � _ �,.� Y N.+ -i. 4 .�,3e�st�§'�: t ',�- �,.�.- }� � jrr;. +� �"` . � � Date � r a � �. - .--�` � .., `-�`: .�?,.� �.�.. :4�.�. & zx ,a>�r .�a'�u+a,�.�w.h., �,,,, � �W7121' ..5 f _ � � ,.�,-:.: , w�:�., -.�.w . , �.�,u. .: -. ..�.;e_ ... . .,...., .�,k,r�m -7 ,3�M -� .' , �.. . �....:......... .�- s,,., , :.:, ..t.,� .x.§a�. .."� d�»v-tA.i"...5, �f:&�.a�»��,`,�«.:Y�.�TrtjF"E!,�;s�„'... .�:.. � � � :!�; :I,NSPECTOR S NOT . �'�,:r . ��i= � - .� � .. .� �r : . ' ' ES ....._._ � �- � .__ .. �..e�, : s� ��s�.���s�'�.�v,.s�� , . .:. .:��.. . -' ..,"_ a.. ,,,:- ., r .��:,.. _ , ..:�. . �' - .fi* ,..u'�i4"` `�'u..� -r,�k ;�. .d�.� .e.�r,� . .wSr�; �° �. � ..F... �.��. .;1� -0, : .� .: � :. .." �.� � � .��m:��.x ara�:- �r�, , ?�� a. ,."�;„� s _.t,, . �.� �_ : � „ � � ���. v.��"t�`:�, , �.. .. . . .._ .. . .qa.,": q.i .e ' L..• �: -� �7r�"�w`����"�^`3r8a�"�:G s'�'�Y��� �' � ..,;; j�,.�....<.,x��.,eo..z�.- .,�ic+,b+..i����'',.��.� t�ms` e Y s�m�:-� k �.� . _ -iY�.l_ - t, ���j.�` 4. . ' . ,�' '. .n .. . .e ':9 ^� Q, . . . �- �,,y 4h:EEetf'9�q+`N+NAM�'�mn .Pi'�' - h � �`'��;, "sN'bHY'.eS. F�.al, .s5.e� kC�dSh$��. �✓�'+"4fWM n n.�,4�"'. '§�Y'... .. MS"� nr^� 'i£�R'c�`' '�)dWtA . . . ^Y'E•�.- '!'� ��M*� .A. ��z��'-�a�.�.' � t .. �kp,'�'#43FkS`°�7rt�`� S+'Y R ='�3 1r '.4.',y''��C ��;�'`kti�'S :Y " `a'_...�.�!"r ?i'�y<Y4'Y �."F 4.:`"rt 'fi' .1.3)1�... .^,�: .� :_ : : . ° :. . , . , �.«:: . . . .. ..-� _ � �i " ., , . , 5r... . . , ... ,..;. .�.:u'�Y.�:as v .a..�+ .....�� i :��rY K 1. r?,�':. � � _ •y&�[` n.J*.. ( t� j�s2.'^S"`rw.�.�kF-�`3..w.. �4 � . .�.;.ut>�.�.x�s. v..2r.,;�x,.�.::t.�.;�N�a._+.:�.�ae��.�,'���:�k�n;��"�"r'�na'�a�,•:�,i�a.e.G4��s�:�.s.•+�3`.��`�e��v�n�`r?�'.�';. . w„ a.� -- _-. . , .,�.-.:........ . .:.:.. . .��., _.� .�.-..�. ,. -�-.- , ... -�: .. . .. . � �� � � � .;. � �� ,. `.:.�, ,, ,.;«,� .,,,�c,�, ��,,;..,� ^z �.s.���fi..=o-b� a" �"�°��w.�'e�v�x:,'�.F..,;:. .-. , .: ... . � �=.s., .;:.. :�.