HomeMy WebLinkAbout0775A � woRKeRsconn�NsanoNoeaAaAnorv � � APPLICA�ION FOR PLUMBING PERMIT {�
I hereby�oHirm fhot I hove a cerri(ica�e of consent ro self in- �A��A�'4ie� �
sure,or a cerfificale of Workers'Compensa�ion Ins�ronce,or o CE BI7(REV.8i86)� , � � I I
ca�lified copy thereof(Set.3800,Lab.C.) '� . ' " - � V
Paucy No.73WC005047�Qy;�(i„yNATIONWIDE COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS ,
� Ce�tified copy�s hereby furn�shed. ' -' - � 42S7H �
FOR APPIICANT TO FILL IN(PRINT OR TYi'E) BWLDING
� Cerlified copy is filed with Ihe county buildinq inspe[fion ADDRESS 911 SOUTH WYNNEWOOD DRIVE
deportmenl. . , NUMBER FIXTURE OR ITEM @ FEE
LOCALITY DIAMOND BAR � '�
Dote 9-1-$H ,qPP���o�,NEW PLUMRING 3 WATER QOSET ITO�LET) 6 18 NEARESi �
BATH TUB CROSS 5T. GRAND AVE. .
. , CERTIfICATE OF EXEMPTION FROM WORKERS' Z LL '
COMPENSATION INSURANCE SHOWER � �12 �NFR ggp�ALEA LIMITED .
(This�ecelon nsad not ba complNed if fhe work inrolved by Mp��
Ihs permit It for ena hundred dollan(5100)or lass.)' , i.4VnTORv � Z ADORE55
I certify Ihat in 1he periormance of Ihe work for which this per- SiNK
m�t�s�ssued,I shall no�employ any person in ony manner so 2 12 c�iv COSTA MESA TEL.NO.gSO-LOOL
os to become subject to Iha Workers'Compenso�ion Laws. DiSHWASNER �
, 1 6 coNTaacro�E PL IN CONTRACTORS INC
Dofe- � Applicant � ' 1 CLOTHES WASHER - 6 nooeess �2141 S. DIIPONT DRIVE �
�'- CE TO APPLICANT:If,aNer making this Certificme of Ex- SwIMMiNG POOL RECEVTOR
�ion,you should become subject to the Workers'Compen- piy TEL NO.
saiion provisions of ihe la6or Code,yo�must forthwifh comp- �p,VJN SPRINKIER SYSTEM ANAHIEM 937-3972
ly wiih such provisions or this permit sholl be deemed revok- SiniE uC.
ed. ' 1 � " WATER HE/+TER 6 uceNse No.426109 CLa55 C-36
� • IICENSED CONTRACTORS DECLARATION oiSTeiCi NO. PROCe55Eo Br
I I hereby affirm ihaf I am licensed under provisions of Chapler GAS SYSTFM 6 OUTLETS 6 /.\
9(commencing wirh Secfion 7000)of Division 3 of rhe Business OUilEiS OVER �U
and Professions Code,and m license is in full force and ef- 1 5 PER SYS7EM 1 5� / �
fecf. ' . y . . DA E� y�y � ALIDATION a
t�cense Number 426109 lic.Closs C=36 �
` � FINAL O U
Co�tractor NF.W P. IN, Date 5-31-88 BY �'A-�^'r'� 6
O
F-
� I om ezempl under Sec. � W
�Q77,„P o.
s.aa.c.io.+h�:�eeson Plan check fee ► �� , � , „� z
� �Date: PLUMBING PERMIT ISSUING FEE 5 lO SO .
Signature� . � � � � � � r*0�
� . TOTAL FEE 114 OO
SINGIE FAMILY�.•. � � e � � C^��
HOME OWNER-BUILDER DECLARATION P�an check opplicanl . , .
I hereby affirm Ihot 1 am exempf irom the Controclor's Litense Name � ��� O-f'S S '
I �tor the following reoson(Sec�ton 7031.5, Business and �
I �ssions Code): . Address
� I,as owner of�he pioperty,will do ihe work ond the �'N iel.No. � � -
_ shocture is not in�ended or oifered for sale(Section 70d4, -
Business ond Professions Code). , � ' � ► � �
� � . CONSTRUCTION IENDING AGENCY �- ' � �
I hereby oHirm thot there is a conslruction lending agency for � � � �
fhe performance of the work for which Ihis permll is issued ' - . -
(Sec.3097.Civ.C.). . . . i -�
Lender's Nome �
Lender's Address � � � . �
I certify that I hove read ihis applicotion and sfate that the � _ � � " � � � �
obove Informa�ion is corred.I agree to mmply with oll Counly ' � , � �
ordinonces and Sta�e laws regulating Plum6ing,ond here6y ' �
authorize represanlolives of this County�o enter upon the �
ab ve-men ioned prOperty ior inspec�ion purposes. • . - �
� � ,3, SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permiltea Dote . , _ ' �
I
.O = G'� q � Z'
� a D C � N 4 G� �
DO Y =r � P � R� v � N v
u�G r .0 �^ Z Di � Z r � �c
-�N n � � T 4) G p p
' q'j7 p 'n � : C�l7 S D
. . , . ' Or 1 0{ Gj 9� ` 'f1 7 N
' � T N �
� y d
V �
, ' '" . � a, � .
A �
, _ ♦ p m
- � . e
� � N
�T1 _ C �p
� � �
� , O
'A
N � m
N
z D
0 � . A
� . - �
f'" -
, , • ,
2
N
'O
• C)
�
�, �
, ' '. t!)
` Z
" O
m
• N
- Q��r
� ` �o �.v,m �N� �
o '^i Q m - w g n � �
��Sro�'� owo,°'„ ia'„��m@o3��0
O� O � O Vi� � �~ CT-„� ��tD c�[ON �W �
� � � nrmm� �c.c�i'Vmawm�oy b^����� � � �
O p� 9° �3 c,a3a�n���'�c"awm�� �m=mynQ .. 7D
£ " '� , m o c c° �-, rn�'_ � v,_,...� .p .
• � m • % o '�m o�o ci�W o��-;-K w�- o ?tD�.m o g W
. � � 3 . `�u;�2S3�r.� a`� �� ���' 'v,'ow�H� "' G
� , . �
� _ �^ � �_--= N r
� , o ''�. af.o� =o� H`$ 3 ��mw0�'m�d'K3-�o3 �
� � 7 - �yam�a{o�w�� "c � m � S.��i+�=^�'n � % ?J
�p CS c f,��m m � o"'3 m �n m � �c o
m . m '. _o��'_.c�i�o 'nv� ���^� n�+ninc ����v �R1
• 0y�► t!► m�'`?� mom omaXcufc�m?�:9.�" C�
, ? �j ���b�ti O� 3oc� ��o w�?� "
m7���.�N`8 � '$ =D �
$�"�KK�o�p4 m�"D�n' o�"in^� q
' ' . . �O �m n
' ' - _ co � '" � �m .,3_ � -i
m . 3f� �o �comc o �pw .��i �.
N�.»
. , ' ' " O�p��p��m � ?np� W�N� in�0�� �Z
, . . a=.oaa'��= o 'cro�o�w3o�����
. ' . �'r�a��N o m � �a m tn�n�u+�r'o�o c���,
, . � - �»m.����?Q � �'w�in�o�.Zi"� � t�cnw•
. ? ��r.4,� M nb o��a�Nnmm•c-
- . a- 1 e �� � �.�'� m
, • . � a�3n�i-�
, �co ��
' , /1 �
,'