HomeMy WebLinkAbout0774A ' "'°RKERS•`°"'°E"S"T'°"°E""RAT'°" qppLICATION FOR PLUMBING PERMIT �7
1 he�eby,,offirm tho�I have o cer�ifitate of consent to sel(in- p"��6 DPW 4/87 �
sure,or a ceruficote o!Workers'Com ensation Insu�ance,or a �6Afi67A
P CE BI7(REV.B/86) � �
ceriified copy Ihereof(Sec.3800,Lab.C.) � . � � _ � �� �
Potic'y No.73WC005047�(�in�NATIONWIDE' ' COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
a LOT PLAN:25 TRACT:
Certified copy is hereby furnished. BunoinlG .
FOR APFIICANT TO FlLL IN�PRMT OR TVPE�
I=J Cerlified copy is(iled wilh the counfy building inspeclion ADDRES..
UU department. ' � NUMBER FIXTl1RE OR ITEM @ FEE
tocnirtr DIAMOND BAR
oote9-1-88 qppliconNEW PLUMSING 3 WATER QOSET(TOiIET) () i$ NEaREST
BATH TUB CROSS ST. GRAND AVE. �
� CERTIFICATE OF EXEMPTION FROM WORKERS' 3 1$
' COMPENSATION INSURANCE 1 SHOWER 6 owNea gg�ALEA LIMITED �
(This��Nton�naed not be tompisfed 1(Ihe work involved by MAII
th�permif it for one hvndred dollors(5100)or les�.) 4 IAVATORY Zl� ADDRE55 3151 AIRWAY AVE. SUITE N
I tertify thot in ihe perlormance of tha work for which this per- �
mn is issued,1 shall nof employ any person in ony manner so 2 SINK 1Y UTv COSTA MESA rE�.No.g50-1001
os to become subjed�o ihe Workeri Compensa�ion Laws.� OISHWASHER
. 6 coNrancroDlEW PLUMBING CONTRACTORS, INC.
Date ' Applicanl � � 1 CLOTHES WASHER 6 ADDRESS
�""CE TO APPIICANT:If,after moking Ihis Certificate of EK- ZIGL S. DIIPONT DRIVE
jion, ou should become sub'ect to the Workers'Com en- SWIMMING POOL RECEPTOR .
v i P CiTY ��EIM TE� "0 937-3972
su��on provisions of the Lobor Code,you must foHhwilh comp• � �qWN SP4inlKlER SYSTEM �
ly with such provisions or ihis permit shall be deemed revok• STnTE LIC.
ed. - �- � � 1 WATER HEAIER 6 uceNse n,o.426109 [LASS C-36
- LICENSED CONTRACTOR$DECLARATION_ DIS7RICT NO. PROCESSED BV
I hereby offirm thot I om licen5ed under provisions of Chopfer GAS SYSTEM 6 OUTlETS 6 � ,^ _
C/
9(cammencin9 wilh SeUion 7000)of Division 3 of the Business OUTLEIS OVER
ond Professions Code,and my license is in full force and ef- 1 5 PER SYSTEM 1 50 F�NAI ,` / L � ALIDATION � ' �"
, feN. . DA7E 7//% �/ . O
ticense Number 426109 lk.Closs 'C-36 6,t
FINAL
Conrracmr NEh1 PLiTMRINF Date 8-31-88 BY � �
O
h�
� I am exempt under Sec. `O 7 7 4 r�.. a
8.8P.C.for this reoson Plan check fee � . ��� � � e �Jr Z
� Do1e: PLUMBING PERMIT ISSUING FEE 5
SignaWre - � iOTAL FEE 114 00 � " 1 1 4 0 0 .
� SiNGLE FAMILY s e � � /�,�.�1�
HOME OWNER-BUILDER DECLARATION Plan check appiicont "
I hereby ofiirm thol I om exempl from the Conlractor's license Name . . . � � � D II� O—H H
L• �(or the following reason(Section 7031.5,Businezs and .
F �ksions CodeJ: Address � '
�'I,as owner of ihe property,will do the work and�he City Tei.No. " - _ �
- struc�ure is nm iniended or offered for sale($ection 70a4, .
Business and Professions Code). �, � . ,
� CONSTRUCTION IENDING AGENCY � �
�1 hereby offirm thot there is a construction lending ogency for • ' ..
�ihe performance of ihe work for which this permit is issued � �' - � -
'(Sec.3097,Civ.C.). , � , � �
Lander's Nome • �
ILender's Address . '
! I ceriify Ihat I have read this application ond state ihot the : � - , � -
' above informatian is corract:I ogree�o comply with oll County . . ,
ordinances and S�a�e lows�eguloting Plumbing,and hereby - � . � � � . � . �
'authorize represenlatives of lhis Counfy to enter upon the
ve•me lionad property for inspedion porposes. , � � � _ . _
SEE REVERSE FOR EXPLANATORY LANGUAGE
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