HomeMy WebLinkAbout0786A '"°RKERS•`°"`PE"5^T'°"°E"A""T'°" APPLICATION FOR PLUMBING PERMIT {�
I here6y�affirm�hat I have a certificote of consenr ro self in- �a�yyjA P�''�°�� �
sure,or a certiFimte of Workers'Compensalibn Insurance,or o �E 817(REV,e/R6) - � � - � � . � I J
'�ca(tified copy thereoi(Sec.3800,Lob.C.) -�� _ � �
Polity No�3WC00$047��,rTATIONWIDE COUN7Y OF LOS ANGELES DEPT.OF PUBLIC WORI(5
� Cenified mpy is hereby furnished. . . � I,OT. PLt�:24���,���, �TRACT:42578 .
FOR APPLICANT TO FIIL IN(PRINi OR TVPE) BUILDING
� Certified copy is filed wi�fi fhe tovnty boilding inspection nooaE55 z0 SOUTH WYNNEWOOD DRIVE
deparlmenf. . � NUMBER FiMURE OR ITEM. p FEE ��A��TY .
Do�e9-1—HH � Applicon{`1EW PLUMBING .3 WATER CLOSET(TOILET) (� � 18 DIAMOND BAR
NEAREST
� BATH TL18 lZ CROSS ST. GRAND AVE. . '
CERTIfICATE OF EXEAAPTION FROM WORKERS' � Z
COMPENSATION INSURANCE � OwNER
L SHOWER ( BRAMALEA LIMITED
(ihi�tstiion nead no1 be compl�t�d if the work involved by MAI�
fho parmll fs for one hundred dellan(5���OI IlSf.) ' IAVATORV - 'L({ ADORESS 3151 AIRWAY AVE. SUITE�N
1 cerlify thal in�he performonce oi the work for which this per- SiNK 12 � CITY ' TEL.NO
mit is issued,I sholl not employ ony person in ony monner so 2 COSTA MESA 85�-1001
as�o become su6ject ro the Workeri Compenzation Laws. DISHWASHER
- 6 corvrencTc�EW PLLTt�ING CONTRACTORS, INC.
Do�e � � Applicont �� � � 1 CLOTHES WASHER 6 A�D2E55
� CE TO APPLICANT:If,aiter making ihis Cerlificate ot Ea- SWIMMWG POOL RECEa70R Z1�+1 S. DUPONT DRIVE
� �tion,you should 6emme subject to the Workers'Compen- � Ciiv TEt.NO.
561ion provisions of the Lobor Code,you must forthwith comp- �,qWN SPR�NKIFR SYSTEM.� ANAHEIM 937-3972
ly with such provisions or this permit shall be deemed revok- STniE uC. ,
ed. � � � � � � � 1 WATER HEATER 6 IICENSE NO 1 CLA55 C— Fl
' LICENSED CONTRACTORS DECLARATION . oiSiaiCi NO. aaOCE55Eo sr
1 heieby offi�m thol I am licensed under provisions�of Chapier Gn5 SvSTEIv� 6 pUilEiS ( � v
9(commencing with Section 7000)of Division 3 of Ihe Business OUTLETS OVER
and Professions Code,and my license is in full force and e(- 5 PfR SVStEM 1 5� FINAL V LIDATION
feU. � �� . � DATE ✓/S/,P�f O
License Number�+261�9 u�.eioss C-36 V
FINAL ft
Conlroctor N�W pT.1M_� R_�INc_Date 8-31-88 . BY ' G�✓ O
�
U
� I am exempt under Sec. �
B.BP.C.for Ihis reason � �O 7��� y
Plan check fee , �� � e o �5 z
Do�e: PIUMBING PERMIT ISSUING FEE S � - .
Signature 10TAL FEE� � f ' 1 �'�n�
10$ 0�
� � SINGLE FAM�IY � • e 1 (j r il Ij�
HOME OWNER-BUILDER DECIARATION Plan check applicant
I hereby affirm Ihat I am exempt from 1he ConhaUor's License Name � � � ��1 �'O I�
}ior the following reosan(Sedion 7031.5,Business and � - -
._�bssions Code): Addrees - �
� I,os owner of the property,will do the wark and the Ciy � - Tel.No.
stroc�ure is not iNended or otfered for sale(Sec�ion 70eE, . . . . . . _. . -
Business and Professions Code). . ' , ► � � .
- CONSTRUCTION LENDING AGENCY � - � " "
I hereby offirm�hat fhere is a constroUion lending ogency ior � �
the performance of the work for which rhis permit is issued , - - � " � - " � "
(Sec.3097.Civ.C.). . . . . .
Lender's Name �� � �
Lender's Addresz - � •
I[eriify that�have-read ihis opplicotion and slate ihot the ' � � ► . � -
above in(ormotion is correct.I agree�o comply with all Co�nry �
ordinantes and Stole laws reguloling Plumbing,ond hereby . � -
authorize represenlatives of Ihis County ta enler upon ihe � �
o e-me ioned propeny for inspeclion purposes. � � -
SEE REVERSE,FOR EXPLANATORY LANGUAGE
Signo�ure of Permittee Dote � � � .
� y C
. T -��r D C � N � O (vn
�L Z Z, r- (f� � t �p � 9
b O D ..� p �L m ,a S N D
mNi r t� � � ..a Z � i'
..� z r �
D?� � O T F � � � O
. v� z x, m , � p v
. : o v c �, c� x �n
� �� m m
, � � y 3�
�
` � D
1
Z , o m
N . -
m _ , ,,;,`� �
—n+ � . �. - ,
�
O r N
�
� � _ � �
� A .
� � N
Q N
m . � ' � Z
cn . . �,
c
. p
. m
. ' N
�o
m
. c?i
O
, �
N .:
� , . Z
' , O
' N
! : �
i. .
' - • - i �. � � � � m��
""w �
. � m �fo�n� g'w�ca°'.,N�������•�
. p p ' � s+ ��� o�c�' � cQ�O�ONc`���c.�$`�" �� �
� i �Qo mm m Cv., _ . .�
. a W . 'fl m . .Q�m�t�n`°Qa w�,Q= a.'=vmioC.a� x �
x �m �,� `� �� m� � �, m �� m
m � to o < oc' mo ��=K.w..,�'o ���"' v �
�-•
C '. "' � A1
. . . p � 3 v,�a3�Na`�i °' o$Nmw .; o �� W
� -• . •• ��E �+ o�o�� '���., or..u`;�'+ w�$y _ C
' � . .r G � O'_p, 3 0 y� � W() � C7=cj� -•N O fp ' �'
' , s � « y � � wm Oco� m 30"3 0
• , : , co ' a m °' �.�yca�w�� `r3c"u'�<�=^y..:� � m
.� - � m O� � �c o �cov'�a' c �' � �7
-• . �=�?,�o �� o'� ya o»o
. a � �m p �o�o m� o m'�,X w��c�'��� ' ffl
, � ����'o �'c�N�i" _ 3c� D���c�'o^ C)
� a
���m o=o��� m������m4��� � �.
- ' ���^ m � �N � b 3c`�o�Wm �. `� cn� jal
oao �oo�e� wawm� �n� oa`-'`c�_ -
, ' �m f �•(D=- ���o"m� a(�, O
� �a � �� �.oa mo� _ `�= o �o 'Z.
' � ��3�.� in� = f mv' o3`ri' ��wu"',3� .. '
V"y"t
' . . � � . L.�� o`.� fn O W � �,�y p)��O !A w'D� W C'� '
�m�Oca � y Gro �p� a�vimapC;,"O
� _ - . � . . . d a•�L] "'.C�1 � 5 �p,f ff Q�C�'p� n C ,a„��'L
' . � �� Oq�' j« a Qa0=O� t�i�A�m.�. W
- 1N � ��, (D
- _ • - . . - ci�34.x.��
.-� 3�