HomeMy WebLinkAbout0784A "'°RKERS•`°""�"SAT'°"°E"ARAT'°" APPLICATION FOR PLUMBING PERMiT
I hereby�qffirm that I have a cartificate of consent to self in• ����A�4i8� �
sore,or a rertificate of Workeri Compensotion Insuronce,or o CE BI7(REV.ei86) + � � �
-cait�fied copy thereof(Sec:3800,106.C.). COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
vo�icy t�lo.7�WG(105047A�91�unyNATIONWIDE ' ' .* '
� Cerfified copy is hereby furnished. ' � ' '�
�� FOR APFLICANT TO FILL IN(PRINT OR TYFE) ' ' bU1LDING
Ceriified copy is filed with the county building inspec�ion nooR[SS 924 SOUTH WYNNEWOOD DRIVE
deparfinent. ' . _ , NUMBER FIXTURE OR ITEM p FEE �OCAIITY �
WA7ER CLOSET(TOILET) DIAMOND BAR
Dare 9-1-88 APPrca„iNEW PLUMBING 3 6 18 NEAREST ,
� BATH TUB CROSS ST. GRAND AVE. '
' � CERTIFICATE OF EXEMPTION FROM WORKERS' 12 _
COMPENSATION INSURANCE SHOWER OWNER B�LEA LIMITED ' � �
(This+actten ne�d net be cempleled if fhe work InroHod by 1 Z ,
Mna
fha p�rmif�s for on�hundred dollan(5100)or I�ss.) tqVATORY � n�DRE55
I certify iha�in Ihe performance of the work for which this per- -
mit is issoed,I sholl not employ any person in any manner so �Z. SiNK 12 aTv � COSTA MESA TEL.NO.$SO—LOOL
as lo become subjecl to ihe Workers'Compensolion Lows. DISHWASHER
� � � ' . '1 F7 CONTRACTO '
Dote � Applicont CIOTHES WASHER
ADDRE55
ICE TO APPIiCANT:li,after'making Ihis Certificare of Ex- 21�F1 S. DUPONT DRIVE
' _�1ion,you should become subjecf to the Workers'Compen- Swih�M�NG POOL RE[EPTOR
�ialion provisions of Ihe Labor Code,you must for�hwi�h comp- . � ��TY ANAHIEM � rE`."o.937-3972 .
LAWN SPRINKLER SVSTEM
ly wirh such pravisions or�his permit sholl be deemed�evok- - Siaie uC.
� ed. � � . " - WqTER HEATER � 6 ' LICENSE NO.LFZ(7109 CLASS C-36
. LICENSED CONTRACTORS DECLARATION DISTRICT NO. � PROCESSED BY
I hereby offirm fhal I am licensed�nder provisions of Chap�er GAS SYSTEM OUTLETS O .
9{commenting with Section 7000)of Division 3 of ihe Business W7lET5 OVER
� and Professions Code,ond my license is in full force ond e6 1 5 PER SYSiEM 1 $� FINAL V LIDATION � >
fect. � DATE ���.�y O
licensa Number 4�F+1 f19 �l�c Clcss� �—"iF
FINAL V
Cono-actor NEW PLUMBING paie H-3I—SS BY � �
O
�
� V
I am exempt under Sec. �O 7 a 4 n W
8.8P.C.ior this reason y
Plon check fee. ► �, . . . •� _ _
� � Date: pLl1MBING PERMIT ISSUING FEE S lO SO
Sgnotu�e , I • � � �U`J
�� � TO7AL FEE 114 OO
SINGLE FAMIIY - • " � � �' ��u
� HO'dE O'.YNER-BUILDER DECLARATION Plan check applimnf _ �
I hereby offiim Ihm I am exempt from the Conhador's License Name � � ��� �—�� .
�for the following reoson(Section 7031.5, Bueiness and . ..
_..essions Code): Address �
� I,as owner of the property,will do�he work ond the Ciy Tel.No. � ' �
strvt�ure is not inlended or oifered for sole(SeUion 7044,. . _ .
. Business and Professions Code). '- � - . , � �
� � '�CONSTRUCTION LENDING AGENCY . � � " � �
1 hereby offirm that Ihere is o construction lending agency for � " � � �
ihe performonce of�he work for which this permit is�ss�ed � � � �
(Sec.3W7.Civ.C.). . . . .
Lender's Name
Lender's Addresi
II certify tha�I have read this applicaiion and s�ote ihal the � - ' � � ► � ' - � � � � '
obove in(ormo�ion is correct.I pgree to comply wifh ail County
oidinonces and S�ate laws regulaing Plum6ing,and hereby ' ` � � - � � . . ,
authorize represenfa7ives of this Caunly lo enter upon�he . -
ab ve-me tioned property for inspedion purposes. � �
� ���u �� ��' SEE REVERSE POR EXPLANATORY LANGUAGE
� Signp�ure of Permiltee Date �� � . .
� 9 y
-� Gi Y C a N N � M
�p A
Z ' N � � < ro N 9
, N C r � N X I� '� G� C � O
. . � 99 0 '� T i , � O y
• , yr , pj G � ' � PT' N
� m
. . p m `„ A
• ' � , o
_ . �J � o
. �
� � m
'. o
Z � � `", .
N
�O
� ' o n,
n �• �
0
O . � m .
� ' N
N �'
2
2 ' �
' G
(�t1 ' � m
N , �
• , .
.. z
. � N
. - 'O
� .
�
�
33
- N
� Z
O
N
.
�
• - _.. � • o �°—'m�W��
� n ��N�. mo3ci� c&'
, u� $m�v, �,��m o ?m'�,�
3Seo� � vi 'vsm3m u� u' �
' o�Teo��o �'���v, �'o��i��,=„�?aw��
� r a � o �oCv� .r � a � ��E.�4 � Z
�'9° Qmm c,c�om i^Q'`c � � �N mn...3 �
O � � � � cam�oa�Ao` a9'nu'c��W -.�no' ��wv° '"
f m �U . � ac,,moa�W� o$�� �� o �m o � W
� � � 3°q-.° en�S-�g w�-��ty;��`���N "s�'w�$�A o� r'
, O �p tifv� o v� mm �� w���io�c�o• � t7
.. o �n�3' .w co v co �w �,,,;�g tn-
' " ' '► {. `3 0'tn ^C�,y " 'K���< y� �+ N Z .�� A
. ' � � 9 ,mm<f°' �,Nv»�� .0 3`° �".m m0�on�j�o�e+ O
, _ . . , . � ; � � .OcD�m n?O .p� =�t»m j arinu�c�p...9 . R�
_. ��-�?°Dwos om�%w�� ��.,io �m�:,, ' �
.:�, . . , • � ' N �� =�o�$vvv�y,� ��$ n3��c�v �D� '� 9
' �gs '�� ' �g,t4mom'{ o�� � �_���i,��o�< �,
. q„� c � � $s W 3 N�
���3n�yv+ c� NO�.p�pmo �o ��'� ••I
m ���� tn �D p - cD`t (� •�
- _' � �- • � ����.-.O��� � � lp � � n� �M '^ � �� ��
�»O -�. tpp ' .. ,
' " m{oQo'om� f �y,o3 `n3owc,3���p�i
� m .• � q� Q,� � �n o �•,.
���nov,�� =mN�n� u>��o �.. °�, .
, - "?��o�a� o� � �;»n.�=a�c��,�cna
. wo ��= � n�.���� y
. . m� � � i� �, $' m ,1-�
, a�3g�-�
� � —