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HomeMy WebLinkAbout1390A (7) � . WORKERS'C0�1PENSATIOND-ECG.XR.�'1'l�Kf.............�.�...-reaae�a",,.. ...,....w..�.,,...w.m...,..p..z....a....�........�„»... . . ,�.v„..+_.._..... i hereby ajfirm that I have a certificate of conset�t to self ceanlz-eo) APPLiCe4T101�1 FORFFLU�N`1B�1��1"� PEF�M fT� �insure,or a certificate ef Workem'Compensa[ion Insurance,or � L� a eert'fied.copy.hereof Sec.3800, aS.G) �^- -^ "`' _.... �y;C�f .��:� z •-.� f COUNTY OF LOS ANGELES BUILDIN�AND SAFETY' �Poticy No. Com�any ' ' �t i��� ��;` . . . . . .,. . .. � .. � . . .._....__ .... . , , . . . . a,...�._.. ' �' �Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRIfY'Y OR"f``�P�������� BUILDING � ` � Certified cupy is filed with the county building inspection NUMeER FIXTURE OR"ITENI����� • FEE AD�RESS � �4'Y l�t �y� department. � WATER CLOSET � - �� LOCALITY ��� Date Applicant ���� �-�������-• " -� �� --- -•� NEARESY ' � � ' SATH TUB � CROSS�ST. �CLR'IIFIC.4TE�Of`"EXE67P'I'IUIV�F'i�OM VJ('sR'�1,"K�S�"'�rr������ � � . COAIPPNSATIO:V INSURAN'CE �� �� . SHOWER OWNER . �. , . � � . � LAVATORY MAIL (This.section need not be completed iP the work involved I ADDRESS ��IVf � by the permit is for one hundred dotlazs (9100)�or less.) SiNK � �, . � . � � � - CITY TEL.NO. � 7 certiPy that ir.thz performznce ot"the work for which this DISHWASHER '� ,{• � 'permit is issued,1 shall not employ any person in any mannet CONTRACTOFt 'so as to 6ecome sut�ect to the Wnrkers'Com ensation Laws. � � � 7 P . CLOTHESWA�HER � qDDRESS O ➢ate� APPi�cant ..- .�. � K . � ,. ... . . ,, :. ,. SWIMMING�POOL�FlE�EPYbR j ' , 'NOTICE I`O APPLICAN7:�If,aPter makin�thzs Cer[ficate of � � �` CITY � TE�.NO.,���'-��'�. I,Uci Ezemption, You should ,become subjec? [o the Workers' LAWNSPRINKLERS�YSTEM'� STATE .E [� LIC. U�8 Compensation provisions of the Labcr Code,you must forth- I.ICENSE NO..p1�J 35� ,,,C�AS '� � with com ly -��� OUTL TS VER OUTLETS �I � � p with such provisions or [his permit shall be I . . deemed revnked. DISTRiCT NO. � PROCESSED eY a ��,ti Licens�D can^ra.ac'riins n�'CL.aRai'i2i�P�'"°," �'Ei ,�J Q,c�.'�-� I hereby affirm�that I um licensed under procisions of Chapter 5 PER SVSTEM � �- ��� � � "" '����"` 9 (commxncing with Section 7000)of Division 3 of the Busi- � � ` FINAL VALIDATIO�I ness and Professions Code,and my license is in full fo«e and '��` 7✓ `������ DATE � _'7 9 �',�J effect.� LC 7 � FINAL LicenseNumber 3���k`'`��l Lic.Class. ���5� BY i— ]- t_ i� �r � , r Contcactor�������Q��Daee� � I am exempt from the licensing requirements as I am a Plan check fee , licensed architect or a registered professional engi.neer pLUMBING PERMIT fSSUlNG K�E��$``��� / ' acting-in my professional eapaci[y (Section 7051, Bus- .... ..._.,.„..._...._. ,. ..�� .! .S� iness and Professions Code). TOTAL FEE J�_��� Lic.ui Reg.No. Date ?lan check applicant , . . .. .. .... . �� HOME 044N�&R-BUILDER DECLARATI�ON-'��� ���������` " %`�ame �1 �9,G A Adtl ress I hereby affirm that I am exentpt from [he Con4rAc[or's ,�,+o � a • •Jr" . ... ..... .... .... License Law for the Yollowing reason (Section 7031.5, 6Usi- City Tel.No. ne9s and Profession;Code): - �) o o '� E+.��, � S,as owner of the property,am exclusively wnGacting , �vith licensed contractors fo c,onstruct ihe project s a o � (�,rj Q� (Section 904A,Business and Professions Code). . �� - ..,..,v.....�.,.... �, , �,,.... . . ..>_...�,...,.x,.w..... _ ..,...d,..,..a .(1 1.2�'8 C , . ,._._a, . � . - �_. _ . . ... . . . ...... . CONSTRUCTfON LEN6��N'��AG�L`NCY�'�::.",:..����,c��.�..�� . . . i here6y�s£firin��thpt�there is a construction lending agency fo_ Ihe performance�of the work for which this permit is .. issued(Sec.309'7,Cic.C.). . ..,...,..,.. .a.,.� - _ - .....,.�-.,....,,.....,....._.�.,...�,»,�...._ Lender s Name. ... _ _ ...�.....,...�...-..,.,....,,..w .. ..�,-,,,.,........... _ _........,.,,,....,....,............ . . . . Lender'sAddress .,...�w...,,,..,.�...-.,«... .,,,,.e..._.,...._�...__...»..,..... . . ,.. .,:,,..� �. . � ....-,_ ,.,............ ._J_._ ..._....,.�.... �v;..��;pP�� .........................._........... .. -....._.. .. ....._.... .,.,..,_.... .. . . . . I certify thui`"��h�ave read this d I'C8~ ..•.,.,.,,� , ,.. . ..., � �� � tion und state that the , �,,,rt�,x w.,,.t. a6ove infarmation is correct.]�gree to comply i��ith all Coun[�� SEL REVERSE FOR C�XPI.ANAtd'KS'LA7�1'��1AG�'���'�'�"'��������������W u�µ�����p��4 �ordinances and St�te laws regulating Vlumhing, znd hereby authorize represe Futives of this Coun[y to enter upon the abore-me e propurty£er inspection purposes. /' - � ��:f7i'�L�J+� L^'f�/B _. . ... . �gnature of Permittee Date � . . .. .,,..:. ,.... ,,..�...,. „���,_..,�...,. ,�.x.�...-�. ,�:,....�:�r-m�, ,�Y�iw� +.��'r,� �-��:�� �,_ �t<ws.�. -�'� �r" - � .°;3+i'�,� -��.-'�'. ����.�—_�� _�-�-�-�-;",,.-��-�- ,_•�-_�-��� 'Ja'F';iTOR 5 n�T ES: `, � , O'�"`dER i3UIL�EI$I3ECLi`s�A ilC/'� APPRCVALS oATE � INSPECTOR'SSIGNA'fU�FE� �� � � . . . . - � - -,._.._...u__._..�..u._...,»...,.m. � � ..... . ... . , . . . . . . . , .,v,� . ��"� U�J['iER S�AB UVORK ' � 6it1 he C0 tC _ "'__ ftOUGH PLUMeING : " '. .. . . . .. �Lrcensc; i�a��thhz io�l ��tnmceas�n ec ron ,i1 �' - [ [ , rs �^�a.--i,y� ,�arainess r.n� Prolessaees Code/ 4n; ai}. or cc�n y GAS PIPING ��v�� '�J - --. ._' "'___ _'__ , .. .Ynv¢, .. .. . whlch re;uires a r,errnir ro .onstn;ct irer, %r, GA5 VENT . ��• • ' � .:. ....... .. :_..,..I..._........__...-"'—_ ' . H07WA"!'EFHEATEft ' .<.—. .—_.—__-Y..,..._..»...,.�..__..._._,_�___..,�. c QErt50Z'SN.OI'�e'�'G�f Q14y'SF"L:fttlle.P/iUr ZO f(S i55i1GKCc" , '"_"u._"__""__.... ............:... . . :... , O{.SO l2la;iil2S FfiA 4I�PJ�lt�111 �.^.Y SliC%! Permi: f0 Ji�C' G PWfv�sING FIXruRES �� `�; _�_ ssgned �aterne t rh¢i ree :s fic�r+seli p:+�su[1n1 t� tMe / ����-^� ��,nrnvrs:ons of!�e Cor:r.:ctork License Law(Chapter 9 GaSTEST //�� uU.�_ . �.�n . . . .. . �... . � ,...,..., .. .'..... .� �ranmem�rg x�r� �ectwn 7sPOl,�g�D;viazon ?of the UTILITYL'O.NOTIFIED / ' '" - ' �Si(sine55 aNQ'�.�YafYRsiOfls t;c�eJ or tiMt he iS exem�� . - � - � ' � � therefrr.:n r.nd?he hesis fnr ihe¢77egnd ex2mp:ian.Ar?� ry �-; .r— .. .._.--.----..�...........:::..:' .- ... . .u_.. : . n �. .. . �. . . .. .. . ""v'iol�h8�.oj Secticn 70.i7.5 by n�y ep2ficant jora yerrs?it Fi�iq�:.-: . �.�mt�Pi2,:6at�gd,eJa9� � � setoieels rne ap�'s�ie¢.=!i re%a i�ivii pene?py of�n.or nsore rF.an — .. .. „- __ 7.:.. . . . .... .. .... �. -.�—.— -..,.--_.. . ,_:_....... .. —' - ;i;�ehundwzddoltArs.($SGOj,:. . ... — . _ . . ._ ... .._ .. •V. ... . u 1,as ov;ne:ci ihe.p'�pecty wit!du ct�e t�•��k,and IND'JSTRIAL : �� � � . . .. .. _ . ._ . . --" . . WASTE APPROVA�: . . ' ., . .. ., .. .'. ...- ,.,.'.:''.."....".� ,...... ." ':..' thE.StiUCttlCG.artntis�ter.dedaxtzfCereS'orsaie. -a--- . :--....�`:k..e-.�,.w:..�..,,...-�,.,,az...;•„..: . /Sec. ?644. Susiness and Professiprts Ccde: TYe Cen- - . . � •. � � . . � ` . ..'.:.-. ....,. `..`' . . . � � tr�ctnr'.a Lfi�ense�Law�does r+i:t app7p v6 ai� c,wrisr�of � . . . . prnner{y.wlto builda or impmve�zheraora,cnG who dozs _ � .. - .. �. �� . ` .. . . . � .. ., .. ., . :. sueh wurk Mnns�iJ.G"�ol�'ed.tkut sEeh impravemants � ��:�-�. . .- ��,: � ' � - � are rwt i;a.+endea c,a�f:errd fo:sele.7f, ho�%ec'er�.�tP+e . .. .. ' �' � �� � . . , ......_.___..__.._. �„...,..,. ,�... �.,;•.,.,.r- �...-,.,. ::.�..=..,bailding cr irr.�royemenl is .roFd wi*nin or,e year of � � ' . compfetinrr, Fhe e�vrer-bu:ldc+- wiii have tke b.srd2n . � --�-��._�.�—.—_..:_�__ . . .- ..- .. ... .._.,_.,:......,".�..�",�..,,... ....,. . ..... of AvnvE.rrg rryai he did r.at harld o° in�prove fm� rhe .. . . . ... . �,u-�n=e af sc.ie.l� �. � . . . 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