Loading...
HomeMy WebLinkAbout1155 DIAMOND BAR BLVD (3) WORKERS'COAAGENSATIONDECLARATION � � �ppLICATIC�N FOR PLUMBING�PERMI�T � {} , I he eby off m thot I ho e a<errificate of consent io self 76A667A . �� in ��,ar a ce 1�fimte of Worke�s'Compensation Insuronce, CE 917(REV 10:81� ,, ,,.:� �' or o cgrtified copy thereof(Sec.3800,LaS.C.I COUNTY�OP.LOS ANGELES __.__.. .... .BUILDONG AND SAFETY�- '. P�olcyNo...... PY'. CoyppnY .. . ...... _. .... .. .-A .... .... ��-. .... �#;�,saer�.�'',.,:.....-: . -. ._ ... . ' Ce�iiied m s hereb f�rn�sned. -� - - -•-� - .--.. _ - , ,'�,�';..."� '�e�'r'r+:� ' . ❑ ��� FOR AP%.ICAM TZ7 FILL IN f7RINT OR TYPEl BI,IL�ING L � Certified copy is filed wdh ihe coumy build ng inspec �� ��• ' - "' .4DDRE55 U -.... , ..WF. r on depo iment. NUMBER fIXTURE OR I7EM , ,�,y 7 FEE �OCAI�Tv ' � ��� : � . .� . . .. _ .. ..; - .... .,. ' WATERCLOSET ��(�Lj ��� ��aie -� Appl cant NEAREST � "._. - ��CER71fICATE Of EXEiJMP710N FROM INORKERS' BArH TUa CRO55 Si. ...,. ,._.- . _. ,a�., . . ___ ,,.. .... � � � '"-� ���COMPENSA710NINSURANCE � owNER ' ��(7his section need nor be completed if ihe work involved by SHOwEa _ (/4-L, � . . _.,.._ „a..r. � �he ermie is for one hundred dollars 5100 or lecs. • � '�M1P��� �„��— . � P t ) ) IAVATORY ...,.,..,,.._....:.- A�DRESS .,. _ � � I certify that in the performonce of the work for which this � ' � �perrriii is issued,I 5hall not employ any person in an� nner SINK �� (f'jS CITY 7EL.NO. .. .... ,..,:......, . .:... ..,. ..y�.....:»:..�6-.:._..,--,_...:., ��50 a5/o 6e[ome subject t/o fhe Worker�Compen= Lows. Di5NWA5HER � � CONTRACTO � (y+�`!. J ��D pf���A. pplicanf CLOTHES WASHER AD�RESS .'`- s`�J�-t �`NQiGE TI p APPLICANT: If, afier ma m his Cerrifiwte ot . � � W� �� Exemption, you should become subject ta ihe Workers' � � .�'. ...,. .. b � �iT� ,�.�J',�._� TEL NO. Compensation provisions of rhe La6or Code,you must forih- CJ�""�""A . wilh cOm I wifh such rovisions or this ermi� sholl be �AWNSPRINKLERSYSTEM •��- pY P P STATE . .� . .LIC. �f�� ' �deemed revoked. - � � . WATEk HEATER � ya L!CENSE NO. baj CLASS �.- . � � LICENSED CONTRACTORS�ECLARATION DISTRIC7 NO._ PR CESSED 8v I here6y affirm that I am licensed under provisions of Chppier 9 GASSVS7EM OUTLE75 f� � / � (commencing with Sec�ion 7000)of Division 3 of ihe Business OUT!E750vER , and Professions Code,and my Iicense is in full force pnd effect. 5 PER SYSTEM fINAL VAUDATION License Numbe Lic Class��� ��" %]% �ATE � / FINAL (j Contractor �*�"'• ate (L���� BY � � F 8/+.l�( �C+ d71 - o , If am exempt under Sec � � � U B&P.C.fo th�s reason � - � - - Plan check fee d ' . � �`Dote PLUMBING PERMIT ISSUING FFE$aa �a �J � z � " Sgnature - . ' � � � . . ' � TOTAL FEE fy� � >�9 i 4,9 A .. . . . . ... . ... . . ' - Plan check applicant .�% �"_o o a a e,�j . � .SINGLE FAMILY - - �"::-. ,.:-' y .. , HOME OWNER-BUILDER DECLARATION Nome _�_ ����y�y�,�r���i � Fa .) � r�v� � I hereby affirm tho�I am exemp�from�he Contractor's License qddress Law for the following reason(Secfion 7031.5, B�siness and - ". " m� ? � �Jc n` �, Proiessions Code)r City Tel,No ❑ - z .» I,as owner of the proper�y,will do Ihe v✓ork and the �, f/� e u, `J.�i`�� � struc�ure is noi intended or offered for sale(Section � "� � 7044,8usiness and Professions Code�. - � -.- . � �� �J � :ONSTRCICTION LENDING AGENCY t � -� � i hereby nffirm that Yhere�s a cons+ruction lending agency for •�!L��� � ;d���' ��'�4' ✓� �he performance of the work for which rhis permit is issued � � � (Sec.3097,Civ.C.J. . . . �^ . , . . � Co �i,_ .__,,,.:. ,..........F. .....,,.. ..._.,.. ._.. .... - ., ,....>:.. .. � ___..,. . - :.,.,:..:;...T.,._...._u..._� :. ..: .. �. ..:..-.-:.::i .-.,.:..., ,,.:�.. . �-. .;- �.,�^ _._._... ter.dei s Nome ., .:�'..-,. - � ..,,v.... .. . . ..:.._... ._....,........ .............. . ' ' .,x,..-=-..e:_.._.__.:..<. Lender's Address . ... .........................,,:...._...,.w.....-,...�,.._. �I ce.r!ify rhai I hawe recd�his pllcohor ana siate that the � � ► above informo��on is c ct I gree lo comp�y with oll Coun!y �ordin s and Sta1 lo s r gulaling Plumb�ng,ond hereby aut ori represen otiv �his Courty ro enter upon the- � - � aoo � enrioned r n for inspechor.pu� oses. � ' � � �� ' � ' � - f-� SEE REVERSE FOR�EXPi'ANA101fY LANGUAGE ignat e of P R Date �� ....�. . . ... .. ...... . . .._ . � . . . : . . � "•: c�a,[+� . . - - � �� ' � '..,.:. ,.�,. , ..-. � . ' -- . . . V 4��'4. � . ,>..,,_.. .,. � - � a.+r,,..»., ..a«....: - ... . ..»»...... >.. ." - ��;nR., _;�..:.� ... ..... . ',.. ,..N,�2�... ..� .. . ��¢''_.. . ���w M.r.� ...,iws9 �w _ . j . _ . AP�RCVAt; CAT INSP R'S 5 A7URE !NSPECTOR'S NGTFS O'�PiN[�-gU'LD`�'1,C;a;2,=.;IC�i UND=R SLA6 WOkK '- , hereb,aff'�rm�hot I om=r.emp�^: m sFe:,c��---'n•'-, ROUGHPLliMB�NG . � ' ._ L�cense '.....a fnr thc fn`lo:•:inn r n (.:ect%�r. %031.5 Ga5 PiWnf� - _. . Business a^d Nrofessions Ccd,>::Any cityo-;:oi�nty,N!�'ch GA54ENT ' ''" - - ' , requires v permil}o cortsiru:t,olfer ?mprove.d-_r,.ol.s:;. °� or repair any str�ciure, erior to ifs i uance, also r '�O'WATER H:ATER � � „�\,. � qui�es tF.e aQP(itdM fot sVch Permit to H!e a s�gned str.te- F'i.;h+9lvG F%%7U�^.FS _ _ _ _ ___ ___ meM lhat he is licensed pursuant�o tl;e provisicns nf��e GAS 7ES? � "' Cnnircc!er's 1 icense Law i Chceier Y'c nm �, UT;il7y[O.�O?IFIE� � _,_�_______ _ Seciion 7000)of Divisicn 3 0?Phe 6usiness ond'Pro;es- . _ . sions Codef cr ihat he is ezempt rhereJrem cnd ih=oasis __ � ' for tha allcgad e �mptio� n.n� v�olot:on :i Secfian F''�`A'- Gnfer n ��osef . 7tl3I.5 by any applicant for o permit suojec�s rne qppli� — !p� canl tv a civil penal;y o�no'mr,re+hon five nundred �� doua�s�ssao�.:, �'NDJSTRIAL � i!�e a u�tu�re owno r n�nded�or olf ered for�so�e vc 1�P5..A-F2C'✓41 ' .. . . ____ .__ .-,__ .. . ,r,. t��� ^ �� . „�,. ,,•L,v � � (Seo.7044,Business and Pral�ssions Coue. 76e CoNroo- .'.R�� ' . .. ... . — — � � - _ � +or's License!aw does rtot apply!o an o�,Nner oF properiy , .- '� "• who buifds or lmproves tF.ereon, crd who does such �, ..- . ., . ,.. ., r�. ::.,3,.. ._...� � . . . � �� ��� � ` work himseH provided fhat such impravements ore nat iMended or olfered for svle.If,however,the building oi , . � . . . . ,. _ , ,. . - improvement is sold wifhin coe y�or of campletion, 'rhe _ � � �owrier-buifder will have the burden of p^oving thot he did � �-��-� � - ��- ��� � no�bqild or improve for the purpose of salo.j . . . , i.,�.,.. . � . .. .. � .... � . , . . . ��-:,�-1r<M...`�,�-„'_, • . I am exempt under Sac�---� . . . . , . .�r,�; ^._� � � . . . .. ,. . ,.,, .� .. . - � � ' � � B�P.C.for ihis reason . � ' � Date— . . Owner !NSPECTOR'S NOTES �� . ... .� . .. .......__..,__. . . .t_ ... . .._ .,. ^ .� . . ...: � .�, .. . -.:._ . . . � � - - � � _..,.:a..,.�.. . � . . . . . . _:._..., .. •. - .- - , — - � .... ..�.... �. .. � >>- .. . . ' . .. _ . _ .. � . _ . ..-. .. .. .......... ..�... . . . . , . ... . ...�.,....:. =��-r h�� ' . .. . . .,. .-..,-. . . ... _ -..:.�.....�_. .- . . ^_ . .. .. . . . . . �...er _�.._;_.. ,�., . . .y �