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1155 SOUTH DIAMOND BAR BLVD (66)
�- `4# x �"v'Sa�is°�� �,�' y�.�.r F ��,'�s�y� �;-�;��. �� . .__. � .., �'? ...a.:���� ., ��'wi' . _--E�f:s:z � s�`.. ,. � VJORKERS'�Cb'�NS�'N'�CL/�A�I�O� x-����r�� '`�"'� ( (�' ++av�xn.r a�r:s��a':. . �.' r t .�-,s+x.-� �...m, -�-,.h.�.,,.,;e.�. .,.. , �M, ,>,. ..�._,. IR��L� �1�� 'I�ie eby af�irm thm I ha e a cerr t cote o�co se t to self �bqby�q . insure or a ce hf cote of Workers Compensotio Insuronce CE SV�REV 1��81) �-"tn't7tA t�ec(copy thereof(Sec 360D,Lab C) . . -�.i '"` -?;.... ..L....�.:���s^,.,;;��;���;;:.:�;�:,�� .�:.��,�:,;„:.�.��,��,_;,..E,_a,x;,r ;,COUNTY OF LOS Al�BGELES_ BUILDINGl1ND SAFETY vq' �Fal cy No Company . .. . . . . . . ... ._ . .. .. .. .. ,,,� � Cert f ed copy s hereby furnished � � —�-������-� ����-�•-• ....... . . ._... ..., -- �- "'"` POR APPLICAN770 FIIL IN;PRINT OR iVPE) BUILDING � t � Cerhfied copy is filed with the cou y b ildina'nspec ADDRE55 u�• t on deparimeni NUMBER FtXTURE OR ITEPh _ FEE n �'� n` -"'� �. rr � „� 'f�•.&` �ocaury Date qpP�4a � � � wATER cLOSEi � " ,� 4.. NEAREST � i ,��tER�tFiC�'A'1�E�'7�`F�S�e1V1`P'�'i'bCTkk�81�nW6k�(ER�" ._.._ enrr+rua cRosssr. �.s �COMPENSA`lION�11�SURA�N`CE£';�� . ,,,,z, _ SHOWER � OWNER � �(Yhia secfwn nee�nof be comple4ed if the work in ofved�by�� MA L , the�Qermd�s for one hundred dollors(5100)or iess) L4VATORY ADDRESS � • �'t cerrify�thaf in t�ie���performonce%f�the work for which Ihis -�::..:::t.,.,.: SINK ..�,;�� permit is�ssued,I sholl not employ ony person in ony manner �ITV TEL NO. . so tls to become sub�ect fo ihe Wo kers Compensat on Lows. : ;+ -'�'. �� � ..� DISHWASHER ' � � •� ..�.k s '$__�tk�'-'�' y�ti's`.M�t cE r-.��c�� CONTRACTOR .. D t� � Applicont � CLOTHES WASHER �`�'�NO`TIC�',TO'�APPlI"C;f1NT: If,�pfter making this Certifi,ote of, AD�RESS . � �"','. Ezemptizin,'you should become subjeci ro fhe Workers' SWIMM;NGPOOLRECEPTOR -�'Compensation proGisions af 1he la6or Code,you must forth- `-�T� . TEL N0. . . . . { wifh mmply ith wch p o s o s or th s permit shall be �A`NN SPRINKLER SVSTEM � : 1 deemed evoked STATE UC. . � . �, , .,��._,. WAiER HEATER ��CENSE NO. '; " - C1A55 �� . �,� x L��ENSED�ON�YRACT��RSv`��C`CARATIOT�J DIS'RICT Np. ' PROCESSEO 8Y � .; . .`� - �....� .� ':. ' :"'.. � "�,... GAS SYSTEM OUTLET$ I he eby affirm�hof I am I censed under p ovisians of Chap�er 9 ";��(eommencing�with Section 7000)of Division 3 of the Business pUitE750VEe } -6nd Professions Code ❑nd my I ce se s n full force and effecL 5 PER SYSTEPh � �' �.�������� � FINAL VALIDA710N � _",��*�c�.r3: �'±�w�'+.���r�',�ti3�%n� DATE - Ll L cense Num er Lic C�ass ��x rS��'A..,qfye.t`- ,y�+�e��a�•n}.`e 3a ,�.� ...�t - . � ..�� �y,...�, ._�+r�.��Y/.��7 r,�.;�>���.��.��:.�=�1! z�s. -,._ .: � � FINAL � ,. _��Co troctor Date ��_�w � BY � I om e empt nder Sec � . � "B&'P C (or th`�s reaso � � �.�. . � ap ' .�����`��E �x`�*� "�-�`�� ``�are '�'�" u Plan check fee S T Y� .�;��; �S gnature � - �4' ; '- "' PLUMBING PERMIT ISSUING FEE$ . � r � .. .. .s �, - M� ; S ' '^ ,��� .,..5µ TOTAL FEE . '�� � Y� 3 �� �'`„o.,a��a-.r.; -v�"�_=� Plan check applicant � `°��,. g SINGLE-F��IIV � ... ; '�f .,:.�":HOME OWNE��U�Lb�R[3�E�LARATIO�J� -��� -� � �� � Nam= , ��I here�y affirm thpt I om exempt from ihe Confroctor's License Address i� ;�` �Lavi�for the foilow ng reason(Section 7031.5, Business and � "���-t�Professions Code): � ,._:,:. ;i7r.,;=j�'� ..- . . - City Tel.No. : .r o.x a x;�. LJ I os owner of the p ope ty w II do the wo k and ihe , str�du e s not ntended or offe ed fo wle (Sec�on a m �¢ ' �. 7044� Bus ess a d Proiess�ons Code) - - � � V .., .. . .,�„y, .��a s. �., �,�.z ' ::r.'..R3...,:.d•�E,.?�t,+.�«yk ...':,;: ,,�.�..-. .�s., . .... ,. , � . . „-„i°,�` h � '* '�..�CONSTRGCI'TOt�I�ENbIhfG AGENCV ..... " . � .. . . - .,.. . _... ...... . . . ... . . . _ ._ a.;'! .-.. �...- .�-„s._.. ..,.......,, . . . .. �. . .... , . _. . , � I here�y affirm that fhere is a construchon lend ng agency fo� �............. .: .: ... . �. . �• � . . ..� �... . ���.-.. . ,. :. ....... . . ....-..�i �X`-�` . ti..�. �.:;;4,.;�,the performance of the work for which this permiY Is issued ` "� ' ''..�?"; (Sec.3097,CiJ.L.). ... �. . � . : �.. -Y ., � . � �3-.��'� x- .t_;.z3,�1i>.z..;-.. _"..'S^.'f.�.;:&ss.W.:�....� . .. , , .�,?�,.F2 ,x,w���,..�".` t.,�:.i. -:�y;:,,:ni:°�i . 4x:::; �e`kY�..4.�.�hr "'A,'?�.r�.�..::tM��- �...v';c+9 F}�".�'tfe' .. �,a-:;',r,:,cky `�_„�""',..'�.-=. � t L'e de s Name �� ' t"a.,�'"s„N;:.�,r�'k.�„w�:��r�:e,��.-:?<�'�.?4�,,uw'°3�.-;r.��....',a.:f. ,�`,L o.-�,.l .,r ,...*.. 7,:,. .. ...... �, :�-�.,.. �i�aiF�:.,�§,{. -%:�,�.,.a�N ...�,... rV-c9?k� . .w5r. '�t-'.!i�i'�.. . ,<. ... ...,� .. _. ,�, �; Len�er's Add ess .�� ___ . . . . . ..:� �._. . , ..... �... �. .. .._ ...... ......,, . .. - � . . . �. . ..�,.... "?-�"�I��ertify that I ho e ead�s�app�icotion ond state that the � �� ► � � �� � � � -�Y.zabove information is correct I agree lo comply with oll County ,; oFdinonces and�5f61e'lows�reguloting Plumbing,ond here6y . � �i'""authorize represenlatives of this Couniy to enter upon fhe 6bo e ment oned p operty for inspect on pu poses .f r�� �t�,��?�^a���.�� �'��'�A s.'r�, r- SEE REVERSE FOR EXPLAtdATORY RANGUAGE. �.Y;,, ... , , , , 'a.'_.. . ,. ., . .:.. ..�. --;.,.. ...., -. - ,-. ,. _n--. - - -_-�... :...........:. .� :,,� .... ..: _ ., .. . . . :. . .,��t..� . �.�' . . - . : � 3"� 5 g atu e of Perm�tee Date ..�: ., _ ... , _.. ,. � k ' h. 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