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HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (157) �_'"r- --......... . .....u..-.., �asas. _. ..y.,.:.-�.,.,,s.;v,S.,.�u ,�.,:..f:::w�.v:�1`w't5��. _' i ;� WORKERS'COMPENSATION�ECLARATION , APPLICA'TION FOR PLUMBING PERMIT - ._.� ..,_ _w...��....,...�.,_._n.<.. ( he�eby aff�m �hat I ha�e a cert f mre of conse t ro.sei(�,_ �yqyb�q � ������ - -��� �� -�- -.� � �- - - �� � --� _ , ._. ., ........ . .,..... � , . .._ . _..�. ,� ' - nsure,or a ceriiticote of Workers;Compensot on Insu pnte, CE 817(REV �0,91; o�a cen fled copy�hereof(Sec 3800,La6 C.1 COUNTY OP LOS ANS'aELES BUILDING AND SAFETY ��� t P❑ol�ityNo. � Company � �. . . . , - --. ._ >.-. . . .,.�_....«....,.,..... . ...... _ -.r s..... . . . .. ... .�,.-,..... ,.,_._. _..... . . ... � ( ) Cenif ed mpy is hereby f�rnished. � � . �. .. ..,.,,.».,..,...,, ,.,•.,p,,,r,�m.�,,,a�� O . .. ..... . _ , . . FORAPPLICANTTOFIILIN PRINTORTVPE BUILDING - ` `� r--�-: Certif ed copy Is f Ied with.the-county building inspec- ADDRESS 0 ' lion deportment. NUMBER FI%TURE OR ITEM � C FEE '` � � � ,...,..-,,. LOCALITV r_ �j ., l {,� �,y . �-,�. �Dote � . . . ...�+PPlicant ..._..,..„. � _ WATER CIOSET .. . �.. '': NEAREST . ... . .............. r ;,, . . . „�,�......, .._ ..__�......, -•-`"' - �-��CERTIPICATE OF EXEMGT19N FROM WORKERS' � " sA7H iUe CRO55 51. C'OMPENSA7"ION�I�NSUkdNCE" ��� -'�-�-'-' � �•-�-�-�• OWNeR 'y ���� ;.. .. . . Yw.. . (This secfion,need nof 6e completed rf the work involv,ed 6y SHOwER fhe permif s fo one.rion�red dollars(5100�or less.)�- �AVA*ORY ' MA�� - � � :- . .,.- _ '�-` , .... ADD RE55 � � I cer�ify that in the performance of the work fo which ihis � �--.-.... � - -- ^�"^,^- n��nw� .��»,rr�+ � permit is issued,I sholl nof employ any perso�in arly manne���� SINK .. CIiY tEl NO.� • so as to become,su6ject�the Worke s'Compensaj:ron Laws. f - --- �- -"�� ,-, -- •�- - �• - -•- -�r-����w- � - „ - DISHWASHER ~�7'. . .! . ' � .. ..,..,,».w... '� �R�i/....�: ',� :,.. �_ COMRACT Dot�--�- � `�''AppliCant f � - : ��"^^'"' CLOTHES WASHER � , NO�I`CE TO APPLICANT� If p4ter mok ng this Cert ficafe'of`.- ! -� ADDRESS /, �' % j� �f � Exemption, 'you should become sub�ect to the Workers' ! $°���'�����Pt�' CiTY r. iel NO��p�l ' , ,,...,..,. Compensohon provis ons of the Lobor Code,you must forth. LqWN SPRINKLER SYSTEM � ^ r' °`" � f � �'�� ' ' :_....,....w. .... .. �- � -with comply with such provisions ar fhis permit sholl be _ STATE ��- " .,-.".' �� �lIC." _, �` .'""..""-' LICENSE NO.�'; F�... . ; '� CLASS �"".`; deemBCl revoked. W ATER HEATER ' � G ' � -� -LICENSED CONTRACTORS�DECLARATION - ....,.,__....,..,., ' DIS'reier�vo."""-"" PRo�Es'5�'BY"`"'"""'"'"-"-"' � . .. � ....,.,.,....� .,,., . _ . • - "'�"�""`�"'- � GASSVSTEM OUTLETS I hereby affirm thaY I am licensed under provisions of Ch'opter 9� �.. � '' � v'-_.�' (commencing wifh Section 7000)of Division 3 of fhe B�siness OUTlET50VER -� """' �'��" � . . a� and Professions Code,and my license is in full force ond effeci. 5 PER SYSTEM FINAI � � . . . . . ._.....,.:. . . ,...._.. .: . i" r � r .� / / ' r �` ,., oATE VALIDATION � . License Numb��., µ�� ,^ ��n� Lic C�assti-- " ���' _ . . � -� � � ; ' ('. „ � FINAL .. .,_... � 'y - J � �.�..r x , . ,'� . �... �..;. �' Conrracior��- :<�.. .t.� Aaie rj. . . _„ � . � : .�._... gy iy � ❑ � . ; , .. ... . . ..,� � r. - :. . . . ... ........... ... .... ......_...�,_ . ... . ..� I , � . .._....., I om ezempt under Sec. . „ . ..�., -r"! w ' � 8.&P.0 for this reason ��� - �` � d •A Plan check fee a a _ . Date� ��,y,,,,.�;,,� pLUM81NG PERMIT ISSUING FEE$ � � ..... , .A.... � ;. , � Signature . � . ...... - . . . �. . . . ' .""'"'" TOTAL FEE :��,,+:�. W .. .......:..........�r�.��R„-..�.W..�,m.s�.:.:..,w:.,,. , .. h' . � .. ,� � . . Plan check applicant � � SINGLE�FAMILY . ._... .,..___.._._:...»:..-,,...«....u,�:....:,<.�.r.�=.� - h ro s � w; � . HOME OWNER-BUILDER DECLARATION Nome . . ,..�...., . ..., s,.,.: : ., �, ^ . � , i hereby aff�rm fhae I am-ezempt from the Contrador s License �" �' ' '� -".`�.���"'^^•�'t*",^°�� ,-++^-�:h^� � - • �� - Address � �� Law for Ihe following reason (Sedion 7031.5, Business and . . � � . •- Professions Code): ' - ' ,_ .,..,."..�.",�","r . ,. -'""x" "." � , . . � City Te.No. �� ��L•�� � � ...r.,,...:....-„u,::_.M�. . . . . .,�, I,as owner of the property,will do 1he work and rhe � ��� ������""�Y�'�"`"H"`�""'�`" � , ,�as:o..;:e�w•,r,w+w+n+�„�v.s+,.wtww - , strocture is not imended or offered for sale(Section - � � ► � � � � 7044,8usiness�and Profess�ons_Cpde).� �� " �� � � - - � � � � - . � .. CONSTRUCTION LENDING AGENCY,� � � � � , ., ._,„. _._... . __. . f hereby nFfvm ihof the e s p consi�ct on lending agency fo..,.'..'. .. R ..'. . ''.,D....--., .. � .^-, --n.-�-�--. ..;......._ ....,....._,......�.,..... ..,,_,_ ...,.�.,„.. _ >. .... �he performonce of ihe work for wh<h�h s perm 1 s issued /r�� (� ,�� 'L(�Y�-�a�/ � M .... (Sec 3097,C v C). �� - L' ...� J . � .lender's Nome - ��`J�'-��' _. . . . ...,..�..,.-.rn�n�.e.. �bMnxW+w-+po-a'vk�'��`.r4K.aW'r!'_" .tl4wie-uN' .y.4� ...;..: ..y.a.��.�'aN-Kv.v«u11�bu+�'d., . . ., . .. - �. ��. . - . .$r,W.+,n as o-.=�M4+i','wy"a'.:i?b'iti�.'t'.'i�'n-c+sWrtda}('N'n4*,-a6m+an'Y.v,pNe:a - Le de's Add e �a.m � - � - .-,..�.,,... o d n f c�s ond STater lows ty p f cat on an�s�a1e fhatihe -W'."'... , ..`_""" `.".`.'."" .^�-�,-_.,,.� ' � � � . Y „ . ..r.p .a.,�...... . ... �,.._ _,...__......,..,., a6ove info mot on is<o e 7 1 agree�o comply w�th all County� � � -' � .-.. ' - gulating Plum6ing,ond hereby �aur ori ' represenlntwgs Af this County ro enter upon the . ent�ored prope�q fo Inspec+ion ou oses � a6 , rK ,., � �` SEE REVERSE FOR EXPL/iNATORY LAMlGUAGE .� �f. , �r J, _.,...T.-.,.,..�. .,a.. . . . ,.w.. ...-.�.......> ... . ,- T- � r .f .!°,R":., •. .'�1"+ �./�✓ �.+^" R- ._,. .,�—, ,.. ., ., . _._.. . ._, .-.. »...... ......._ ,.. �S gna+dre of Pe,rmine=_da" .._..Date ... �� ...... . . - . - . .