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HomeMy WebLinkAbout03_27_1985 - 21073 PATHFINDER RD '"'°�'�""�"�,T'°^'°�"T'°" APPLICATION FOR PLUMBING PERMIT ° �hercby�offirm that I Fave o certifimre of mnsent to self lyqyy�p . � � irqure,or o mrtii{cqte of Worken Campensarion Inwwnce, CE 811(REV.10.�81) . . . �� � . 1 or n eenified copy thEreof(5et.380D,iab.C.) /� � CrSllNTlf C3F LD5 ANGELES BUILDING AND SAPETY { ��C�� I P❑oliey No. .. ._,TComppny ��T . . . - _ . . . Ctnified copy is hem6y f�rnished. � � Conified mpy is fited with Ihe county 6uilding inspec-. _�a������N������ BUILqING ' �� o2/D73 I��i��iND�, i NOn de enL � � NUMBER � FIXTURE Of1 t1EM � � FEE ��//� � / . ,J/f . . . LOCJLLIiV '� v/Y pnte . �'S Applir,ont�`r/"��� . WA�a� . . . . i5F.4�5i i CERTI IfAIE OF EXEMPTION FROM�WORKERS' eniH iue . . QtOsS bT. ; mu�snTioN iNsuwaricE �R � y JY/�P ; s�o�r�a (Tht�seetien nNd nori b�eomplatad ifihs work Imwlved br � , ths p�rmif is(br one hvndnd��d011un(5100)or(o�sJ -...� �AVAiOev . - �,poR�55 t'f Z / e � I cenify d�at in the performance of fhe work tar which�his � �� - pprinil is ip�pd.I thpll+m10TPlOy qny.ppnon in U�lymnnnEr S�NK � - C,ITY ���, ,��� TFt.rp. ao w ro become subjecr�o fhe Workers'CompensoYfon bm. �/ �— . . .. � MSHWAStER� : . COMkAROR . �/� - �� � I Dofe . e�licuM CIOiHES WASHER � ' . i NOTICE TO AP�IIGANT: li,che�making Mia Cerrlfitote of ������� _ �� . � i EYemption, yov�ahould bacamo wb"eU Yo fha Worker� � Compensatfon prwiaiam of rhe labor�cde.Yvu mys�forth- . GTv�� iEl. ���9 1 with compiy wifh such proyisions qr 1hi#peYTit sholi ba ���INKLERSrSTEM � d �7Ah L g •1 deemed rcvaked. �WA��p�g� � UCFNSF NO. ,' � %� . LiCENSfD CONiRAGrORS DEGlARA71Q�1 . � OISiRK7 NO. BY � � �hambr arWm fr,ai I am(icen;od w,ae.pravision}�E�F�pprer v � � cnssXs�F�M � ouners (cotnmefxing rnlh$eclion 70pD)of birision 3 a1 tf�e 9usimss q11IEi50VER - - . �" � andProfessionsEodp.ami�myli�emeninfpllf.qlAcaondeffecL SPERSYSiFM �Np� d ticenae Num r ����� 1�c.Ctau`� Dq� a/�b� , VAUDATfON � , Z „i �FINAL � � O �= COnfraclw ,��Ote � _ �/' :� - . . HV � f W � y r I am exempi urdm Sec. B.dP.C.for this reason - ' � . . ' . - . . Z . _ Plpn check fee �3 7 z a.A �re: �unnHm�G vERnnir issuir��5 �� . . . . � — sigrKrt�••• _— � . _ TOTALfEE Q . ��•,• ����� • . � � 16�0� i - Plan check aPPlicqnt s�n�ctE Fannur 0 u 1 2—8 5 HOME OWNER.BUILDER OECIARATION Nome . . . . . . . _ .. . . I fipreby cff�rm thot I am e:empt from rhe Confraetor's tieense Address �� lnw for fhe followi�.eoson(Secrion 7037.�,Businesf and , Professions Code): . � C�iy � Tel.No. " � � �,as awne�of tha properry,will do fhe work ond the � -� . - ahucturo is not intended o.offered for wle(Secfion - � . . � 7044,Busineu ond Prafeosions Code�. . - . CONSTRUCTION IENDING AGENCY _ . . � . I hereby offirm Ihal ihere is a co�ruetion le�ing ogerrcy fw - _ �he perform4nce of ihe wo.k 4w which thia oermit i�Iuued _ . . . y lSec.3097.Civ.C.). - � � � - j lendx's Nome . ... � . . . . . . � . . I i Lendd's Addresa . . � . . i I cenily IMt 1 hove read this application and atafe ihal the - ,� � } above information n corrM.I agree to comply with ali County " {� ordinance�and State lovrs regulatmy Plumbing,and hereby . } authorize represanMeives of fhis Counry�o enter upon the � � - � � - � - ? a6ov -mentioned propeny for inspecfion p�rposes. � � .• . . � � � r SEE REVERSE FOR EXpLANATORY LANGUAGE � c� a`� i Signa e of Permittee Dcf -. .. .- . . . . . . j i � e y G) A p Z .� . - • '� -G+ �y C O� � U+ � �' �Z Z a N., � � r�d -�—e x c�n q . " . �C r�- .0 rn 7 2 � y 'e . y� O � � N � � � � O ��", < - -' � � v r�- . Z � �i�y' S io � _M " _ O . O-� p rt� • 41 � cn �--� - 1 � . �� � . � � � r p �, . . . ' . . '�_ � � � ' � ; � ., y rt, . C t ^ � � � . .. . , �4..� . .. ' ^ ^ � . 70 .' . 7�0, N � m y 4 �' � m ;k � ' E . �. �. ' � - 4 Z N � � �. ti � fA � � 0 N 1 ' , E � , ,. ; �� � ;; r , .. � - � � � . �� , . 1q � � . - . (� ,p O � � n 7- � . 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