HomeMy WebLinkAbout04_24_1985 - 21073 PATHFINDER RD '"°R��•�°^"�"�r'°"°E�`�,T'°" � APPLICATION FOR PLUMBING PERMIT �`;
I hereby affirm tha�I hnve a certffimee of consent fo self �ypay�p � � -
irisGre,or o car�ificule af Workera'Compenwtian Imurance; CE 8�7(REV.10�8��� � - . �
� or o cartified copy thereof j5pc.380p,I,ab.C.) � � �
4��84�1 Q4.9� Western ERIp10ye1^S COUN7'Y OF LOS ANGELES BUILDING AND SAFETIf
� Compony
Certified copy is her�by fvmished.
� roa e�wucp,ror ro Fiu ir+�rrsiNr ai nrE� suunirrc
Certified copy ia flted with the couny building inspeo� /�DottEss 21073 Pathf inder Bl d �C
rion deportmen�. _ i rvuMeEa FlXTURE oR rtFM � � . �p�qutr . y
�re 4�24�85 A�i;4,,,, Lee's Plum4inq w^�Ru°�' �n�st Shaded l�ood Rd. ;
CERTtFICAiE OF EXEMPTtON FltpM WORKERS' s�cTH rile � tRoss sr. i
� CpMPENSHTVON INSURANCE �� �ER- �'�R PATNFINO�R I I � � �i
(ihis ssetlon n�ed�rof b�rn�np�oted i!ths work Inretrod tir: ;
ths p�rmft is foe ons hvndrod doflms(5100)er loss.) . tava.roRY � �
""'Ao�oa�ss �21U73 Pathfinder
1 certify that in tF�e performOnea o1 tha wark}w whkh thca� . '
permil ic issued,I ahall rto1 emPloy atry pelaPn in a�ry monner. SINK Q� GTv T6.NO. }
— ao m ro become�ubjec�ao�1+e Worken'C4�Pensotion Laws. piSHWpSNER � . .�-
� . . . , CO�RACTOR � - �
i
ppte � nppiicon/ � � � C10T1¢SWASHER noo�ss 2407 N. lee Ave. � - ,
NOTI�TO AP7l1CANT: If, after muking thy Cer�l#icate of �
Exampflon, you should become �ubjeer ro the Workera' Sww�nn�NC''v�001uECEv1pR _ ,
� Comperuation provi�iom of the labor Cpdq.Yo�m�st fortF- �yyp��wK�R 5,�� 'C�TM $0. El Monte ��. . i
with comply with rwch,Wrovls�wa or thia permir shail ba Stu�A��. , `,36 , t
deemed reroked w�YEe r�w�a �
.LlCDVSED CONTRAC�ORS UEGtARAi10N . � Dlmi�c7 No. o er '
I hereby affirm Ifpf I am licemed undn{Kwitiot�4f�fhapter 9 . � �SrSTE!N �uREfs . � �
.fcomme�rcing with Sedivn 100Q)of Div+sion 3 of Nte Busioeu .OUREiS OVE7t . . .
and ProfessioroCode,ond my ficerise�a in fyll farce.and effM. '��p S�� � �fIN� � �
' VAUQATION O
_ Lieense Nvmber 3Q814H.� ���.cb„ C36 �H �. � - , �°�^� = 7--ff . o �_
��,��.�eTs_.P�.u���en-za-s� 6`' W i
❑ �om exerri�,�vnder sx. - , � _ . . , . � m i
B.6P.C.for thia recaon P�pn Cf16Gk fC9 . . � � ,� � Z j
-- . Da�e: . PlUM81NG VERMIT ISSUMG fEE E � .� � :-
� Sigrw�mr� . � , .f
. . TOTAL fEE I . r�i �� � -;
. � . ,:e, ., �
Plan check applicant •.� '.
' SINGLE FAMItV � ��i � '.
� HOME OWNER-BUIWER OECLARA"f�ON Nmne . ...... -. j_ _ , '
I heraby aMirm thot I am exempr fiom�he Controc�or's liceme � - '
low(or rhe follow�ng reason(Secrion 7IXi1.5,B�siness and �r�' � . . .. . . . �as-S� . 1
Rofenion�Code1: � � Gry Tel.No. . . .
� 1,ae owner of�ha propeny,will do�he wrnk and the `r '
anuc�uro is rroi�nYended or offerod for sole (Secnon � . , . �` �O , 1
7M4,Businesa ond Rofeyfions Code). � . . ;
CONSTRUCTION IENDINCa AGENCY � . ��.5�P�J' t
I heroby offirm rhor iha.e is o comtruc�ion lending agency fw + . . {
ihe performanca of the work for which thia permit ia issued - . _ , , .. . . . . . �
ISec.3097.Civ.C.)• � . - � . , i
� � . . . . . . . . �. . i
leMler"s Nama -i
LeMler's Atldreas � . .� . ' . . . . .
I certify tha�I hove r�od�his applica�ion and s+ota that tha . � � _ � '
obova infwmo�ion is correct.�I oglee io comply with oll Counly . - . . .i
ordinances ord Sbre laws�egulming Plumbing,and hare6y . � . �
ourh ze repre»ntatives of rhia Caunfy b emer vpon�he � � . - - � � �
abov -mentio�ecf properry for�nspec�ion pWrpwn. � . .
SEE REYERSE FOR EXPLANATORY LANGUAGE ' �
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