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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 ' � 4-24-85 {{{ ure of Pormin� � 04�e � - � .. . . . . . . � i . _. ._ _ _ - � = � � A � �Z Z � D c O D D O Z ' � fD/�� D N �C N N C � m�'N'1 � T � G � � � � . ' . �D Q � � m ~ Z r N D . ' p r • .� A fi) Cz � '�o , � O O � = F f O — � Z � D . � ; o N A � � � . Z � u, A - r'� ' -ni � ' � ' \ D . O ~ .'V f n m N � �J -- z . o o � '� Z �-i N � r� � � . Cn � Z • D c • � � r i N r�i � � ' A Z I O � m . � N � � II i , ip �y , . i . O v Q, . - 3 o SF f oi.,T an vo., a, n3-0 o . w� - O O �F 3 O S� A W �] w� O n � n � �'.qo � " S . . , . � � QO � . ��?'�� , �O N A N O �. N � � � 1 � � 19 � : . 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