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HomeMy WebLinkAbout04_27_1987 - 21073 PATHFINDER RD WORNERS'COMPENSATIONDE�RAT��� ' APPLICATION FOR PLUMBING PERMIT . � � I hereby,offirm�ha�I Flhvd u�cenificafe of c e t elf TB 7A � insuro,or a certifica�e ofyy wken'Com nsoY In nce, 81T qEV.8l86) � . . . or a car�ified�opy�the+j��5 fc.�(10,ta6.C.j CDUNIY OF LOS ANQELES DEPT. OF PUBLIC WORKS � i��✓ oity No. � Company Certified copy is hereby furnished. .a . ' ." FOR AOOII�ANT t0 flLt IN(PRINT OR TYPE) BUIIDI � C rlified copy is fi{ed wllh i e n i ding inspec- �R� � m � MBER FIXTURE OR IifM Q FEE - LOCAIiiY Do �ppliSaM � � WATER CL06ET - � � � NFAREST _ . .. � CERTIFICAtE OF EXEMCTION FROM WORKERS' - � e�ninls . _ _ Crm55 57. _ � COMPENSATION INSURANCE oyy�Q.. (Thb��cNon nNd oot b�rnmpl�Nd if fh�work Inroh�d br S�qWER th�p�rmb b for on�hundnd Aoilon(5100)or bu.) LAVATORY ��� AUuaE55 �.I ceriify Ihaf in the performance of tbe work for which thts _ — permit is is�ued,I sholl not employ any person in any manner S�NK ,� C�TY, � 1Ei.NO. � �so as�o become aublect�o rhe Wwkers'Compenw�ion lows. � �� D�SHWASHER CONTRAR �. .. . Dafe � � �.�piiwnf . � � ttOTHES WASFIER - - . � .O .NOT�CF TO APMICANT: if, ofter mqkioq this Certifico�e of A��u - -- � Exemp�ion, you should become ¢ubject �o the Workers' SWIMMINGPOOLRECEPTOR Compa�sa�ion p.ovisions of rhe Labor Code,yov musr fwrh- G 7EL LAWN SVRINKIER SVSTEM �wi�h comply wilh such provision: or this permil :holl be SiATE LIC. � deemed revoked.'' � - WATER HEATER - ������ � . LICENSED CONTRACTORS DKLARATION , DISiRICT NO. PROGESSED BY 1 heroby oKirm tiwi I om licensed umler po�isions of Chapter 9 G0.5 SY57EM - WttETS � � (tommenting wi�h Secfion Tq00)of Division 3 of tM Busir�ess . pUTlET50VER - y a�+d Ro�ess�o„s e, '�e is in foU force and eHgcl. PER SVSTEIu� FINAL VAUDATION � — ticense Numb Lia CI �% DATE `V � — FlNAI 0 Confrada Dor BY . V O "' I am axempt under Sec �..';(�8[i']R 2 H B.BP.C.for rhis reos � � � Z Plan check fee � � • • • • •5 � �}e PLUMBING PERMIT ISSUING fEE S �,°�• � �5 O Signotu�e � . � TOTAL FEE (� • • ° � E�J O� . Plan cbeck applicant � . � OC.2R-87 � SINGLE PAMILY � . � � HOME OWNER-BUIIDER DECLARATION Name - . �� � � .. � I beroby affirm thol I am exempl from the CoM�actor'c license � qddress - � � � - - � � � ---��� - -- -��� -- --�� - � - low for��he foHowing reason(Section 7031.5,Busineu and Profeesions Code�: Ciry Tel.No: . . ❑ 1,os owaer of the property,will do the work ond the strucwre is not inbnded or offered for sale(Section - . . . . ... . -. .. . . ► .. . . . . . , 70U,Business and Profes�ions Code). � - ' CONSTRUCTION IENDING AGENCY � �� - � � � � � �- � � - -� - �� I hereby affirm�har�here is a conshuctioo lending agency for - - the performance of Ihe work for which this permit is issued � - � - � - � � � - �- " � � - � (Sec.3097.Civ.C.). � — Lender's Nome � � � �.Le�dePs Addreu . ;I certify rhot I hove read this applicaeon ond s�ote thot�he . � . _ . ._ �. , . . . . _. . ._ ._ _ . - �.above inf tion is arxt.I aq�ee 10 comp�y wi�h oli Coonty � . ��.ordinon 51 lowi requloting Plumbing,ond heraby ., . , . .. . . . aut o ro olives of�his County to eMer upon the . - �� - -- �� � a i pro spedion pyrpo��yr�� . . , ... - -_ , . - `u / SEE REVERSE FOR EXPLANATORY IANGUAOE iignolvre of Permittee Date . .. . - .. . . . . . . _.. 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