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HomeMy WebLinkAbout07_27_1989 - 21073 PATHFINDER RD `"°RKERS"`°'"PE"5"T'°"°E""RAT'°" APPLICATION FOR PLUMBING PERMIT � 1 hereby,��affirm thot�I have a ceriifica�e of consent�o self in• p-�6 DaW aie��.. . . . � � , sure;or a certifimte af Workers'Com ensation Insurance,or a �bA��A . � � . - . -. . - � " - P � CE 8D(REV.8/B6) � . . rt�fi co y rhereof(Seu 3800,Lo4.�tCG.)�L�� I� COUNTY OF l05 ANGELES DEPT.OF PUBUC WORKS. �W�- �i43-�1-2S .. . olicy o. Company . . . . .. ��-Cartified copy i5 hereby furnished. �. � , �- �� � FOR APPLICANT TO flLL M(PRINT OR TYPE) � BUILDiNG �� Cerlifiedcopyisfiledwiththecountybuildinginspettibn ADDRESS a 10'13 � pn7�ar-r��e� - � AP n C. - - BC�ill.��1LS11JLiSS NUMBER FIXTURE OR�TEM FEE �«A��TY D 1�,�..�01�0 �1��+ � � , de artmant. .� . . . . � �. .Dote 1�'�1'1') 1 . APPlicant �p-:.PIAI��"�d�� � -WATERCtOSET�TOiLEi1 -�� NEAREST . . . � � CERTIFICATE OF EXEMPTION FROM WORKERS' � BATH 7U0 � CROSS Si. �Q F�� CIj'1�'C�17 �� , . �� �� ,� - �COMPENSATION iNSURANGE - � � � SHOWER - � . � ' � OwNER ��U�iG (�1�,�7 PA27 r{2,OPl,��Lc,"S�Jl,� � . (ThIP�ection n�ed nof h�complNed ti`tha j ork inr;ved by ... . . . . . �i� � G N 1 T���J� �� _ � �ha armll h for ons hundrad delltln 5700 or bss. WVnTORY - AODRESS 1 O 4� (Llb� �C117 � i I certify�thbt inlhe performance of the work for which this per• � n 'f � � , ' mif is issued,I sholl not erriploy o�y person in ony monner so - SINK � C�TY �'��L�„�G �a,1�V, rE�.N 1�41 U tvo� � - os lo become subjecf to the Wo�kerf'Compensolion Lows. � DISHWASHER � � � � . . . . . . . CONTRACfOR �-1C� ��{�r�S !LP• Y . .- � Date�� - '' � 'Applitont � � `�� � � CLOTHES WASHER ADDRESS � - �� NOTICE TO APPLICANT:�If,afler making this Cerlificele of Ex• �� � wZ' p�'� ��'�'� � �em fion, oo should become wb'eci fo rhe Workers'Com en- SwIMMING POOL RECEPTOR P Y I P CITY �aL uU TFL.NO�(I¢)�{{O�C�� � wtion provisions of the Labor Code,you musf forthwith comp- � � LAW.N SFRINKLER SVSTE1d .� - � 'ly with such provisions or this permit shall be deemed revok- STnTE ! / LiC. . � ed. - �. • - � �� � - ' � WATER HEATER IiCENSF NO. �lb�1� QA55 Ci—t3S� � � ���� � LICENSED CONTRACTORS DEClA2ATION��. � "� DiSTRiCT NO. PROCEySED Bv _ I hereby aNirm that 1 am licensed under provisions of Chapter � � Gn5 SrSTEh� OUTlE75 � ti�\ � � 9(tommencing wilh Section 7000)of Division 3 of ihe Business OUTLETS OVER `�L ond Professions Code,and my litense is in iull iorce and ef- 5 PER SYSTEM � FINAL (�/� y VALIDATION > DATE (,L O — L cense Number ,�1 bf3 b'i' u�.ao:s� C'=3 b - � , ' L.S9 t>C, � U _ g�`r7�+-� rbu.Sr.xysscou. lJA�+—S�OrCrJ FiNni � a � Controcfoi' Pl�;f+rS IA1(' � - Date 3'3�'�� . .. . . � . . BY � . F- -� I am exempf unde�Sec. - . . W � _ a 8.8P.C.fo��h�s.eosoo Plon check fee ► `� _ z �— � , , � 'Dofe: �' . � PLUM6ING PERMIT ISSUING FEE S O O . � . ' $ignature " � . . � . . . . -. . . . . . TOTAL FEE . � � ' SINGIE FAMIIY � � � - •- . � � HOME OWNER-BURDER DEGIARATION � � P�an check opplicant � � . � � . - � . �. I here6y affirm thot I am exempt from the Conirador's License Nome . � � , - - '-� � - Law for�he following reason(Section 7031.5, Business and � -- � � � � �- - � Professions Code): . . . . . - Addrers- � � . � � . �� I,�.os owner of the propehy,will do the�work and the �'�Y ' � ' Tel.No. ' ,-,� 9��� . struc�ureisnotintendedorofferedla�sale($ection7044; ���� . � . , . . . . . . . ,. . . . � . . , 8usiness and Prafessions Code). ' � � -� � _ � - ► . � . k • • • •5 � � � � CONSTRUCTIONIENDINGAGENCY � � - - � � �. � � �I hereby affirm fhat�here is o conshuction lending ogency.for � � � .. � � - � ' � ' � ��� the performancebf the work fot which this permit is issoed �_- �� � , � - � �o�'� o � h��'� . (Sec.3097.Civ.C.). �� .. - � � " _ .. 0�3.19—izg . Lender i Name � � - � � � � Lender i Add�ess �� - � - ' - � I cer�ify thdt I have read this opplicafion and staie that�the � - - . � � � �� �� � � � � � ��� . obove information is correct.I ag�ee to comply with all County � _ , - , ordinances and State laws�egulating Plumbing,ond hereby ' � � ' - �- � � � - - . � �� � � - � -- , � 0 orize representotives of this County to enter vpon ihe � . , ob ve-meniio ed property for inspection purposes. � . . � � � � - - , - - � � - �� � � � � �g;�C�_4� SEE REVERSE fOR EXPLANATORY LANGUAGE ' natur f Permittee� . - � Dale � . � � � . . � I . _ . , �- � �2 Z -�—. �C-1 A G 6 D �' c O y N 3'' � G 'O y r � � '� � � 1�t1-N1 � N Z �4 � N � 9 . n -1 y� fn -1 Z f' � V O y �p � � . v� y T S � m � �t 0 0 '� � � Zo q . p .. T 9 m , p X � r, T y 77 - v , .� Z . "" ; - � � (p ��:. ' -_ � , � ' �, a � �-1 , ` o n m ti'� 17 � Z � N . �j . ; , 'o ,. m 2 ...._-'_- - - o O � - � m . , "' N r . m - . i� . x � '� c . m . ? ' " � . 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