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HomeMy WebLinkAbout10_29_1984 - 21073 PATHFINDER RD (3) YYORKERS�o�NSATioNOEcu,w>TioN � �� APPLICATION FOR PLUMBING PERMIT � - � ;' I hmeby offirm that I hcve a cert'rfiwta of conseM to seli � �dqyy�q � ' . . insure,M O Cert�fiCale of Workere Com.penaaffon Inauroixe, �CE 817(REV.10i81) . � � - or c ceAified copy tFreraof(Sec.3@00.�ab.c.) � � � COUNTY OF LOS ANGELES BUILDING RNb SAFETY . : ���0 0984-1099�9om�ps�tel'q EIDpl0y2t'S j , , � CpA(fied copv is herp6v R+rnixhed- � � � � 'F�RAPRIGANTTOfILLINIPItMTORlYPE) � A�0� . ., . , .. . . terlified wpy is filad with Iba eouny boilding inspec- � NUMBER FI%7UREORI7FM � f{E t tion departmanl. ���ry Diamond B�Ir � - � ' oaro1Q-2_9'.��.-Aaai�w�� Cee`�.P1um6in4 ��,��r � c : CERTIf�CAiE OF EXEMPf10N fK4M WORRERS' DATH NB . - � (.RO55'S1: v t . .. . . � . COMPENSATION 1NSUkANCE � SMOWFR �R . � . . . S (Th�s sMlon nNd aot ba mmplrtad if 3he wiork Inrolwd Iry � . . � � � the pormh 1�for ona hv�red dolfan jS10D}or lars.) �qvnTortv „�,�ss 210�9 Pathfi nder I cerrify�haf in tha P���ce ol the work for wl�ich thie � . j parmit�s issued,I shall ra�employ a�ry�Person in ary rtanner S�� � �n' , Diamond��Bar. �.�. .. '— so m W bemme subl�fo tha Warkers Compenwtion Laws. � ! o�sHw�ee . cor�rRnnoR Lee's Plumhing i Oera applimn� � ctottiE5wn5MER . , � . � . R AOORE55, hpTICE TO APPLiCANT: If, ahr maki�thia CeAHimte of 2�Q7 �. Le AV$. � E�emption, yau shwld berome subjeCt to the �Kll(orkers' Sw�mhu�c'roO��ra� � ef1' � 44-U528 i . CamPe�aarion prpvis�w�s of fhe taber Cede.Y�+musr fonh. �aMrt�SwtidiciFa sv57FM � _ wifh cam I with tueh rovisiOns or 1h1� 4rmit yhofl be STAiE - � IlC• � daemed revcked. p � wnTEn�a7�t u�+SE wo. 3Q81��, 6 i UCENSEb CONTRAtTORS DECtAR�+T�QM aSiRICr NO. ev I here6y aNirm�hai I am litemed�underprovisiatqafaGhapter9 � �5��'�'- ��' � � (cnmmenKirg with Ses+ion�00p)of P�riSron 3 of�he 6usinesa p�i�7g ov¢R . y i andProfesaioroC.ode,a�mylicenseisin4vllfaceandeNect. S�b�� ��FtNAI VALIDA710Nr - � �j �.. . DA'� •�"'` � V , liceme Nvmber�OS��Et-- - ��c.Closs �(� 9= co�+.«rwLee's Plumf�Xng oO1e TQ-Z9-84 � �, Bva. _ m r G � � ❑ I am exempf�nder Sec.. .: . r .. � �'r-`.. . .� . � 6 5 � �g "�0 8�� H � B.sP.C.fw+m:.�n� Plan check fee � Z j � Oate:�_ �PLUMBMG PERMIT ISSUMG fEE S , . � . � -- Signoturo � � . � � . . � TOTAL fEE '��`� � . . . -. Plan check applicant . � . SINGIE fAMIIY � � HOME OWNER$UIIDER OECIARATION Name .. . . . .. . . . . _�.F��F1 I tro�eby offirm that I gm exvmpt f/om ihe Conhocta's liceme p�dresp � � Law for the followin renson Setlio�7031.5,Bvaineaa and -- - -- . . ... �tt• • • ` •�Jr � Professioro Code): . � �ity�" � Tel.fao. . . ❑ I,al owner of�he proparry,will do�he work and the • . - . � � � � � •L�'�.�� � ahvcNre is�o�intpndpd or oNered fw wle(Seclion , . .. . . 7D44,Business ond Prafeuiorn CodaJ. - . . . . . •�>C��::i�? ; CONSTRUCTION LENDING AGENCY . .. � . . . _ . . . � � � � I.L C�',—�� I �hnreby affirm rhat rhere is n wnahudion le�ing a9enay far , - ' i 1he perfomronce of the work fw whieA d+ia permit is issued � . . . . . . . � � (Sec.3097;Civ.C.). � . I � Lemder's Nome - . ... .. . � . � lande:s Addresa . . . . . . .. . � I ttnify�hat I hove read this application und stale Iha1 1he . .,_ � . . � above information is caren.I agrea tv wmply wit6 atl Co�my . � . � ordinances and State laws regvlv�ing Plum6irg,and hereby . . . aWh rize represenMtivey ot Ihis Counly to enter�ppn tha .. .. . . . . . . . . a�o -memioned properry for inspec�ion p�rposes. SEE REVERSE FOR EXPWNATORY LANGUAGE � � 10-29-84 j' ' noture of Vermitl4e - Date � � - � -- _ .__ ___ . _ _ . ___..___..__ _ ..... -- . _ _ __ . �z '� = � � = c� c� A � � � '� z � N � o � � ° o a� _ � n � � A �e � t� N Z � x ' AD � � ~ � N ~ ni C � V �' - � � O ' n O � � Z f O f m � D �f ' , �0 � v N A - � � f/� Q , z y � �. r� � � � � N � ' v O , W. a `!. : � � ti, 1 �_ `� _ O W _ � ' ' � , \ ..` � I� , � - � � � , � , � ` - � � -- 'r � , . _ � , - r -, _ _�. I - ,- , � j , ` ' � � � � � � ; � Z � �� _ � � o � � � � � ` � o m I _ = � � N � { � \ . 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