HomeMy WebLinkAbout1242A . i
WORKERS'COMPENSA710N DE�LARATION ,qpp�.{CATIafi1 �OR PLUA�AB1i�G PERii�IT �
;
i here6y,offirm thoi i have o certificate of consen�ro seif 78A867A � ,
insuro,or a cartifitote of Workeri Compenwtion Insvrante, CE 8f7(REV.8/86} . 3
cr a cerrified copy ihereof�Sec.3�ab.C.) i
P❑ol�cy��_company C�UNTY OF LOS ANGELES DEPT. OF RUBLIC WORKS �
Certified topy ia heroby furnisF+ed� !
� FOR AP�IiCANT TO FILL IN(PRINT OR TYVE) B���w� 3 i
Certitied mpy ia filed with the caunty building inapet- /�� k
tion d�eporlme� NUMBER FIMUREOR ITEM � FEE �
3 i ����
WATER CtOSET ;
Dale Apppqant NEAREST
CERTIFICATE OF EXEMPTIQN FROM WORKERS' BATH TUB CRO55 ST. ;
COMPENSATION WSURANCE OWNER 4
(Th1s s�ctlon nwd nof In cornplNrd if Ih��rork inrolv�d by �OWER
flw parmtf Is for ona 6uedrwl do{(ars(=100)a ks�.} wvaiOkv ���
I certify fhal in the performance of the work fo/which this ADORESS
permit is issued,1 shall not employ any penon in any monner 51NK p7y �,ryp, j
so m�0 6amme cub�ecf to the Workers'Compensotion Lows. `
DISHWASHER CONTRACTOR !
�IR � ��1(`�'••^�� CtOTHE5WA5HER '
ADDRE55 �
; :E TO APPIfCANT: If, aftar rrwking Ehic Certifiwle of ' D• �
' �ption. You shoutd become wbjecl ro��1he Wakrs, Sw�MMING9�.RECEPTOR . c�n 7EL.NO. �
Compensafion p�avisions of the lobor Code,yov mvsi forth- �e,WN SPRINKLER SYSTEM -
wilh comply wilh such proviaions or this permit shpll ba STqTE :
IIC.
deemed revoked. WATER HEATER LICENSE NO. �Q CLAcS �" < <
410ENSED COMTRACTORS DECLARATION DISTRKf NO. VROCESSED BV �
1 hereby aff'rcm rhat t am(icemed�nder provisio�n of ChapFer 9 GAS SYSTEnt Ot}TlEiS -
(commencing wi+h Sectivn 700D)-ot Division 3 af the Bnsiness purtErSovER � g
and Proiessiona Code,ard my license is in f�ll force and effecf. 5 PER SYSTEM
� DA EL r � VALIOATION v :
t�,�
licanse N�mber 3 o q A�3 �ic.Clau � 2' �l�C � �
���� L FINAL O i
Coniractor�l�.k. AT•^r�Dote '� 'Q BY / F" `
� � � C
{om exempt under Sec. pw, %
''zTLl4.C11 y '
B.6P.C.for ihis reason z �
Plan check fee ;;.. . . .�
DaFe: :
PLUMBING PERMIT ISSUING FEE$ �Q � � i �G�� 3
Sigrwture
TOTALfEE
r n �=.. .,., i
Plan eheck applteam e ,� r
SINGLE FAMILY ����� —R 7 {
�' HOME OWNER-BUItDER OEGkARAT1pN +� Nome �
� i�Y ,�y oEfirm Nwt f aen�xanpt frain t!�Conhaelols Ltcams . . . . .. -:...,:.�_-..-.,
,. . ..: ,. � � :„ . . . � ......��:::... .................. . .. .�:...
' 16w for�the folbwing rcason(Sectton 7031.5,Business ond Addross � � � �
Profeuions Cvde�: �iy Tel.No.
❑ I,as owner of the propeny,.wil4 do the work ond Ihe
sMucfuro is not inSended or oHered for sale(Saction � j
70aa,Bufiness ond Professions Code). �
�ONSTRUCTION LENDING AGENCY
I here6y offirm that there is o conaNucl'ron lending agency for ;
the performance of the work for hith this permit is issued
(Sec.3097,Civ.C.�. �
i
Lender's Nome
!
lender'c Address
I certify ihat I have read this apptication and state that the � `•
above infwmetion ia correct.I ogree ro comply wirh all County �
ordinances and Siate Icws regularing Plumbing,and hereby
ou+horiza rapreaentatives of this County ta entar upon the
o ve-men�ioned propeny for in�4�pec�ion purposes. SEE REVERSE FOR EXPLANATORY tANGUAGE �
���,(����/f�Jc �.�/�7
ignature of ermilt p Date � i
_�_ - - `---
..a,�„
�.� W-� : � I f,"'�-
.. � � S' L �; �` ' � N p �0. � .i� J C U 1 'V - 1 . . � •- . . , . � ' ' f' .Y
fh" a, �
'- - Y' �7 - i O ` 4 b �],�'n `U .�- !:� . • . , ' . ..... .
' � o.=.� � �'� U .a �,.c < ��,n -n o 1 ' + . ' . ..
, C ._ ,. ` c 2i .� u°-'' `r c, � � �n.p N�� -��� . . .,lF'�'.
=. v c - � �. �f; ; �m»_ -p _n�,� �.�'. • � :
�� � ` C"L, �l � L C G � •�n, b f, I'-F ' � w..0 _l, C � i ' , '' ' (
t ` � � a [�.n'� �. � ti i, c;� v' . _ - ;� -� i y �. ._ . I ,. ,j,�
s�� a� - L. o m � a i: _ c c :'T, _ � -' • .
:� r .. � � :_ o �. '1.O C y] L; _-' � �• �' �).:1'O 'T a �. ' I � , .
�r- >. _` ��•ti U. N ; (. � -- [!V : - �: � .. '� Y � � I � . .
Cr' �Si t; ._� ..c:_ p, � _� �' ^: Q1 rJ �'f q: � � �. �� � A
., e � �� ` e c�. n � �� • . ;.; � L`... : � I - � . , •
_ �; ' C. � .. �-U 1: �' � S' C ' i;�..i..L Zci • i . ,. �
. .i�, F '�i „ ^.i , I j , . f!
TM� C ` C 4 <�, c._.. :_* v� .� �- " :� �. l.-�� i� 1 � �
" - - r� :o I. , c; � ��� i,� _�7 � t
� �c _ U �� c ` �...i` q U 2: p _ �:-:. t: - } r � i / -
_ ' :� _ = . i: o c, '�� T ...i �.':.: � - .. �' _.._, ,
Y �:' ;, - ��` '� :, . .. . i .- • ,
r- � O � � >. _ " - ;-�, ' t F— , i 4 '
- - �f` _ N C+ ' ... 'Q,Ca' � �J wJ il C ..^ .'r,( I �
' � • J f'.5 (1 {�' 1 ~ ' �
. � � .. �� ? .t. _ . •' N _ � .
:C ' - - �:� '� - L� U. ' � ^,I l) �:. 3 �' u. - _ � I ' _
�: '- .._ .- ��O�_ 2: '" ;,,� �,L :.�/: �: ,� � _ 't . i _ ' ..-. i i ; i
- G' p , .-.. � ^ N �' ...i fl...•�,� �� — ' - ' � i , .
��c " ,,,�i].�" -� C� ^ `� � _ +., , I .
... ..T..�.:� *- �. �y '"�� (i '._ 4 V u. ���'• .i��- 1� ••_ i M • .
� ._ - � C:. O•{�'� ;� C] C_' �C ' 1'. - " O : :";-- •
� -� v � ,_ �'.�' 1: �`�. t: i' �- 0 ,es _: +'��-h. �`, _' ;.i�;_ ` _.?'�i i •�
� • •� 'Z r: c V '� v., y) N i-I M Q ::Y�,�y_ _ ;� f . � � G .
� �� i_.i;;,n 5 - �i f L y I � r ;.
� h - CI N ���/
' 'C.' v, L^�r^ '�; _ �' i O O Cl L `/1 'F �`� '_ � '• 1f�._,1 L;J I C U . 1,..�
'_ _ 7: � ;d y �'.. �n i= ..' n �p .- ' s .' -, - - y� '( �,.
I ��c� ! � , � � ` �+ � ' i I I II � +I 1 I i ,II
j � ' , 'I � � � � � i 1� I � I � . I ' `
i � ' ,I . �j', l � � I � �
f �_ ` • � � I f L• � . ; ; i �
.; , � ' ; � ; ! , l, i I , i
� . ; ; , I � I
l , I . � I .h _.. I , � 4 � !
4 � 1. • I ...�. .:Y- , � ' , 1 I ; i
{ � �� � �� •r= • ;,� =�' � i � i � � �
h
� , , i � ', ; " �, 4 , � �, t. � � ' ; ; � i
i i `' �- � I
4'I� - ' i ' � � I I^:�y ' , . I � 1
. �J�• � . � ,1'-' � i I I I
' F-1, � i j i I � y ' i
��; ' ' i i �� 1 II I � � • I' I� �.
1 �
(Y�� � ' . , �. i I � 4 •�'� :+"I � � I
. �,; �` � I � 'I % I � ' I� �� , R ��' � ' � ;I
'-:� � � �j � � ' t , 'I "f- , � l
`�._f .'. 'i i j _� � ; � � I� ' �1
! � i
' f ; ' ,� ,
' i _. t .
„
, i , _ . j I . � • . ; 1
i . . � I .. . . , �
. i . � I � . .. � . � � .. - . ., e ..
'� . � . . i � . . .. .. .
.�... , ...... .........-I....—y�....i..�.. ^;,� . - � '' , . ,' ! f
x,' ".�"' . �^�^ l j .!I �; �� •�...>iµ', , i ;� �
�� .yl ��'l' � � =�� % � ` ' I
. , '' 4 ; . , '".} I � � i
�
L I .�. t' � � ` I I
{ :, j t.�� �'� ,, I i ,. �� . �, I I
��� � .' ; � �� �y :''• ' ' I i
, I ; w•.ti:� � c.,_ `r,i ', � � I
�-�� :f" : _i � W
� ' � � .f �l d _, . - �� I i
"`�.� •``' � . wl . N� .I 7 � � I
e �.._..-._..:'.'-,_'_'__.r�` '__'._" i� � .. �° � � j` ,
. � ,'�. ��""l _i- .�1 • V��'� . ' . ; ` 1
`:� f ` el �� � z; �,•y w �� , � �
i�,t�. , -- . :� .:� i .� �;; � � z� ' ` '
� '� -�-- --�---�-- � ; .j � �; _.\, , � �
; , L �
� ��yj��J ! !, , "•.' .,,��' ;.,� , ; '! '� • '
, i '�-}!., ;� �": 1I i} ���` i I , � ; �.
yW! { 7 . V
�: y '�� Q:.i AA- i W ,.� i , �
', x�4 �;�"+ ��; :. I ,�' � ; , i
" l�I 4 I n.i� ��� � ; �� .-' � � ' ' i 1
C� :n� zl " �7' 1��i �� j ..J � ` � ! ' � . , l
�I`s� J � uY�`^ r�c'' I�� I . • ' I
�x I�. '�:�..Zi4 W. U,. .,.. � � �
' n. �i. j�''I.Y. F. � �i)
V �.. =1
��-�� ir, In Y ' "
. . ��
I' 4 4�
� C. .f�.._� � �_.� _ �w � —_._`_'_'._'.�..__....__._..._.
. �-.
. � :,
' � - i,: . '�: .,' - •
JI� �. �, . __