Loading...
HomeMy WebLinkAbout1370 VALLEY VISTA (56) WORKERS'COMPENSATION DECLARATION ppp�fCqT1dN FOR �'!lJ��ING �'ERMIT � I hereby otfirm!hot I have a certificate of consent to self �6,q6y7q insure,or o certificole of Workers'C pensa�ion Insurance, CE 817(REV.10/91) or o ce�tified copy�hereof(Sec.3B ob.C.� COUNTY OF lOS ANGELES BUILD{NG Af3D SAFETY P�o-I�icy No.���Company . Certified copy is here6y furnished. FOR APPUCANT TO FIL�IN(PRINT OR NPE) BUILDING Q ��� �V, S C rtifie mpy is filed with ihe m bu' ' speo- AWRESS �'��.Vi•' l �fi n de rimenf. NUM iiXTUREORITEM � FEE LOCAUTY � Dat AppliS t WATER CIOSET Q� �qREST / t+ ERTI CATE OF EMEMPTIQ ROM WORKERS' BAtHTUB CRO5557. �}.� f w v�,,1 COMPENSATION INSURANCE pyyryEg � ' (Ehir sxtiort n�d nof bQ eompiv►od if Ihv wosk involvad�y SriowFR tho parmle is br onr bundr�d dollars(i100)or lo�s.) tAV.4loev � MAII A�ORE55 I tertify thol in Ihe performance of the work for which this ', permi�is issued,1 shall not emp�oy any person in any manner SiNK Cltt TEL NO. so as ta become su6{ect to the Workers'Compensatian Laws. �,R '�� CONTR.4CT0 � i DPt¢ Applicpnl CIOiHES WASHER qppRE � CE TO APPLICANT; If, ofter making this Certificate of D� j �p��on, you shouid be<oma subjea to �he Workefs' 5WIMMINGP00€RECEPTOR � � �ompanaatiort proviaiorta of the lo6or Code,you mvst forih• � TEL.N0. LAWN SPRINKLER$YSTEM i with comply with soch proviaions or this permit shall ba STA / �I�, �� ? deemedrevoked. WATERHEATER ��� • �-�' + ���N� ' �P cwss j LiCENSED CONTRnCTORS DECIARATiON OISTRICT NO. PROCESSED BY � I hereby aifirm tfwt I am lica�sed under provisions of Chapter 9 GAS SYS7EM OU7LETS � � (commencing with Section 7000)of Division 3 of the Bosines OUTlET50VER � and Professians Code,and my license ie in fuH force ond effeci 5 PER SYSTEM ���� � � vauaAria+� ,:,� Llcense Nu Lic.Class � � � DATE ��-��� Q� . r+I FfNAL 0`j Q L�' V' ContraUor Date �f iQ �A�� B� „�/ � `r �.; � Q C7 � o; 1 am ezempt under Set. Q �� a. � U� 8.8P.C.fw ihis reason , y,�� Plan chec fee � f 7, 0—� p,� Dota: � fA: PLUMBMG PERMIT t55UfNG FEE$ Z: Signature �1��O��` ��� TOTAL FEE g"Q � 1 7 Plan cbeck nppiicant � SINGIE FAMIIY HOME OWNER-BUIIDER DECLARATION Nome .�by affirm that I am exempt from the Contractor's License � L w for the fottowing reason(Sec�ion 703t.5,8usiness and a�`� ' � � ' � � Professians Code): Ciry Tel.No. ❑ I,as owner of ihe property,wi41 do the work and thC strodure is nor intended or offered for wle (SeUion - � 7044,Business and Profesvons Code). z G b�,�R CONSTRUCTION LENDING AGENCY I hereby nffirm that Ihere is a construction lending agenty for �• • • • •5 � the performance of the work for which this permi��s issued � •d 7 a 5 Q � (Sec.3097,Civ.C.). Lender's Name • F�7��V W� }� Lender's Address O��, 2 r 8 7 ! I cerirfy that I have read fhis applicaiion and srafe iho�the � ' above informalinn is correct.I ree�o comply with oll Counly 1 ordinances and Sfate laws �ating Plvm6ing,and hereby i authorize repreienlohves f t is CouNy t enter upan Ihe � above-me ' ed pr ty fo mspectivn p rpose �� (�� SEE REYERSE FOR EXPIANATOitY LANGUAGE f d , Sign ure oi P rm �e Da � � � � .;� -o �t v� �. �t ; G N L :` M �h O Q 4 C "' ` N C O� 'r '^ . C �L' p � ^ ' O 1] u 4'D G a 61 � C L l� O v� p y O C L C, � � cl _.-Q �� LL� �i � ] � � v b a 0 � , , � � C "� � C p G C .0 0� 6 ?i m�L� c � d w U C G � �:Oi.'^ �; O [ '^� rJ�ti p Or 0i a C1 � . Z v � � c o E ,� o c u ' s o d t � ,�c-. � i a - - C�;; � a a a o E � E o m c a r 3 v °u o � - - . �_ ` �. Q a a,a ° � „°�_°�?� �'-'.°v o v o m o `a o �,�- m , - o c � n c ,o o �� + o � o, m a � ` m 3 �°'v o ° E; o`o °' ' • -- N � � ` � c �,_ _ ° a, y .r �. E a �.mcQ � ° �'' vn l: a Q- o � '- - u- a - £ c c-� E �E m Q H� d �,� cb � - � � �'zi �, o a .°� U � � o � c`o,� °�L � _.o y°'" -- . 0 4 w �' 3 � � a� � - M x c o a d ° � • �-� u c G E o V ... N Q 3 � m :..a}o a�d o n� h'� � ' G1 0 :J ooc � a+ r000 = � c � Lmc � a'a `o3i° � o tn - � � � � N � >-aGS � U O C C 0 v ��O„"�= 01 N � I y � � � m x • � H o q. 'p > �p ,°-�' --L� m ° �..c- ?; � c� o °'am a� oa� Eov °� o � � �� a . � $_ m .c� aa c � e 3 ' v � '3 `2 � :} z H u o �, o� ; 3 0 � Q� • � 'I . E ° 2 E a�•- � o rn �.�> � =' 3 -' � o � a E �- � 0 �= 3'�c, ab o.c" a�°' a �"� o ;'° C� « o y� o E, � .. � � „ ° �� ati ��° °-0°`= uav ' E� m-'n,°' . x U I '' � � w m ar-= o ous �n ° 4❑ 2� _,-�Y c o �-'� � °- a � , . .. � � � c � m m•� c � a � � „ o ,_ d a� E' w� � 3 . . r "� " d � °1 ° m °o0 0 ° �L °3 3 � E o e° , � . m C O _ =, m � o vcU �n � � �'ti . .- I . •, � �. ' i � :� O � � . w � j Oi � , � � � � ! I � W I ' 1 � ; � Z i i ; ; � � � ; 1 ; I I ; I t I i � i ; , ,, � ; � . � , ; ; ` ; , i � ; , ; � � � I ' � , ; i � I ' . ; j � , ' ,� �i 1' � � � � � � I I I , ... g w �" � � � � = � . ; � s � . � � . i ', • � � � o � I �� I � � � a � � >i �y � � N - 'i , w .. . Z � _ t � � � -�. - — -- � ' "' � �� q •�\ . � ,`�A W��� II I� � . p � f �� � fN} !,; i�. f-I. ��I c . � L 4� \J � � � ' ' �. � . ) i E :rh: I -� �' � � � \� � � ; i� ' � � Z� V� � N I -�~N'- -�-- -� j.. , ^� � �l � � i j i �" . ! I��, j � � � � , ; � � � � � �5� . ; �, •. ��; 'c,' , � �� � '� 'J� � ,I , :� cr:c?�i. W!;� : I - � • �� 1 � N 1' , � c, �I`''. ?�" ,z� % ' �� I � I � �t �=t�Z �,�� 'o� . - ��:::� ' ` �' � `�j N � ; , ! ii C��II." _ �� �°!�.�.�o_i Z Q i z j��V ' �u tt.U' � ��� � 't_I : �v?in �• .jv:�v� `_ n'.�� ' - G�, , z i.� F OI- �i� _ � � ��:C;=C: x .« �.._�....._,_,.�._.._....�W,. __..-�--