HomeMy WebLinkAbout1184 DIAMOND BAR BLVD (2) \1 `�
WORKERS'COMPENSATIONDECLARATION ' ��•�•�• � APPLICATION FOR PLUMBING PERMIT ,�7 �
1 hereby affirm ihat I have a'rertificate of consent to seif �, cc�n�x•�o � r�'
insure,or e certificete of Workers'Compensation Insurence,or , . ' � �� .
a certiCed co y thereof(& .3800,Lah.C.) U
��e'/v^/LS�O �l�� Cfr.vwrrS Z'�Vt COUNTYOFLOSANGELES BUILDtNGANDSAFETY
Policy No. Company
�Certified Copy is hereby turnished. FOR APPLICANT TO FILL IN(PRINT OR TVPE) BUILDING
❑ ADDRESS I /�A �
Certifled copy k filed with the county building Inspectlon � NUMBEH FIXTURE OR ITEM • FEE �
/� LOCALITY
1 �y���� WATER CLOSET V �/
Date�APPlicanl��5t"• NEAREST � (/
BATH TUB CHOSS ST. � '+— I',
CERTIPICATE OF EREMPTfON FROM WORKERS'
� COMPENSAT[ON[NSURANCE SHOWER � OWNER
LAVATORY MA��
(7'his section need not be completed if the work involved nooqe3s y7�Z wCC i �
�. by Ihe petmit is for one hun&ed dollars (5100)or IessJ ' }
. SINK CITY .='Y t NY �i{- TEL.NO. SS
( I certify that in the performence of the work for which this DISHWASHER � �
� permit is Itcued,Cshall not emptoy any person in any manner CONTRACTOH �f G� O � '
� so a5 to become subject to the Workers'Compensation Laws. CLDTHES WASHER A��RESS � U �
Date AppilCant SWIMMING POOL RECEPTOR W
NOTICE TO APPL[CANT:lt,after making thls CerHficate of CITY TEL.NO. n'
�
F.xemptinn, ym� chnulA hecnme suhiect tn the Wnrkers' LAWN SPRINKLER SYSTEM� gT,4T� �j _ LIC. ,/� Z
� Compensation provisions of the Labor Code,you must(orth- WATER HEA7ER LICENSE NO. J � CLASS �'J
with comply with such provisions or this permit shall be �ISTRIC7 NO. PHOCESSED BY
�deemed revoked. GAS SVSTEM OUTLETS Q ` /� 1��
� LICENSIiDCONTRACTORSDECLARATION OUTLETSOVER ``1 \�\� .
` 1 hereby affirm thet I am litensed under provisions of Chapter 5 PER SVSTEM
' 9 (commencing with Section 7000)ot Divislon 3 of the Busi- � FINAL VALIDATION '
.` ness and Wofessions Code,and my license is in full force and DATE �� �/ �
? effect. � . �
���,,p FINAL
�Licrnse Number3/��LLSL1_ Lia C�ass BV � � �
ContreetotT K C�1AS[� pate
� I am exempt from Ihe licensing requirements as 1 am a Plan check fee � . �
Iicensed arcfiitect or a registered D�ofessional engineer pLUM81NG PERMIT ISSUING FEE S - S� .
� - acting in my professionel capaciry (Section 7051,Bus _ .
iness and Professions Code). TOTAI FEE �, Q �
i
j Lic,or Reg.No. Date Plan chack applicant '
i HOME OWNER-BUILDER D@CLARATION Name . � �� �
�1 Merehy nffirm that i am exempt from the ContractnPs Addrn� y�� ' � w. �
License Law for the fotlowing reason(Section.7031.5.Bust• ��ty � Tel,No. SS�.^ �. y� �
ness and Professions CoJe): � � �
� I,as owner ot the property,am exctusively controcting � �
with licensed contrac�ors to construct the prnject �a��2 A
(Section 7044,Business and Professions Code). . .
CONSTRUCTIONLENDINGAGENCY � ������� ���5
1 hereby afCrm ihat therc is a construction IendinY agency � y • •' �5 0 '
Por the performance o!the work for which thie permit is . -
issued(Sec.3097,Civ.C.). - � ' � -
Lender's Name � • •�� �t Jr�c=i .
Lender's Address � O Cl D� —$��
�I certify that[have rcad this application and state that the
above intormation is correct.1 agree to eomply with all County � . SEE REV ERSE FOR EXPLANATORY LANGUAGE - �
ordinances and State laws regulating Plum6ing, and hereby �
authorize reD�esentatives of this County to enter upon 1he . � .
abov mentioned Droper tor inspeHion purposes. � � � �
� �. r'��� �/�I�/
ignature of Yermittee D e � �
�:
�Z T C � "v 2 � � � C
Dp , - Z � N C O ` N O Z
; c v
. n,,Cn rD' � -i c: < < Z L� m D'
� .;;i �� , -I � 1 � �m z S 9 �°
. J :J �� n i L� m Z Z � �� �
' ,'i O -i r r
� .� .� �D - 7 X ? . C C D �
. . :Y • J�, � � • p O -i m ? p D
_, -. s - . , , < . T � � � ` r .
r . . � T . m Z O u�
� � o v� � c� D
' . ' m . . . � • �. � � - _ � �
� - I y.,�. � o
O . ' ' Q' �'I � - D
. 7 . __ . ... , ' , � e,� V _� �' m
O : i . � � � .
N ,
.. , . , . . �rl� ��,' o
, i : ��l> x
�
. � � c�
' � z
� .
, . : ' c
. � � �- �� � , � ..
' .
, 2
. �
, i �
' -i
. , O
- 77
i N
, Z
, O
. . �. m
�
� .
i
. _ - ' - . . . . _ �C O n C a �O ��C `�'�.� " �R7 n'b `' n 4 F. �["
. . � 1.�.'O` Y�• �.=O � n N n 0'C � .�„�. O O a�:p.. -• .`^�...n ^
. . . . . Q .0 -`-„Gry.', y O'O� C� `� 0 � �❑�nn�+:� 3 �'�c-.� � �e> >�� . � .
. ' . .. .. . .. (•"� � � �� � r 1 V C ....�. h.O O a' �'a C'' o' fJ n
' ' " � �(: ,...�. r. . - �G O 4' �''O n . �. N � � y�C.�-.�1 N �C Q
� ' - � � f9 O " O \ 1. N �"' � n in q 3: :� �..iY. �
� . . . . ' ' . , . ... n � �uc- O .�.. ?�.X h i.� �ri�.G 4 � C �"� C L q � w ! .
_ � - � - . .., .. ��.„� _ � �O � b_ C �p y�C ov ti ti " } ^�+ f`� � .CT: ..
'. .. - . . _ . � � � `p m a n` C�� '�^ � ^ �b'"�'�'�-�Y X �'� �a �' .�"t,O. .� �,"7' .
� � � � � � � ^ ti �� �- �� � 'i O iy C �N r..ej G C 0 ,,, _
- ' ' • . ' . _ . . . . - � � �J � � O���y 7.�h O � o-N''n`aq Q�Cl.h^'^ C ..
' ' . . � . ` ^y..� V n F �C � [i
- . • '" .. . . - ' IG, 'S a�' r1 C� � < Q •�• �� w H•�.��`. � �,�C � O � , r .
��. C i ' w
� � � .... . � '. ' - p � ��'� i O ` n a'`D 4�4.�n O h � ^ "� ro `" �` " 0 3• C7
� �+�j.�„ 4 n 1 O n /"7
' . . . ' . .. n _ o .�.�C' ` �o� ' lQ,. o�o �." � o � X.
� � � ' - � ° ^ �`'��4oh•_.c � � .
. . � . . . •• ' ' _.� o e�t°., � S°., ►, 'C o-r'`o;v`n'�ti o`°a,3 R'1
� � ' . • 4 F Q h C .�. C O f•�' ��! �C O ej'� N `� F �� �� .n .
. . . _ ... 1 Y o �' ��,.�. n i ��o`.Nr, � O � � n'b ���� .n C"
. . . . . .. ' . . ..'��. ,� :e C �`�`" F� ��� -.�'`� i`..-�O�^�c 7 �.� � ..
. . . . . .. . . . • � „ `o �1+...0 (�M G�� C �.0^ � U� `� � _
� .. . . . - � - �•`.'. .. C^ O C � ti C k �'� � Q�w Cq..
. . . , ' ' .. � -'C � C �Y O'Q:e�j'� _ M1 .".. � �n � yl _ � � �� f:� �
.. o � � oan= �' �� . �,� ^+ £ � �� n p
. ..�q '�^ .p O C
. � . . � rC..i� � � 0�r � ` � .�. 1 � n• n'�" ,� � ''� 7 Z
' i'. O-� O C C� w � C n'�'
. .. _ . -`�o } � L`�, � m' s.; �O ` h C's�.` C�[� p O� .
, � . � ' - �. 4, �. 'o tZ.�"ry F, � �� ,L.��i .,, �'� o fi �.p _
- _. . . . ... . .. ::. .. m� �c,,'o h `��°ti.� c . o :��a � �o n c-� !�`=�"�, . .