HomeMy WebLinkAbout1625 BEARS DEN RD (4)APPLICATION FOR PEUMRIMG PERMIT
I hereby affirm that 1 have a certificate,of consent to self
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or certificate of Workers' Compensation Insurance,
p
CE HI (REV. 10e6I I
oi . certified copy thereof (Sec. 3d@R, Lab. C.)
C40UWY OF LOS AMMES
BURDING AND SAATY
No. Company
Policy
Certified copy is hereby furnished.
FOR APPLICANT TO FILI. IN (BRIM OR TYPE)
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ADDRESS
ADDRFSS55
Certified copy is filed with the county building inspec-
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Tian deportment.
NUMBER FIXTURE OR ITEM Ca.
FEE LOCALITY
Dale Applicant
WATER CL05fT
NEAREST LL
CERTf FICATC OF @X€AhPTION PROM WORKERS'
BATH rub
CROSS Sr.
COMPEN49A.TION IN£URANCE
(Ttfrs sasrEibn rseed .A ba eatrrrpt tod it ilia werk ievelvad 6y
SHOWER
----
MAIL
EM pam rET Is fas' one hami.ed dahan (�1 tsr lase.)
LAVATORY
J�
ADDRESS
I cerfify that in the performance of tMe work for which this
SINK
�� CITY TEL. NO,
mii is issued, I shall not employ an monne
pp pay any person in y r
so as to become subject to the W-kers' Compensaton
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_
DISHWASHER
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64 CONTRACTOR
Date 2 /,� i 7 Applicant L
CLOTHES WASHER
ADDRESS.
NOTICE TO APPLICANT If, offer making this Certificate of
Exerrrption, you should become subject to the Workers'
SWIMMING POOL RECEPTOR
UTY TEE. tdO.
Compensation provisions of the Labor Code, you must forth-
LAWN SPRING LER SYSTEM
with comply with such provisions or this permit shall be
STATE tic.
doe revoked.
WATER HEATER
LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION
DISTRICT PROCE56ED BY
I hereby affirm that I am licensed under provisions of Chapter 9
GAS SYSTEM OUTLETS
.`1
G!
(commencing with Section 7000) of Division 3 of the Business
OUTLETS OVER
.
and Profeseions Coda, and my license is in full force and effect.
is PER SYSTEM _
FINAL
AidtLicense 't4
�'7, DATE
Number Lic. Class _
FINAL
Con tractor Date
BY
1 am exemier under Sec. _
B.&f.C. for this rea.en
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
SINGLE FAMILY
HOIyiF OWNtR-fAUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 703).5, Business and
0�ions Code):
I, as owner of the property, will do the work and The
sfrudura is net intended or offered for sole (Section
704►, Brat— —k Areissw:a+a Cocie-1.
CONSTRUCTION LENDING AGENCY
1 hereby af4irre that there is a construction lending agency for
the performance of the work far which this permit is issued
(Sec. 30R7, Civ. C.).
= timB as.
Lorlip'R
I certify that I have reed this application and state that the
above mi-r ien Is correct. I ogres to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of [his County to enter upon the
bave-mono—d propart f inspac+ion purpose.
2-12 61 f
cheek applicant
Tel. N..
SEE REVEM FAR EXPLANATORY LAUQUAW
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Poo
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1..<..5
1•e2850
0210-87
Signature of Permittee Date
APMOVALS IN6iE�C'T't S SIGPJa iC
UNDR $LAIR WORK
^7DATE
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ROUGH PLLJO0446
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_GAS PIPI14G
GAS VRNT
HOT WATLR HATER
PLUnING FI%TUR`_s
GAS TOST
�UTUITy CO. NO7MED
FINAL
INDU5TWk
WASTE Fti'4'ROVAL
INSKUOR'S NOTES OMfN"-RUN-C€ft nw- ,
I hereby aH- that I a ampt born tl- Can�ra.ie-'s
❑censc Iaw for tho following re - (Section 70.3V5,
- 6usincys anal Frofassions Code,. Any city or county which
-�^"- requires o p—it to mnstrucl, alter, impro c. demoli<h,
or repair any structure, prior to its issucnce, also re
quires the applicant for such parmit to file c signed storo
ment that ha is II —a pursuant to the provisions of nc,
-'--- Contractor's License Low (Choptar 9 (commending with
Section 7000) of Division 3 of the 19-4 ae and Print -
sions Code) ar Met he is exempt therefrom ord the basis
for ti:e olieged ex rvnplion. Any viola Hon of Section
7031.5 by any applii,.W for a permif subj-s s the: cpph-
cant to a eivil P Ify of not mere than five hundred
_--- dollars 055W).:
O I, cs owner of the property will do the work, end
the sf-t- is not intended or offered far sole.
(See. 70*C Business oad Profeesions Code: The Controc-
-- ta's License L-does net apply to an owner of property
wre bands or improves iNw~i, and whe deer wch
—' - work hlmself p - We d that wch ore net
intended or off--.d fur sale, ff, however, the building cr
impfovsncarit is sold vrf*f" one year of csmplM+on, the
ullder will have the burden. of p,•eving that he did
"-- not build ar improve far the purpaee of sahe
I am exempt uncle; Ste.
B & P.C. for this recson
Date
Owno-.
INSPECTOR'S NOTES