HomeMy WebLinkAbout1625 BEARS DEN RD (8)APPLICATION FOR PEUMRIMG PERMIT
I hereby affirm that 1 have a certificate,of consent to self
76AA67A
J
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)
/ 'z `�
AD DR
ADDRESS
Certified copy is filed with the county building inspec-
aS
c� •lfSf=6A''�f
Tian deportment.
NUMBER FIXTURE OR ITEM Ca.
FEE LOCALITY
Dale Applicant
WATER CL05fT
NEAREST LL
CERTf FICATC OF @X€AhPTIOW PROM WORKERS'
BATH rub
CROSS Sr.
COMPfN6ATION INSURANCE
,LY`nl.-fir/ �r L,f�'�,�yr•
(Ttyrs sasrEibn rseed .A ba —pt tad it eilia werk ievelvad 6y
EM pam rET Is tat' am hw,&od Behan (�1 tsr lase.)
SHOWEROWNER
----
LAVATORY
MAIL J�
ADDRESS
I cerfify that in the performance of tMe work for which this
SiNr
�� CITY TEL. NO,
mii is issued, I shall not employ an monne
par pay any person in y r
so as to become subject to the W-kers' Compensaton
�
_
DISHWASHER
/ /!>< l(Jh�'l i�',7'
6Z CONTRACTOR
Date 2 /,� i 7 Applicant L
CLOTHES WASHER
ADDRESS.
NOTICE TO APPLICANT: If, after making this Cc tifcate of
SWIMMING POOL RECEPTOR
-------
Exemption, you should become subject to the Workers'
I�
UTY TEE. NO.
Compensation provisions of the Labor Code, you must forth-
LAWN SPRINI SYSTEM
with comply with such provisions or this permit shall be
STATE tic.
doe revoked.
WATER HEATER
LICENSE NO. CLASS
LICENSED CONTRACTORS DOCLARATION
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-M-I LDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 703).5, Business and
Jof+ns Cooke):
, as owner of the property, will do the work and The
sfrudure 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 agree 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 propert f inspac+ion purpose.
2-12 61 f
cheek applicant
Tel. N..
SU REVERSE MR EXPLANATORY LA*QUeAA8
S
Poo
�5S7,5A
1..<..5
1•e2850
chi
0210-87
Signature of Permittee Date
APMOVALS IN6iE�C'T't S SIGPJa iC
UNDR $LAIR WORK
^^77DATE
-`r r.��.
//•� "--. .. ...
ROUGH PLLJO0446
<.✓�
]c....a _
_GAS PIPI14G
GAS VRNT
HOT WATLR HATER
PLUnING FI%TUR`_s
GAS T09T
�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 reoacn (Section 70.3V5,
- 6usincys anal Professions 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 arm Prof-d-e Code: The Controc-
-- ta's License L-does net apply to an owner of property
V h. bands or improves iNw~i, and whe deer wch
—' - —k hlmself p - We d that wch imryrovstnerNs ore net
iml-dad or off--.d fur sale, ff, however, the building cr
impfovsncarit is scald wf*fn 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