HomeMy WebLinkAbout1217 PORTO GRANDE (6) � '
WORKERS'COMPENSATION�ECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm�hat I hove o cernf�cate of consen�ro self �y�yyp
�mu�e,or o ce.nficata of Waken'Compe�sWion Irrsu�ance. CE 8171�V.i0�81)
rn a ca.nfied copy�hneol(Svc.3800,Lab.C.) COUNTY OF LOS ANGEIES BUILDING AND SAFETY
vol�Wefn1711047 Compom Fireman's Fund 302/4AR
� Cen�fied copy�s hmeby furnished.
� Fp(t APP�I�AM TO fILI ttJ IAtINI ON TYPE) BUI{DING .
Cerhfied copy is filed with rha eounty 6uildi1g���Pa�- noor�ss 1217 Porto Grande Di. Qnits 1�
tion deppr�men7. NUNIBER FIMURf OP ITEM � F(f
pa�e 8/22/83 � WATEPC105ET ��"v D' mo d Ba
Aapi�so�rRCR b : NEaREsr
CEIiTIFIG4IF OF EXEMFf10N FRQM WpRRERS' Q �rH TVB � CRO55 Si. '
COMPEiVSATION INSVRANCE y�p °VN"'�R Presle o So C i �
(Thl�sMlon n�ed noT 6e eomplehd if th�werk inwh�d b� il .
�h�p�nnir N fer en�h�ndnd dollan{SI00)or lya.) uvaropr �ry
I cenify�hv�in�he performonce af�he work for whieh�hi� � �D nDURF55
perm+i 4 itsued,I shall�roi emp�ay anY Person in vnY manner yNK � cnr �i.'p�p.
N ort Beach 540-0 00
eo aa�o batome sublS��b�he Wo�keri Compansar�on lows. o�s�+wASHEF � �
COMRACTOR
na�a e�uw�r c�nTH�swa�R nwr�ss 12785 Ma
NOTICE TO APPUCANT: If, cfrer moking �n�.c�n�fKare ot � � gnolia Ave.
ERempfion, yo� �hould become subject ro Ihe Workers SW�MMuuGPoOtRKZviOR
Compansa+�on prov�eiom af Me la6or�ode.vou musi fanFs ��T� Rivereide �'�'3�1-5�0�
wrtn comply w��n sucn pro��saM w 1h�s permn siwll bp I s�����EP cr5*EM STAIE_�---"— lIC
deemed roroked. yyq�p�qhp n � IICFNSE pip, Uq,u �
IICENSED CONTRqCTORS OEGIARA�IpN �' asiaKr na e. �
I fKxeby uffirm 11q�I pm hcemed under porisiqy e6 OYqpter 9 ���µ �T�� �
(commenc7ng w��h Section 7ppp)oi Oirision 3 oi tha 0�sinm q�rlElSpVEp O ��- �'
and ProFesairns Code,and mr liceme K�n i�ll force an�effec�. 5 PER 6Y57EM Qa .
336428 C-36 p,�� �,//�j�,� VALIDATION O
Uceme Number lk.Clasa
x
FrNn�
Co��.acroRCR Plumhing.� Inpa,a 8/22(}}3 sr��,��',t.�.,.< V
❑ W
I om exeTp�undx SeC. {�
v� .
6.6P.C.for this remon plun check fee � �
���� PLUMBMG PERMfT ISSUMG FEE S s�
Signen.rw .
TOTAL FEE ,3 ,�
Plan chedc applicon�
SINGIf fAMILY
HOME OWNER$UILDER DECLARA710N Nome R.C.R. Plumbin � ZIIC. :;� `� �
I he.ebv a16rm ihar I am exemp�from the Contractoi c l�ce�se �� � `• '
Low fw rhe fo1loK�ing reosor,�Sect�on 70�1.3,Businass ond
Profess�ons Codal: Ci�y Tel.No. •. • � • `
❑ I,os owner af�he propeny,will do ihe work and�he �- ,, „ ,_
struc�ure is no�ineended or offered for sale (Senion � y �
7D44,Busina�s ond Profes��ona Code). • � , ��i`
CONSTRUCTION tENDING AGENCY � �,� -
I FKreby afiirm thai there is a consbuclion lending agency for , ,:.�,—;':: '
rha perFormance of the work for which this permit is iasued
f5ec.3097,Civ.C.). �
Lender's Nome �ECuilLjt P8C1.£i�- A9^U
lender's Addrns890 N Main, Santa Ana, CA
I certiiy rha�I have read lhis oDP���a��a�a^d s�ate eho�ihe ►
above infama�ion�s corroci.I ag�ee�o comply w�rh all Coun�y
ordinances and Stofe lows ragulaiing Plumbing,ard hareby
au�hori:e represenW�ives of�h:s County lo enlor upon the ,
abo�e�mentioned property fo�inipMion purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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