Loading...
HomeMy WebLinkAbout0 i - _ _ . ---- �,� _ : �r--��i �-.�+.-, -i# � ��� WORKERS'COMPENSATIONDECLARATION � � . ..APPLICAT�QN FOR P�UMB1�1�/V7 PGR/IFI�T� �� � f� I hereby affirm that I hava a cenifiwte of consant to self 76Ayy�q � � � F�. inaure,Oratertificate�ofWorkers Compensationinsurance, CEBt7(REV 10/81) � �: �� . � � � . L! G or a carritied copy rhereof�Sec.3800,lab.C.) , CQUNTY OF I.OS ANGELES BUILDIN6 RND SAFETY �P_Jalicy . Company �.� '� "�•�Y•± � . : . - : .. . . .. � � � , � . yJ �Certified copy is hareby furnished.� BUitDiNG ��--11 � � FOR APPLICANi TO Flll IN(PR Wi OR TYPE) A���, - N' ��f�� �.Cartified copy is filed with fhe courtty buiiding inspeo NUMBEii� FU(TURE OR ITEM ��(4� FEF � � � . `�"��lion deparfinent. � 1 � - �OCAUTY�� . . � � ry���, �" ��' �,`..�� `* � �i � WATER C�OSET. . �..�� ��Qate�CS�F"�—APplicant � NEARESi � A, q,,� � � CERTIFICATE OF EXEh4PTION FROM WORI(ERS' � BATM iUB � � � . . � CRO55 sT. � 1H _ �e�.�.� ��!��+����� , �� � � COMPENSATION INSURANCE - � � � gHOwea� ���� � � �� � - (This wclion nwd no4 bs compl�led�if Ih�work Imolvad b� MAII � � . .� fh�permi}is foe ona Ilan�t�A EOCIOn(S1U0)or I�ss.� LAVATORY � . � ADORfSS� . °.�Re�IA ��,JF�L '. � � I certify ihat in the performanae of 1he work for which ihis . . � tc� � �permif is iss�ed,1 shall nat employ any person in any manner � StNK� GITY . .!:� � : TEL.NO.*�.� ;�,�+�� �� � so as�o become subjecf to the Workars"Compensvtion Laws. � . +� � p " � . . �� DISHV,�ASHER � . CONTRACTOk �y,��.�+ry . . '{ 3ii�F. S'.,P.�• �' l;�q �� Depe Applimnt � � -� � ` CLOLHES.WASHER � A��� . k; NOTICE 70 APPLICANT: If,.afler.making this Certificate of � � � -'� � ' � Exam tion, ou shou(d become Su6 1 fb the Workers' � SWIMMINGPOO{RECEPTOR� �. R Y � . Cliv � ' 7EL.NC,� g 1�yyy�' Loinpensotion provisions of Ihe Labor Code,you musl forih- � ;qyy�ySPRINKLER5Y5TEM ��' `� . � with romply with such provisions or this permil sholl be �� � - STATE � � �t�ry UC. .� + !�" deemed revoked. WATER HEATER UCENSE ttl0. "�a�� � CLASS "'�+ � � � � ' - � LICENSED COAiTRPcCTORS DECLARATION � - � � .�;�W3iRICi NO:�-. .PROCESSED BY � I hereby a$irm that I am(icensed undar provisions of Chapter 9� Ga5 SVSTEM � OUTtEiS '� �. � , � � . � (commencing with Section 7000)of Divisian 3 of ihe Business OUTLETSOVER . . � , - � G'� � ond Professions Code,and my license is in full force and effect 5 PER SVSiEM � FINAL � � �� . �//+���{T�QN i� � p `... .- ��1�' � l�: ,� � �s ��r,31�Ni�:� :,.�a'1'�D"?�.00 � � DATf,. ., . - ;� ,_.:..-_- V License Number Lm,Gass . �� –+ ' . � ..�;lii� .� .� ` �"�,!�^.e'ri�. - � FINhI � ; .. � � - _ } f Contractor '���': �ate .. .. . BY .�� �: �❑ I am exempt under Sec. . , . � . � � � � . � � � B.BP.C.for this reason � �.:. � � .�� `.." �" a Plan check fee ," � � ,�',' I. Date: . . PLUMBING PERMIT ISSUING FE€$ � f'i . ..� k . � Sfgnature . . . , � � � y - i � � TOTAL FEE � � . . '.�.. '. i � . . Plon check applicant . � . � . � � _ � .�.^��.�,.'� ��� i-. _.. . SINGLE FAMILY . �� .. . . � HOMEOM��R-Bi11LDER0ECLARATION � Name � � � .,j_�� � � � . . I_, I here6y affirm ihat 1 am ezempt from ihe Contrador's License Address � � � - - � � _ � � law for tke following reason(Section�7031.5,Business and � Profassions Code): . . � City � ' �� Te�.No ^� . � -�� � - . � � I,as owner of fhe property,w�ill do ihe work and the � � � � � . � . . structure is not intended or offered for sale(Section � � - . � � .,� � . . .. � � 704d,8�siness and Professions Code). , � - , ' , �, � � � . � � � CONSTRUCTION LFNDING AG€NCY . �� . - � "'"�' . � ,. .. � . ' � �I�beve6y offirm fhol�hme is a construc+ion lending aqency for . „•�`���, the performance of ihe work.fw whicb fhis permit is issued , � . � � „ � . (Ssc.�69T,,Civ.C.)�.� . . , . . . ., t�+rteY�s flertta . � � . ... ti .. , �.�� � . �. . � . EiilO�r'3dJ6t$#!S - . '..... .. � � . �.,.. . .. ., 4 I cerfify fbal�l hove�read ihis ppplical�ion pnd slote that�ihe � � � . , � --above informotion-is Carretl.i oyree to comply with al4 Co{��nry. .. . . _ , . .. . .. . ordinancas and$fate laws regula7ing Ptum6ing,and heieby � � - � � r- � authorize representatives of this Coomty to enter opon the , ' � � � � � . , . . (. � a6ove-mentioned properry�for inspecfion purpose5. - � � - � � , � � . SBE REVERSE FCR EXPU4NAT�RY LAN6UAGE � �Sig,rw�fu�e of PermiMea . _ Date ' . � � � �� . � � " � - � . � . y i'. � . . . . y ii�._ . . . . .. , t . � � � i • . . , f�,�r� ' • _'k - .-I . 1 � .. . . . � - - . •. � � � �' . . . . . . . . .t .. . . . , . . . .. '� � • . . � . N . . .ry�'.. . . . . � V �, ♦"� c� �.�� �