The URL can be used to link to this page

Home My WebLink About11_16_1981 - 20948 MOONLAKE ST (4) WORIC�RS'COMPENSATIONDECLARqT10N �umw � � I he:eby afPum that I have a'certificate of consent�fo self � ce.,;,=_.o, �APPLICATION FOR PLUMBING PERMIT� � insure,or a certificate ot Workers'Compensation Tnsurance,or . . . - � �a certified copy IhereoE(Sec.3800,Lab.C.) ' � � ' - � , COUNTY OF LOS ANGELES BUILDING AND SAFETY Poliey No. - Company , � � ' - � - � � � � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN IPRINT OR TYPE) OUt�DING AODFiESS � Certified copy is filed with ihe cnunty building inspection NUMBER FI7CTURE OR ITEM • FEE , � . departmant. . - � � LOCALITY . . WATER CLOSET Date Applicant - NEAREST �� - � - � BATH TUB CHO35 ST. '� � �CERTIFICATE OF EXEMPTION FROM WORKCRS' . COMPENSATIONINSURANCE . SHOWER OWNER �� G �D ' (This aection need not be com leted if the work involved � � LAVATORY . MAIL � ADDflESS } by the pemfit is for one hun rcd dollua (5100)or leas.) ' SINK CITV TEL.N0. 0 — I certify that in the performance o[the work for which ihis DISNWASHER � V — yermit is issued,I shall not employ any person In any manner CONTAACTOR � - so as to become subjeet to the Workers'Compensation Laws. - CLOTHES WASHER ADDRESS � � � F G�Date Appllcant - SWIMMING POOL RECEPTOR U ' NOTICE TO APPLICANT:-If,atter making�this Certificate of CITV ' TEL.NO, W F.zem tion, you should become su6'ect to the Workers' LAWNSPHINKLERSYSTEM �" ComOensatlon provisfons of the Labor Code,you must forth- STATE LIC. � wilh comply with such provieions or this permit sha�l be WATER HEATER LICENSE NO. CLA55 _ deemed revoked. ' - . � GAS SYSTEM OUT E S � DISTRICT NO. PROCESSED BV � LICENSED CONTRACTORS DECLARATION OUTLETS OV I�� 1 hereby.affirm�that t am liaensed undrr provisions of Chapter � 5 PER SVSTEM � 9(commenCina wi[h Settion 7000)of Diviaion 3 of the Busi• � � FINAL VALIDATION ness a�d Profesaions Code,and my license is in full force and DATE `�—p�� ettect. FINAL License Num6e� �Lic.Class , � gy . � Contractor Dnte � � • � I am exempt fmm the�icensing requiremenfa as I am a Plan check fee � � licensed architect or a registered D�otessional.engineer pLUMBING PERMIT�SSUING FEE S °v�J t!A , � atting In my profasional capacity(Section 7051,Bus- �. `� . . : inas and Profeuions Cnde). , TOTAL FEE � �!1 -��'�4r,�1 � • Lie.or Reg.No. Date plan check epplicant � � y ,.��.n= _ , . . �'.a n .. �. HOME OWNER-BOILDER DECLARATION Nama � � � . I hereby affirm that I arn exempt from the Contractor's Add�°°f �� ,�1 7�i_-j - � LiCense Law for the following reason(Section.7031.5,Busi• City Tel.No. - ness and Professions Code): . , � i,as owner ot the properry,am exciusively eontncling � � � , � � with licensed contrectors to conatruct the projea . (Section 7044;Bustness and Professbns Code). . . . .. � . . � .- . CONSTRUCTION LENDING AGENCY ' � . I hereby affvm that there is a construction tending agency � � - for the performance of ihe work for which this permit is . issued(Sec.3097,Civ.CJ. . � - � � � . Lender's Name � � Lender's Addreu � I certlty that 1 have read this application and state that the � - . � above Information is correcL I agree to cromply with all County . 5EE REVERSE FOR EXPLANATORY LANGUAGE - ordinances and State laws regulating Plumbing,and hereby authorize reprountatives ot thls Coonty to enter upon the, � above-m�e/ntioned property to ins ectioq purp�oyses. - � � � /I"G'�Ll�Z(� �i'ar-GI/ fl�ll��l . Signature of Yermittee Date . . - � � � Z\ b � y �, G � P �" -� N ry\< < %o S' N\33 yO v � :� m Z �a � Z � � O . �� ` - �"� ." 1 , C X m �,' ; t� � cn -, � � `. G� � ' .. ,. ,, �I' G+ G � �. ' . 9f :�. N � . � O •�. c� ,� , � . . ,` { �;. - ''"' v"� , . � �,.; m - . �.� l� '. 1 t:; � ' i�: �� ',t. � �� / *9 ' `, �. � �;:_. �� l � ' , �, ,� ''� o . ° '� �'� - v v� . , � � � :'� � � � , . • '1 " �7� .i. ;� y , � �, . '1 ,.' .�ym Z �, t • �� i O� , . , _ _�;: N 4 , . � . ' �'��- , . � 'i.. � \ _. � - � � , , �•: . � � � �. � ' �� ' , �� ` Z . ' „' �•� `�'o , , . } • � � . Q �; ' � , �� p� � , � - - .a �� . � �'� . �� , V . � � ��y<... �.. ,� �� ' �, • .. .�� p ro��n � � ' '_ - ' . ��.o�o o�� , O ~:� o��. �P.;, c. �,,c �� _ -. . ,a..,v�t�+ "`e�o"-'m-^��'�'.�` ai' �� fi . � d,P �' p p(., � �p��'.O O v` �v� P N��'�. � ,� � " ' 'c5-..�..� �.°S «4 O �l G +�O.^_.O ~ � ' ��-w= �p'^ "�i 0 — � . � _ .�„ "' ¢3 �, .ri p i m m"'Q p'� .+ ��p q p �y � ,,, .a�ss�cs .. O �.c. a.C L'� a, v�p. £ `" A .- ` d c%- �: :=°' �°.�, t",'�'c o av �=,o�'° _,��.,��, " .� d � � �.o o _�a�;yo�p�N c� ,� =,:`a c,w � � � `^O> ' � R " � �v. 7 AQ P C' v+�C �. `"r :.N G'.� � � � �" � �� p ^ •• '-,'¢� �`°'�� O '^ .,o� Q ^ p �P�' ~ ry`r- y, d . , . . . _ � � n � �o~P io'6 O.M N�.v� 7.* r� � �v. O �' .�- 7�.ry��c�� n .C1 "" �D "�" �J O - � '? O C. O Cn' n �o� � � � " ' � - .. .- - " ' •��a . p r, � b ,C.`i�,a y n CS R"�V,o n p� p� ��'''� . . _ - G . . .fO�� R ��L1��A.n'O , n.C .,.� ��' �-� .�.� w _ �r� . . , .. , , . . , � �. '' G.�m �, �n G O � �.`'i �..n'.,O�'.ec t'cS .'Y fS O " .[�_ . � � � � � .. . . ' - . S"i, h � .A, �y•ty v, '� O�O ^o c� ��3 7 , � _ � � ' � � � ^ ,r �� ¢p " C,.p� ��e^O O�0,+, p, ��-."� V��' r1� . . , . . , - r„� C/l .� �f'n' .N O»N �:C �p pA, ^"'io C .n--<° cc O , �• �•- , , , o � � o �. c� o� 'r.. b c..�C�. � .�.o �e. .2 . , . _. . . ; . • i - 4' � '` a =.�cs a � �i .-. o �� .ie o� , ' G•� =;K T�„ ��•v, -O 4� . _t �'.'' ' ' \` , , . , , t''��:`c�„��o~ o° �. o..:�� o Q^�' `� �. o w%. . �, o ' � o,�`G,,: o'��' ,,,�', c'Cz � ..o . ,� - - . ^ ' . . � ' ' . .a �-.-�~.Q'n �o � ; p O tu �'C O�P.� O « �N " . , �c. o : ss ..,,.� �,m r, p.�. , .. -�a fO a o v t'' Q � a ;� � ., �Q.eo � � � . ' � o =io `�- o'=.'F. io �'". �.- =�c;c `o .. � � q .. • . � . � � v_ IC ry C � (� � ¢ ^� � � � � - � . - ' .-„Q� " � �~ c p. � _ ' . a � ¢� � O C. ' , . ' Y Rf�..�.'.� . � , .. „ ' �A�•�p» , � r ' ' � ' � ` \ •• i��