HomeMy WebLinkAbout0897A °��'���'w APPUCATI�N FaR PLUM�ING PERMIT ��f �2 �
� I hereby affirm that I Mave a cenificate of consenr ro self 76A667n
� insure,or o ce�fifitate oF Workers'Compenso�ion Insurance, CE 877(REV.10.'81)
� or a certifled copy thereof(Sec.3800,1a6.C.) COUNTY OF LOS ANGElES BUILOING AND SAFETY
' a�y nk�'8532138$mPa„Y Fremont Indemnity
Certified mpy is h�reby furnished. ��8 J3�
, � FOR APpUCANT TO FILL IN(PRINT OR TV7E) BUILOING
Certified copy is filed with the counfy buil 'ng inspec- A�DRESS
liondaportment. / f/��� NUMB[R FIX7UREORItEM @ FEE `�A��TM
Da+e
6 j 21/85 qPpliGant RCR �L4�--�",t- WATER CLOSET I � NEAREST
CERTIFICATE OF EXEhM1PTION FROM WORKERS 9ATH TUB � � CRO55 57.
COMP€NSATION INSURANCE SHOWER OWNER South Country Corp.
(TMIs��ction n�od noi ba compld�d lf ihe werk involwd b� MAu
fh�prrmlf is for onr Mundr�d dotfnn{F700)or Ioss.) ,� LAVATORV nooeess P_0.-. Bos 3329
I certify ihot in the performance of the work for which tbis �
� permit is issued,I sholl not employ ony person in ony monner SINK CITY (�+OV�Il$ TEG."o. 96 -9 4
so as fo bemme sub��ect fo Ihe Workers'Compensplion Laws. DISHWASHER
^ CONTRACTOR R.C-.:R. PLUNIBING, _INC:
�ate Appliconf CLOtHES WASHER ADDRESS
!""�TICE TO APPLICANT: If, afte( maki�g thi5 CerfifiCtlfe Of SWIMMING POOL RECE7TOR
mp}ion, you should become s�bject to the Workers'
' �ompensorion provisions of the Labor Code,you must for�h- LqWNSPRiNKIERSVSTEM CIiY TEt.NO..
with comply wiih such provisions or this permit shall be STA � � lIC �
� deemed revoked. WAiER HEATER L�CENSE NO. ClASS —
� LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCES�E�BY
I here6y offirm that I am licensed under prowsions pf Chopler 9 GAS SYSTEM � � OUTLETS � � � y�n �'L�
�. (commenc ng with Sedion 7000)of�iv sion 3 of fhe B�siness OUTLETS OVER �� �� . �
and Professions Code,and my license is in full force and effect. 5 PER SVS7Eh� pA E� I��,j. VALIDATION �
1�S`
License Number ��.j��'z2.� Lic Class�,� V
FINAL ��'
co�+�o�to�•C.R. P1UIIibix},P„e fi/21�$5 av aJ-�/�...-�7r� �
❑ �
t om eaempt under Sea �
B.SP.C.far rhis reason `��
Pfan check fee -.-
�. Date: P�UM8ING PERMIT ISSUING FEE S Q 6"
� Signature
. TOTAL FEE ''7�p s
- Plan check ppplicont ����.�FI
SINGLE FAMILY
,�., HOME OWNER-BUILbER DECLARATION -Name �• • . e .5
" eby affirm that I om exempr from the Contracror's License Address � �
�_..for the following reoson(Seclion 7031.5,Business and � e •%E,S Q
Professions Code): Ciry • Tel:No. /�
O � . t c c�i EA J�J L
i,as owner of the property,will do fhe work ond�he
structure is not inlended or offered tor sale (Sectian , ���� —&Jr
7044,8usiness and Professions Code). -
CONSTRUCTION LENDING AGENCY
I hereby offirm rhpt rhere is a construc�ion Iendmg agency for �
fhe performwvice of the work for which this pe+mil is issuad
(Sec 3047,Civ.C.).
6e+da�s ropma�
tencie.'s A{(d� .
I cerrify that I have rer�d this opplicarion and stote thot the ' �
a6ove informotion is mrrect.I agree to comply with all CauNy .
ordlnances and State lows�egulating Plumbing,and he�e6y '
authorize representatives of this Counry to enter upon the
above-menlioned pro ry far inspey�on purposes. �
R.C.R.�. By: f��hl^p _/J Q� 6/21/85 SBE REVERBE FOR EXPLANATORY LANGUAGE �
t ' .����t:Y
Signature of Parmi�te �Dpte
'_ �
� APPROVALS DRiE INSPECfOG'SSfGNATURf INSPECTOR'S NOTE`S Q�"JtdtR-3iJl!b[R
UNDER SLAB WORK • v'&'S I hereby affirm fhq+i nm er.empt from the C��nfroct�r's
, ROUGH PLUM6ING Lirense Low for rhe follavainn, r n (Section 703I.5,
GAS PIPING Euslne^,s and Professions Code��hny cify or county which
GAS VEN7 . requires a permlf to consirud,aker,improve.dsmollsh,
, or repoir any sirucNre, prior tu its issunnce, also ro-
HOT WATER HEATER qulres the opplican�for su�h permii fo file a signed stvto-
PLUM6NJG FIXTURES' � � ment thaf he is Ocensedpursuanf to ihe prorisions of the
GASTEST � Confratlori License[aw(Chapler 9(commencing witF.
UTILITY CO.NOTIFlEO Seciion 7C06)of Division 3 of Ihr Business and Profes�
. sions CodeJ or fRaf he is exempt ffierefrom and the bosis
n `� ' cy ' � ` � for fhe allegsd exemption, kny violarion of Section
FINAL � � Gnfe�on _fronf ' 7831.5 by any app(imnt for a permit subjects the arpl�-
, . . � cm�!to a e vil penalSy of nuf morc ihan live Fundred
� d�cllars($500).:
INOUSfRIAL ❑I,as owner of the property will do the vrork,and
WASTE APPROVAL � the siructure ia not intended or offered for sale. —�
� �� - (S�at.7044,Busirtess ond Prolessions Code: Thc 0. c-
� . � for's L7csnse law doos not apply to on owner qf properfy
� �- , . . ' � who bWlda w lmproves Ihereon, and who does such
� . • � � � work himself provlded tfw�t wch Impr¢vemer�fs are not
InTendad or ofiered for sale.lf,haw�evor,the 6uilding or
, � � tmprovemenf is sold withln one yeo(of co:r.�atetion.�he
� awner-6uilder will havc the burden of proving�hat he did
. rrot build or Improve for fhe parpose of scic.J
I am exempt onder Sec. _,
B&P.C.for thi,recson
Date
Owner
INSPELTOR'S NOTES '