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Home My WebLink About0896A _ _ __._ _ � �°^^�,�T'°"°Er�ARAT'�" APPLICATION FOR PLUMBING PERMIT ��' !� � � i hereby afflrm thot I hove a certifiwte of�conseni io self� ��yq��q insure,or a cerlificate of Workers'Compenwtion Insurance, CE 817(REV.10/812 � o�a ce�tifled copy thereof(Sec,3800;lab,C.) CGUNTY OP LOS AN6ELES BUILDING AND SAFEiY ' Pou�y r3�853213$�mPa,,,, Fremont Indemnity 438 2B � Certified copy is hereby furnished. � FQR ADPLICANT TO fllL IN(FRINT OR TYPE) BUILDING � . Cerfified copy�s filed wifh fhe couMy 6uilding insper AODRE55 fion de arlmenl. NUMBER ' �-FIXTUREORITEhl (� FEF P LOCA4i7V Diamond. Bar Date � ti�`»�gS Applicant ' � WATERClOSET � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' o� BATH 7U8 CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (Thi�a�elion nwd net 6�tempid�d il lYn werk inrolvad by Mau The p�rmif is For ona hundr�d dollars�5100)or Iasa) LAVAiORV ' j�— ADDRE55 F.0. Box� 3329� I cenify fhat in the performonce of the work for which this . pa�mit is issued,I shall no1 employ any pereoo in nny monner SINK CITY v• tEL.NO. so as to betome su6jed lo fhe Workers Compensation Laws. DISHWASHER � CONTRACTOR Da�e Appliconf � CLOTHES WASHER '"�'ICE TO APPLICANi: If, ofter making lhis Certifico�e of AoORESS 12785� Ma nolia Ave. nption, you should become s�bject fo the Workers' SwIMMINGPOOLRECEMOR - � . Compensation provisions of fhe Labor Code,you must forth- ��T� Riverside � T��."0.371-5000 wifh cOmply Wifh 5uth provi5ions or fhis pe/mit Shoil be �AWNSPRINKLERSYS7EM STATE UC. deemed revoked. Wq7ER HEA7ER LILENSE NO. CIASS IICENSED CONTRACTORS�ECLARATION DISiRiCi NO. PROCE55eD BY . I hereby pffirm thot I om licensed Vnder provisions of Chppter 9 GAS SYSTEM Ol1TlE75 �- � (commen<ing with SeUion 7000)of Division 3 of the Business OuiLEiSovER . . _ �„ and Professions Code,ond my�icense is in full forre ond effect. 5 PeR SVSIEM FINAL �• �ATE i7-/3!'d� VALIDATION ,,y License N�mber�_,�(�.�� Lic.Class� �� FINAL � co,,,,a�,o�t•C.R. Plumbitbg1e 6/21J85 ev J}'^ ,.,, � ❑ NE I pm exempi under Sec. � B.&P.C.for ihis reason �^ Plan check fee ... Date: pLUMBING PERMIi ISSUING FEE$ � 6 4 Signofure j� TOTAL FEE � S"` r Plan check applicanf "`��9•6 F 1 SINGLE FAMILY �e • • � � 'rj � ,r HOMEOWNER-BLIILDERDECLARATION Name R.C:R. Plumbin . . Inc. !eby affirm thot l om exempt from�he Conirador's License Address �-��]$Jr M1 nol ia Ade.� � � �7 6'"p Law for the following reason(Section 7031.5, Business and � � Professions Code): City Tel.N6. ° f�'��n� ❑ I,as owner of the property,will do�he work ond 1he � � � 0�L� '8 Jr structure is not intended or offered for sole (Sec�ion 7044,Business ond Professions Code). CONSTRUCTION LENDING RGENCY I hxe6y affirm�ha�tkere is o construclion lending agency for the performance of Ihe work for which this permff is issued (Sec.3097,Civ.C.). � L�a 457�a,�--- Lmrt1�'s� - I cerfify that I have read fhis applicotion and sfafe Ihof the � above informotion is correct.I agree io comply wi�h oll CouMy ordinances and Stple lows reguloting Plumbing,ond hereby au�horize represenfa�ives of fhis Cdun�y to entar upon ihe obave-menfioned pr perty for inspe ion pur oses. R.C.R. By: 6�/21/85 SEE REVERSE FOR EXPLANATORY LANGUA6E Sig�alu�e of Permit e \ Date AaaROva�S Da7E IrtS�CrOa'SSk^awniUkE INSPE�CTOR'S NOTES OWNER-&'J1LD�R DCC:LAp�TIDfd UNDER SLAB WORK I here6v a�firm�hot I aro exempt from the Coriro<tor's ROUGH PLUMBiPK; Ltcense Law for tha followinq r oson (Sec�ion 703I,5, � GASPIFING f 8usinessandFro/essicnsCedc):Anycilyorcocnty�which GAS VENT requires a permit fo construcf,alter,i.mprove,demolish, H0T WATER HEATER or repoir any struc�ure,prior fo iis issuancta. also rc- . quires fhe applicanf lar such permit to file a signed stote- . PLUMB4NG FIMURES � menf lhat he is Iicensed pursuant lo the provisions of tFe GAS'fEST 9 ContracTor's Licensc Law(CFopler 9(commencing wifh UTILINGO.NOTIFlED ' Section 70G0)of Division 3 of fhe Eusiness and Profes- � siens Code)or thr3fi F,e is exern�t therelrom o-nd the basis �c-�}-� -� - " 1or the alleged sxemption. Any violation o� Seciion FlNAL ' � '�(nfer ort .3ron.t � � � ' 7031.5 by any applicant/or a permit w6jc:cts�he opplf� cant!o a clvi!Fena;ty oi not nore fhnn five hundred � dotlars(S500J.: INDUSTR1kC -- � ' ' . . � ❑I,as owner of the properh�will do tnn work,and WASTE APPROVAL the slructura is not Intended or offered for sole. , • (See.7Dd6,Businoss and Frofc;sions Code: Tho C ar . . � � . fer's Lie�nse Law does not ap�ly!o an owner of�roperfy � , who buifc/s w.lmpraves thereon, ond who does such � � � . � . , , work h{mself provided fF.at sucfi im�rovemenc�re not Infsr�alwd or offared io:sa!e.f`,Fowevor,ihe building ar . improvemeni is sold within one�year of compfefion,Ihe � ownervbWldsr viift ha�e fne burden of provin�fhat Pie did . nat build or imprcve 1or fha purpose of sale.) ' I�am exempf under Sec. � � , B 8 P.C.for this recson � Date � � Owner `� � INSPECTOR'S NOTES � � � �