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Home My WebLink About1755A �' OMPEN3RTION DECLARATION APP�LICATIQN ROR PLUMBlNG PERMIT ,,p / I here6y affirm thot I have a certificale of consent to self 76A6b�q ,�L„7�/7 � � insure,or o cartifiwte of Workers'Compensation Insurance, CE S77(REV.10/81) � � � or a certified copy thxeof(Sec.3�0,Lab.C.) COUNTY Of LQS ANGELES BUItDI AND SPFETY�/ �cylki�R5�9'I3861,mpany Fremont Indemnity , ��'yt+�-yy�,7��i � Certified copy is here6y furnished. ' FOR APPLICANi TO FILL IN(PRINT OR TYPE) 8�1��DING . �Certified copy is filed with�he co�nty 6oil ' g inspar AooRE55 �� ion daparimenf. NUMBER FIX7URE OR ITEM �iD, FEE �OCAUTV Diamond. Bar � Dale ��.9�ASAppli4onf - . WATERCLOSE7 i- � NEAREST CERTIFICATE OF EXEMPTION FROM WOItKERS' BATH TUB d -- cRoss sT. 60/Phil li s Ranch � COMPEMSATION INSURANCE � SHOWER OWNER S011tll COU.I1tY CpT (This ooNion nNd�roi bs comp#olod if tha work 9nvoirwd by . . . . th�p�rmN is for ano hundnd dollcra(�100)or I�a.) �L4VATORY / �I� ADDRESS I certify that in the performance of fhe work for which Ihis permit is issued,I sholl not employ ony person in any manner SINK CI7Y TEL N so as io became subjecf fa fhe Workers'Compensation laws. DISHWASHER — � CONTRACTOR . ppfe opplicqnt � CLOTHES WASHER — � � ' -- ,jdOTICE TO APPUCANT: If, after makinq ihis Certificate of ADDRESS � ' mption, you should become su6jecl b the Workers' SWIMMiNGPOOLRECEPTOR , � .npensotion provisions of rhe Labor Code,you must forth- C1TY . . T£L.NO. IAWN SGRINKLER SYSTEM with [omply wi�h such provisions or ihis permif shall be STATE LIC. ' . deemed revoked. � WATER HEATER I�CENSE NO. CLASS LICENSED CONTRAC70R5 DECtARATION DISTRI PROCE E6 I hereby affirm that I am licensed under provisians af Chapfer 9 GAS SYSTEM OUT�EiS /,ry (commencing with Section 70p0)of Division 3 of the Business OUT�ET50v€e 1 v y. � and Professions Code,and my license is in full force ond effect. 5 PER SYSiEM � F�NA� ,,•• � DATE �y./G�/'�"S v LIDATION Q License Number �4��.qZ��_Lic Class '��_ [.'.. Coniractor RCR P111A1�11h�Date 6��'9�'�5 . BYAt �) � !✓�i ua ❑ e. I am exempt�nder Sec. � B.&P.C.for this reoson � Plan check fee Date: PLUMBING PERMIT ISSUING FEE S �Q Q Signafura TOTAL FEE "7/_ C_`� �� 7 5,5 A � Plon check opplicont �� \J SINGLE PAM�LY ING . INC.. �� 5 HOME OWNER-BUILpER OECLARATION Name r y � "'eby offirm that I am exempt from the Coniroctoi s License Address ��'• � • �7 b 5 0 , � �for the following reason(Section 7031.5, Bus+ness ond ' ,��5 O� Professions Code): City Tel.N � �• • • '�, ❑ I,as owner of the propery,will do the work ond the � . - � ► a Z 2 9�8 5 � structure is nof intended ar offered for sole (Setfion 7044,Business and Professions Code). CONSTRl1CTION LEND{�AGENCV� ��. I hereby affirm that�here is a construction lending a9ency for the performance of the work for which Ihis permit is issued - (Sec.3U97,Civ.C.). . � E��e�:HCme � keraieJrRdMaaa I cenify tho�I hove rec3d this oppliwtion and state ihot ihe � � above infarmation is mrrect.I agree to comply with all County � ordinances ond State laws regulating Plumbing,and hereby authorize representafives of this County ro emer upon the above-mentioned pro�rry for inspection purposes. SEE REYERSE FOR EXPIANATORY LAN6UACrE R.C:R. BY�f_�ltt�,� 6/19/R5 Signafure of�ermittee Dote , ,� � APPROVAlS hi � It P�CTOR'SSIGNATURL WSPECTOR'S NOTES OWN€R-BUILDER DECIARATION UNDER SLAB WOiN( ,S�d' (},�`_ �I hereby atfirm that I am e�xampt from Ibe�Contrac+or's ROU6H PLUMH�WG � � �.�' ,�-j'�`� � �License Law for the foliowing reason (Section 7631.5, GAS WIING � �-(-� B�slness ond Profe;sions CodeJr Any city or county which GRS VEfd� requires o permit to construct,oller,imp�ove,demolish. or repalr any sirudure, pnor fo ifs issuonce, also re- HOT NiqZER HEAiER quires the applican}for such permk to lile n signed slate- PLUA18iNG H%7URE5 - menf fhvt he Is licensed pursuent ro�he praWslons of the GASTl6T �, �1 . ' Controc}cr's Lieensa Law(Chep/x 9(tommencing wi1�4 UTILIN CO.NOFiF1ED Section 7009)01 Divislon 3 of}fiQ 8usiness ond Profes- siaros Ce<Mj or ihoth�Is a�e�mpl tlwsfrum ad Ti�s 6asis cy for 1he aUoged exsniplicn. Any violalion of Secllon FINAL � �nr r on _}ronf � � 7031.5 by any appficant(or o permii subjscts the oppli- cant to a civil penalty of nof more than flve hundred dollars($500).: INDUSTRIkt � � � � ❑I,as owner of Ihe property will do Ihe work,ond WAS7E APr'ROVAL �� ihe s;ruclure is not intended or offered for sole. - � � � - (Ssc.7(744,Buslness andProleesiens Code: 7h¢Cr �c- tor's Llcense law does nof apply ro an owner of pro,._rry � , . . . � - who bWlds or fmpt'o-ves iiaereon, ond who does such . work himself proviclwd fba!wch lmprowmants ara no� � ' intendso or offsred for sofe.If,however,iha 6uilding or � . - , improvement Is sakl witAin ons yeor of complelion,fhe � ownervbutldor wlll have the burdan o�proving fhar he drd nof buitd or improve ior the pwpose of sofe.) � .� �I cm exempt under5ac. - , B 8 P.C.for lhis reason Date F Owner tPoSPECfOR'8 R8OT�3 -