HomeMy WebLinkAbout1754A ���°�°E��"R"�°" qI�pLICATION F<JR PLUMBING PERMIT ,,,���777 �
I hereby affirm that I have a certificate of consent fo self �yqby�q � �
insure,or o cerfificate of Workers'Compensation(nsurance, CE B�7(REV.70/81) �
� or a certiHed copy theraof(Sec.380f1,lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAPETY
��y�4dPc�5����R&mpany Fremont Tndemnity . '
Certified copy is hereby furnished. �..
FOR APPLICANi TO FILL IN�PRINT OR TYP�) BUILDING
�,Cerlified copy is filed wilh the muniy bu'Id' g inspet- ADORESS ,
tion deparimeni. ! (�_ NUMBER fl%TUREOR ITEM r� FEE
� �r.a r� ( �o���r Diamond Bar
Date C+�l q�R SAppli4ont �-Q.� �.Il� cL WATER ClOSET / NEARES7 �
CERTIFICATEOFEXEMPTIONFROMWORKERS' � oZ Ba7HTUe ceosssT. 60/Philli S R3T1CY1
COMPEtJSATION INSURANCE SHOWER OWNER outh Cou � r T
(Thb s�cfion nNd not be eomplwbd if tha work inrolvad by MA�� , . . .
the p�rmit if for on�hurtdrad dollor�{f100}or(�sF.) � LqVATORY qDDRE55
I ceriify thot in the performance of the work for which Ihis ,
permit is issoed,I sholl not employ any person in ony mannei SINK- _ QTY TEL.N .
. so os�o become subjeU to the Workers'Compensation Laws. DISHWASHER •
CONiRACTORR.C.:R. Plumbin INc.
Date Applicant CLOTHES WASHER A�pRE55
_. A1q710E TO APPLICANT: If, ofrer making this Certificate of SWIMMINGPOOLRECEPTOR
� nption, you should become sobjec� �o tha Workers" Citv � � iEL NO.
..rnpensation pravisions of tha Lobar Code,you musf forth- �qWN SPrzINKIER SYSTEM � � �
.� wifh cpmply with such provisions or this permit shall be �ENSENo. 336428 �IC
' deemedre�oked. WATERHEATER . CLASS C-36
. LICENSED CONTRACTORS DECLARATION �ISTRiC7 NO.a PROGESSED BY
I hereby affirm iha!I om licensed under prpvisions of Chopter 9 GAS SY57EM � OU7lET5 /�
(cammencing with Secfian 7000)of Division 3 of Ihe Business OUTLETSOVER l �
ond Professians Code,and my license is in full force and affect. S PER SYS7EM FINAL e
DAiE I��4��y V IIDATION �
License Number �i�6(#i8, Uc.Class�jII_
�������, S!
co�,�a�,a, RCR Pluuibin�,a,e 6/19/85 svA���'�"-�'"/ �
E,;
� �' 6i
I am exempt under Sec. 5�.
B.BP.C.for this reosan "�'
Plan check fee .
Date: PLUMBING PERMIT ISSUING FEE$ �(� �Q
Signature �'n'-� 7�4 A
TOTAI FEE ���-� ,
�.a . : .5
� Plan check applicont
' SINGLE FAMILY ,R. PL ING � � �7 6'`��
HOME OWNER-BUIIDER DECIARATION Name ��.INC..
� "� � ry�reby affirm thot I am exempt from�he Contractor's License ���,��'d��1b-�. d. V8. • •:�]6,5 d�
� .for the followinq reason(Section 7031.5, Business ond Address
Professions Code): Ci�y Tei.N �7,2 9�$5
- ❑ I,as owner of the ro ert z��` �-i�Fa"—Tz� � � -
p p y,will do the work and ihe . . �
struUure is not intended or offered for sole(Sec�ion
7Q44,Business and Professions Code).
CONSTRUCTION-LENDING AGENCY �
I hereby offirm�hot thmre is a construction lending ogency for
, the performance of the work for which Ihis permit is iscued . '
(Set.3097,Cir.C.). - .
4mrtdbds htatme --
� lace�'sAIV�--- � .
, I certify Ihat I have read this applimtion and state tha�rhe .
above information is correct I agree to mmply with all County
, ordinonces ond Sta�e lows regulo�ing Plumbing,and hereby
.. au�horize representatives of ihis County 10 eMer opon the �
above-mentioned pr rry for inspe wn purposes. SEE REVERSE FOR EXPIANAipRY LAN6UACiE
R.C.R. Bv�Qa�DI `�.5.f14�R5
Signofure of Permitiee Dpte
APaaoV.eLS DRt I 'eeC70e'S 9M1F7nTUkE INSPECTOR'S NOTES ` ON+NER-BUIIDER U�CLARATIOhI
UNDERStHB W'pRK S �f'S li..l.a..r_.- � ' 1 tiere6y affirm ihof I om exempf from-the Controctor's
ROUGHPLUMBING (�/} -q,._!.j"�, License Law for ihr, following rposon (Sattion 7Q31.5,
GAS PIPING J Y + �q► Business ond Professions Code):Any city or ca�nty which
GAS VHJ7 ' . . requires o permit io construct,al�or,�improve,demolish,
HOT WATER HEATN! or repalr any sirocfure,prior lo ifs issuance, also re-
� � quiras/he ap�hcani for such permit to:file a signed stafe�
PLUMBFtJG FI%TURES �� � � � ' meni thaf he is Iicensed pursuant fo the provisions of ihe
GASTLST t .,7 , kT.!� °�1.#�.�, Coniracfor�s Licsnse Law(Chnp#�r 9(commencing wifh
UTIUTYCO.NOFfH@D � ' Saefion 7000)of Divlzion 3 oi ihe 8uslness ond Protes-
.. sioRs Cods)or thef hs is exsrrspt 4Ferefrom ond the 6esis
�+ cy lor the otleged axo-mpfion. Any vio/afion of SecNon
FINAL Gnfar on ,tionf ' 70JL5 by ony app(icont lot a permi+subjects!fie appli-
� canf to a c{yil panalty of na}more iFan five hundred
� dollars($S00).:
W�USTRiAL � ❑I,as owner of ifie property will do ihe work,and
WASTF AWROVAL ihe structure is noi intBnd6Cl or offered for scle. ,
(Soc.70M,Buslness and Professions Code: 7he C� �c �-
� _ � ', _ tw's Lieen.oa Law doos not apply ro on owner of pror erty
� who lwilds or lmproves thereon, nnd who does such
-� � work hlmseff providod tbat such improvements are not
intended or olfered for sa(e.If,however,�he bullding or
� � improvement�s sold wlfAfn one yeaf of mmplefion,fhe
, owe:�rbuilder will hove the bwrden of proving ihot he did
. rrot bvild or Improve for the purpose of sal�.)
I am exempt under 3ec. ,
� � 8 8 P.C.for ihis reason
Date
. +
Owner
INSPECTOR'S NOT£5