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Home My WebLink About1225A --- --i:�:.�---- -- - -- ___ woRKeRs coMPeNsnnoN oeaa,Ranorv APPLICATIQN FOR PLUMBING PE�MIT � I hereby offirm that I ho�e a certificate of mnsen�ro salf �dqy��q _s ,�� i'nsure,or a cer�ificote of Workers'Compensation Inswance, CE 817(REV.10/81� Y� •� or a certified mpy�hereof(Sec 3800,lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY O�0-R O�Y�8632138gomPa remont Indemnity _ �� • -----�—� Certified copy is hereby furnished. 53� � � FOR APPUCAN7 TO FIIL IN(PRINi OR TVPE) BUILDING I_� A2TI11 C 0 S Certified copy is filed wi�h ihe rounty 6u'Iding inspec- ADDRE55 �4 tion department. NUMBER FIXTURE OR ITEM [¢ FEE �OCALITY � Da�eB/14/86 qPP��a��RCR B 1 � WATER CLOSEi —_ NEARES7 � CERTIFICATE Of EXEMPTION FROM WORKERS' BATHTUB � _ caosssT.Golden Springs/Carpio COMPENSATION INSURANCE OWNER e n 211 roup (Thls��efion n��d not b�compl�ted iF fhs work Involrod by SHOWeR MAIL 1h�permif la for on�hundr�d dollars(;100)or I�cs.) � lqvqTORv AD�RE55 1074 Parkview �T. I cer�ify that in Ihe performonce of the work for which ihis SINK � ..--� GITY .riOV1213 re�.�:Ei7-9541 permit is issued,I sholl not employ any person in ony manner so as�o become subjecf to the Workers'Compensation Laws. pI5HWA5HER ' '� '� � ' CONTRACTOR /'^•e Applicont CLOTHESWASHER ^ A�ORE551Z7tgS M3 nolia fICE TO APPL�CANT: If, pfler making this Certifica�e of SWIMMING POOL RECEPTOR taemp�ion, you should become subject to �he Workers' ��T�1V2rSl 2 �i.N . � . Compensotion provisions of the La6or Code,you musl forfh- 4AWN SPRiNKLER SYSTEM with comply wi�h such provisions or ihis permif sholl be STATE LIC. ' deemed�evoked. WATER HEATER LICENSE NO. CLASS LiCENS€D CONTRACTORS DECLARAiION Di57Ricf N�J rRocE55Eo ev I here6y affirm thot I am licensed under provisions of Chapler 9 GAS S�STEM OUTtETS � � `� (commancing with Section 7000)of�ivision 3 of the Business ouitEi50VER ond Pro4essions Code,and my license is in full force and effecl. 5 PER SVS7EN, FINAL '/y-f VALIDATION DATE � �'✓� / O, License Num6er�.,�F'+�7R Lic Glass �'--�F+ 1tCR Plumbing 8/14/86 ' gyA� V' Contractor Date a I � 1 om ezempt under Sec. � U 8.8P.C.for ihis reoson Plan check fee a� oore: N PLUMBING PERMIT ISSUING FEE 5 Z Signature =`.� ��,�� ' TOTAL FEE ) }'r.n.o . • .$ . Glon check applicant SINGLE FAMILY ti, o � � HOME OWNER-BUILDER DECLARATION Name I �E O �..e�eby offirm thai I am exemp�from the CoMraclor's License Address °� - �"�C��ii,��n czi law for Ihe following reason(Secfion 7031.5, Business and Professions Code): City Tel.No. �£�J Y�i b ❑ I,as owner of�he propeny,will do the work and the � structure is not intended or of4ered for sale (Section ► 7044,Business and Professions CodeJ. CONSTRUCTION LENDING AG€NCY � � . I heraby affirm ihat there is a cons�rudion lending ogency for the performance of the work for which Ihis permil is issued (Sec.3�D47,Civ.C.y. l8rtdbr's NOmE Lender's Ad�ress I certify thaf I hove reod this applicatfon and s�ate thvf ihe � above informalion is correct.I ogree to mmply wilh oll County ordinances and State lows regulatinq Plumhing,and hereby . au�horize representatives of ihis County to eNer �pon the above-men oned property for inspeUion purposes. � .�,, SEE REVERSE FOR EXPLANATORY LANGUAGE RCR Sy�-O-�vQ_��.1��/14/S 6 Signoture of Permittee Date1 . i �� - � l � � 1�� r""'��' �' rr� � _ �R td� naaeOt�a�s DATE iN5reG70R'S SiGroAiURe �NSPECTOR'S NOTES ON/NEP.-BUILDER,'_IEQ.ARATION urvoeR s�ne woRK � �� 1 I hereby afflrm thal I om e empi from the Conircctor's ROUGH PLUMBING �p . License Lav� for tha £ollo�N ng reason (Sectian 7G31.5. GAS FIPING �O ��i Business ond Professions Codc�1�Any cify or covnty which GAS VENT requires a permi/fo construcf,alfer.improve.demolish. or repair ony afructure„prior to its issVance, olso re- HOT WATER HEATER � ' � - quires the appficbnf(or such permil to li7e a signed str.te- PLUMBING FIXTURES � . men/fhaV he is litensed pursuont/o ihe provislons of the GAS7E5T �� 4� . ConTractor's Licensa Low(Chup/er 9(commencing��i}b UTILIiV CO.NOTIFIED Set�lon 7000f of Division 3 of the Business and Profes� . , sions Code)or fhal Fe is exempf therefrom vnd the bask � for the olleged ezcmpifon. Any violaUon oi Seciion FINnt � r' � � 7037.5 by any applitant ior o permil subjects Ihe oppli- Gnfer on ron! . canf fa a tivi!penaFty o1 not more thon live hund�ed . dollars(5500).: INDUSFRIA� . � �I,as ownar of the property will do Yne war��--nd WASTE AFPROVA, � ' the structwe is oot infended or offered far sale. �. - (Set.7QI4,Bustnesa arrd Prolessions Coc'e: ThQ Contrac- - � ` � tor's Li[ense Law does not apply to on awner of proper�y who b�flds or lmppoves �hereon, ond who doas such � work himseif provldad tko�suoh improvemenrs ore no� intended or offared fo(sole.If,however,the building or . . Improvement!s sold witRin one yeor o(complotion,the , � ownerbuf(dar wlll hovo}he burden oi proving fho�he did , nof bulid or improve for the purpose of sale.J I am ex�rnpt under Sec. - , B&P.C.for this reason ___ Date Owner INSPECT�R'S I+#�TES