HomeMy WebLinkAbout1227A �_.r _._�__�A_ _-_L_:_�::. ___.._.
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"'°"KERS'�°^^°E"SAT'°"°E��ARAT'°" APPLICATI�N FOR PLUM�ING PERMIT �
I hereby pffirm thm I hove a certificate of ronsem to self 76n667A �
insure,or o certificate of Workers'Compensalion Insuronce, CE BV(REV.10/61� � ��'�
o�a certified copy�hereof(Sec 3800,Lab.C.� COUNTY OF LOS ANGEIES BUILDING AND SAFETY
O�Y i�JP$632138�9omPFremont Indemnity �� 3 G
Cer�ified copy is hereby fumished.
� FOR APPUCANT TO FlLL IN(PRINT OR TVPE) BUILDING /y/ AL�SILZtO S
Cerlified mpy is filed with Ihe counly buil �ng inspeo ADDRE55 /
�iondeporlment. NUMBER FIXiUREDRITEM C' FEE �O��IT� iamon ar
Dole8�14'�8� Appli4antRCR B i � WATERCLOSE7 `
NEAREST
CERTIFICATEOFEXEMPTIONFROMWORKERS' p'z BATHTUB /� „ CROSSST.GOLC�2T3 S rin s/Car 10 �
COMPENSATION INSURANCE SHOWeR � owNee The Anden Group
(TA7s s�ction n�od nof(»compfof�d ii th�work Invofvad by MAII
fM pormit i�for ona hundr�d dolbro(5700)or less.) � �qvniOkv a — ADDkE55
, I tertify that in the performance of the work for which this
' permi�is issued,I sholl nol employ any person in any manner � SWK � � CITV Covina TE���b7-9541
� so as fo become subjecllo Ihe Workers'Compensotion Lows. DISHWASHER � � . . . llIIl lh RC.
CONTRACTOR g+
�e Applicanf CLO7HES WASHER �-- qDDRE55
(ICE TO APPLICANT; If, after making this Certificate of �.2 85 Ma nolia
Exemplion, you should become subjeci to the Workers' SWIMMINGPOOLRECEPTOR
Compensarion provisions of the Labor coae,yo�m�s�+o.rn- c�T,Riverside 92503 TEL N437�.�SOOO
IAWN$PRINKLER SYSTEM
with compiy 4vith wch provisions or rhis permit shall be STATe f3 uC. ' .
deemed revoked. f waree HenTee �ICENSE NO. CLASS
LICENSED CONTRAC70R5 DECLARATION � DISTRIC7 NO. PROCESSED BY
I hereby affirm that I am licansed unde�provis�ons of Chapter 9 GA55v5iEM J� OUTtETS J
(commencing with Settion 7000J of Division 3 of the B�sinass OUTtEisOVER
. ond Rofessions Code,and my license is in full forte and effecf. 5 PER SYSTEM FINAL r cr^� V IDATION
License Num6er 3�(1{2� Lic.Class r�T__Z�+ DATE � 7 !� / �
RCR Plumbing 8/14/86 F'"^` �
Contrador Date 9Y
❑ O
1 am exempl�nder Sec.
U
8.8P.C.for this reason Plan check fee � "��
n,
Date: p�UMBING PERMIT ISSUING FEE S [���� F� L�,I� �
Signoture -
TOTALFEE ,�p �(j �
+ ���k s o,5
r^— SINGLE FAMILY Plan check applimnt I c p��v�
�� HOME OWNER-BUILDER DECLARATION Name
i irereby affirm�hat I am exempt from Ihe Contractor's License c ¢� '/�;�(}�
Law for the foliowing reason(Section 7031.5,Business ond Address
Professions Code): City Tel.No. U(j 7 rj—�j b
❑ I,os owner of the propeny,will da the work and the
structure is not intendad or offered fof sale (Section �
7044,Business and Profess�ons Code).
CONSTRUCTION LENDING AGEtJCY
1 hereby affirm thot there is a tonsfruction lending agency for .
the performance of the wark for which this permit is issued
(Sec 309T,Civ.C.).
�bda Ntrme---
kemler'alcddie�s-—
I certify thot I hpve read�his appliwtion ond s�ate ihat the �
obove informaiion is covect.I agree to comply with oll County
ordinonces and State lows regulating Plum6ing,ond hereby
aWhonze repre�sentotives af this Co�nty to enter upon Ihe
aF�ove-menti ed property or inspection purposes. '
SEE REVERSE fOR EXPIANATORY LANGUAGE
RC • � 8/14/86
Signature of Permiftee T—Dote
, � � � �� �� �'�
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' a „�"-� =-`�--�"''�'�,3':�l�
APPROVALS OATE 1ld5eECTOR'S SlGNRTURE �NSPECiOR'S NOTES O�NNEP.-BUILDC-R��CI..ARATION
UNDER SLAB WORK � � I hareby off!rm iha�I am exempt from �he Conncuor';
ROl1GHPLUPl,eiNG '� - � License Lwe for the follawing re�son (Secfion 703L5.
GAS PiPMG Business and P�olessions Code):Any<ity or counfy which
GAS VENT
requires o permil ro<onsfrucb al�er,improve,demolisn.
- . orrepair ony sfructure, prior to!fs is3uance, olso re-
HOT WA7ER HEATER quires fh0 appliconf lor such permit to fife v s%gned slofo-
P;UMdING FiXTURES ' � ment}hal he is lltensed pursuanf ro the provls7ons of the
GASTE57 I� Contractor's L7cense Law(Chopfer 9/mmmencing�•�i'h
UTILI7YC0.NOTIFIED Section 7000)o/Division 3 of the Business ond Pro/es-
. sions Codr)or thof he is exempf iherafrom ond the besie
r for the alleged excmption. Any violation of Section
FWAI - (n�n�on �ronl � � 7031.5 by ony applicant for a permil su6jects fhe oppli-
. . , cant to a crvil penalty of not more fAon /ive hundred
dollars($500).:
INDUSTRiAL � ❑I,as owner ot ihe property will do the wor'—nd
WASTE A�PROVAL � the strutfure is not intended a offered for scle.
. . . � (Sec.7014,Buslness and Profess�ons Code: The Controc-
� � ior's Lltense Low does not apply to an owner of proparty
� who b�ilds or improves thereon, ond who does such
. work him�elf provlded lhaf wch improvements ore not
� intended or o(fered for sole.1f,however.the huilding or
- � Improvement 1s sold wifhin one year o!completion,fhe
ownar-builder will fiave ihe kwrden of p�oving thot he did
. � nof build or(mprove for�he purpose of sale.J
` � t am exemp!ander Sec. -
� 8&P.C.for this reason
Doie
Owner
INSPECTOR'S NOTES