HomeMy WebLinkAbout1453A piioro oE��AQAT�o� qppLICATIOIV FOR PLUMBING PERMIT �
f`'iereby offirm thot I have a certificate of consent ro salf �yqyb�q
� �nsure,or a cenifimte of Workers'Compensation Insuronce, CE 8V(REV.10/el�
or o c ti ��jd copy rhe��Q(f„(Ssc.3800q,�ob.c.) .q�r(� COUNTV OF LOS ANGElES BUILDING AND SAFETY
' P❑olicy��6 34�q -Company �✓r�vN•lJ � !��- �y j
Cert�fiad copy is hereby fomished. BUILDING AT?M 11 L�M 4�7t
FORAPPUCANiiOFILtIN(PRWTORTYPE) qppRE55 V 7 / /Tn�•��/ `� �"
��Cerfified copy is filed with the county bullding inspeo
ti d tment � �,,/� NUMBER FI%TUREORITEM � FEE �OCAU7Y
�� �^����L,`Y�L ATER CLOSET
Oate � Applitanr NEARES7
� CERTIFICAiE OF EXEMP7IQN FROM WORKERS' &4iH TU8 �^ CRpSS ST.
COMPENSATION�NSURANCE OWNER
(ibi.,.e+ion n«d nee b.compla.d rf rh•work��.olvd bY SHOWER
�1 n�na
tM�p�rmlt Ir for on�hundr�d dellon(i100)or bss.) LnvnTORY vL� qppRE55
f teriify thot in the performance of the work for which this ' �4�f7l�
permi�is issued,I shall nof employ any parson in any manner SINK .�^ ��TY t T � /V�r
so as to become subiect ro�he Workers'Compensation tawa. � DISHWASHER "� CONiRACI'OR
sc�tc
Dple Applicont � CIOTHESWASNER �1 �^}tih,/'y^..�
AODRf55 y/Tj(/T V
o.�"anTICE TO APPGCANT: If,after moking ihis Ce<<ificate of SWiMMINGP00tRECEPTOR
� mp�ia�, you should became subjact �o �he Workers' CiTY � O ��,��
_�mpensotion provlsions of Ihe Labo�Code,yo�musi forfh- LqWNSPRWKLERSYSTEM
ith comply wi�h s�ch provisions or ihis perm�t sholi be STnTE f'� �f� li
deemed revaked. WATER HEATFR �. LiCENSE NO. a7 �d CL 55
LICENSED CONTRACTORS DECLARATION DISiRICT NO. PROCESSED BY
I heraby affirm�ho�I am licens�d under provisions of Chopter 9 Gn5 SvSieM ouTtETS �p
(commencing wi�h Sxtion 7000)of Division 3 of the 6usiness OU7lET50vER
ond Professions Code,and my license Is in tull fwca and e(ffect 5 aER SVSTEna� FINAI VAL ATION
� �J JQ6.3 � �YJ DA1E �/!Yr �� 0.�
Ucense Num6er Lic Closs
��-K/� C� °Q��'� FINAI U
Controcror ���L��"" ' �+ Da/e� BY � � p
I ❑ �am exempl under Sec. U
B.&p.C.fa this reason p�an cheCk fBB �
Dme: PWMBING PERMIT ISSUING fEE$ � Z
5qnoture �1 4.`.z'�A
TOTAI FEE
Plon chack applicani � tr° ° • • •5
SINGLE FAMILY ( a �']6,��
HOME OWNER-BUI4DER DECLARATION Name
'�'re6y affirm that I am examp�from the Contracior's License . e .. .,%(,jO�
„�for fhe following reoson(Section 7031.5, Business and R��ess
Professions Code): . Clry Tei.No. G 9,1 0--8 7
❑ I,os owne�af the propeny,wiil do rhe work and�he
slr�cture is not intended or offered fo�sale(Sectian ►
. 7044,Business and Rofessions Code). _
CONSTRUCTION IENDING AGENCY .
I hereby o€firm fFwt fhare is a<onstruction lend�ng agency for
fhe perfamonce oi tMe work for whi<h this permit is issued
(Sec.3097,Civ.C.).
kesides'a�iCpe� �
Lender's fn��eas
I ce�lify fhat I have read�his applimtion and stme thot 1he - �
a6ove informa+ion is orrect I agree to comply wilh oll County
ordinances and S(ote laws regulaunq Plumbing,ond hereby
authorize repre'senta�ives f ihi County to eMer upon fhe -
above- enl n rop rty ior i pedion p�rposes.
SEE REVERSE FOR EXPIANATORY IANGUAGE
���
� Signe re of Perminee , Dote
_ _�._-- __ _
__ __
npF��qN r wsa �R� ��NatuRE i iNSPECTOR'SNOTES OLViJERB�ILDCR�ECIARAiiON ,
UNnER SInR W'JK� J? 1 e ' I hereby affirm�ihor I m�exempi f om Ine CnnirC.�ra•'>
ROUGH P U �(�� � '�� License Lnva for th f Ilow ng eason (Se t n '031.5.
GAS FIFI� ,�__ �f/7'��� _ _ _ __ Business ond Professio�c Code!;Any cify ar c nty wh�ch
� � requires o permtf to consfruc�,offer,improve,demolis'y
GASVF.h:i !, .�i � � � �
� or repair ony,structure, prior ta iis�ssusne�e, olso re-
HOT wt.7PR HCaT.2 __i _ _ - quires fRe applican�for soch permit to Ole a slgnod stcte-
�IUMBING=ixTI1KEJ � 1 ' ' meni thaf h�is llcensedpursuan'tp iha pro�lslans of!he
- - �,+- -'-�-' Coniroctor's Cicanse Lew(Chap�er 9(comme,xiny v�i'h
Gn5 TES'_ - i�j j �- 'i.�
UTIu7Y CO.KOiIRE'J � Saciion 700Bj oT pivision 3 of fhe Business ond Profes-
----------- sions Code)or thai he ls exempf theretrom ond�h=6asis
y� for the I! p y violaffon oi Secfian
______..:__._..'____:_._______c.7_��_.__. -� o eged exem tion. Hn
Fin^'. . 'r�,:frr on _i.on,l � ' � - 7D91.5 by ony opplicanf/or a permit subjxfs�he oppli-
-----�-- .. . , . cant ro a civ�l pena(ty of not moro tfion five hundred
. _ �' doqars(S500J.:
itdoUSia�r.l' � � � � � � ❑I,as awner o`,the proporty wi'�I do the work,and
�WA578 qFF.Cvnl - � � the structum is not intended or offered fw sale_
�_��...._..._.__._�_._ ..
� . �� � • ' (5ec.7041,Huslness cnd Profossions Code: Tho Cc + .
. � � . . . �-�---�-- tor's Llcense Low doss noe apply r�an ownef oF pror,,.r�y
� ' � � � ' � who 6WIds or improvss tharmn, and who p�OLS sutA
� � � � � � • � work himseff provided}fiaf such improve'»ents are not
� � 7Mendad or offered for sale.1€,however,iho building w
� - �� � improvement is sold wifhin one yeor o!conrpbfion,the
ownerbuilder w111 ha�e the burden of proving iho�he did
, `� �� noi buifd or improve 1or the purpose of safe.j
t am exemp',under$ec. ,
�� ` B 8 P.C.for this reason
Dore
Owner_
r<a_
�_._____ .-i��,.F'CfOR'S NQTES r