HomeMy WebLinkAbout1452A � AT10N DFC4ARATION APPLICATION F�R PLUMBING PERM17 {�
I hereby af{irm �hat I have a cerlificate o4 ronsent ro self �yq��q ��
�,insure,oroterlificaleafWarkers'Compensolionlnsurance, CEB�74REV.10�81) �
o�o Ye�tyf�copy�hereqj�ec.3800,106.C.�� n GOUNTY OF l05 ANGELES �B`�U�IL_DING AND SAFET��
Polic �o�Company .� ^!r� ..
�er�ified capy is hereby furnished.
FORAPPLICANTTpFIIIIN(PRMTORTYPE) 9UIL�ING /J I'�"�j y ♦ ,
Certified copy is filed wi�h the counry building inspec- ADDRESS �� j VJ �-'�
rian da tment NU R fl%TURE OR ITEM Q FEE ,n n
r' �!�C��� WATER CIOSET LOCAtlTV Py-��
Da1e Appli4on/ NEARES7
CERiiFICATE OF EXEMPT19N FROM WORKERS' BA7H 7U6 — CROSS S7.
COMPENSATION INSURANCE SHOWER OWNER � �
(Thi�s�Nion n��d net b�eampl�Md if M�werk invo{vad by ���
fha permit b for orte hundnd dollarc(5100)or I�rc.) LAVATOFY ����. qpDRE55 '
I cerfify thof in rhe performonce of fhe work for which�his SINK � "'� CITV d T �
permit is issued,1 shall no�employ any person in ony manner
so as ro become subject to�he Workers'Compensafion Laws. OISHWASHER �C'/wi /"
CONTRACTOR v� �
Date applicanf CLOTHES WASHER "� ,/
AODRESS
„J^kJTICE TO APPLICANi: If, after making this Cartificale of �D /V��
� mption, yov should become so6jecf to the Workers' SV/iMMiNG POOI RECFRTOR �� � � �
..ompensa�ion provisions of tha La6or Code,yau musl forth- GTY ..7 � � N
IAWN SPRINKIEB SYSTEM
with comply with auch provisions or this perrtlit ehall be StATE � Q r�3� tiC. /
deemad revoked. WpTER HEATER , r LICENSE NO. �J�p ClqSS ir
LICENSfD CONTRACTORS DECLARATION plSiRiCT NO. PROCESSED BV
I heroby aff��m tho�I om licensed vnder provisians of Chapter 9 GAS SYSiEM OUttE7S
(commencing wllh SecHon 700D)of Divition 3 of ihe Business OUTLETSOVER p
and Profassions Code,o�l3v����s In full for�an��ct 5 iER SYSTEM FINAI r8,� VALIDA iON . y
i DA7E � /�i�
. License Num6ar ^ Uc.Class �
u{��,Q FINAL U
Con�ractor-���r7�,`— Date`� BY ��'�"�
Q.'
I � O
I am exempf under Sac. �
B.BP.C.for�his reason pian check fee W
a
Date: UJ
, PLUMBING PERMIT ISSUING FEE$ Z
Signarure ��
TpTAI FEE
,�
� Gian check opplitant � ��� �l 5.2 A
� SINGLE FAMILY
� HOME OWNER-BUI�OER�ECLARATION Name n;o • o • •Jr
�eby affirm�hat I am exempt from the Contractor's License qddress
d for the following rebson(Sedion 7031.5,Business ond � ,� ���,�Q
Professions Code: �`'
� t City Tel.No. � `
I,os owner of the proper�y,wili do the work ond ihe �-J C��
st�ucture is not intended or offered for sale(Seclion .
7044,Busina5s and Professia�s Cotle), h 0 9,1 0—8 7
CONSTRUCTION LENDING AGENCY .
�. I heraby nffirm thaf there is a construction lending ageacy for
the pelformance of ihe work for which 7his permit is issued
(Sec.3097,Civ.C.). �
Le�lbr's IVan�e
lender's Adcicros .
I certily rhot I have reod�his opplicalion and s�ate�hat the �
. obove informmion is mrrect.I agree to comply wirh oil Cou�1y
, ordin nces and S�ole lows iegulating Plumbing,and hereby
��� aurho� repre`sento�ives of rhis ouniy fo enrer upon Ihe
� obove- e io propert for ec��on purposes.
� SEE REV'ERSE FOR EXPLANATORY LANGUAGE
L � '
I noture af Permitree Dat�
- .m._- �-- —
+,fi+ti i 4 .���M�#�.�� �LJ� ���ItJ��J�. _ . . . -- ` ---���r�a!�r
qar�ovnis� nTe iN 'iOR'S S�cNnruee INSPELTOR'S NOTES p�NIVER-BUILDER.5�AR7S�fl}7
___.�.. . . , . . - i�:
UNDERSL�E N,'GN� I Fereby offirm�Fat I o . mpt from the Contrec+or',
HOJC-H P�l � License Low for the follo•.v ng reason (Se�c1 037.5.
Gq�p�p�yr � _--�-I��R . Qus'ness ond Prafess�ons Code) An�c'ty or ty hrch
—��-� requlres a permll fo construcf,alter, mprove,dAmol�s,ti,
GAS VEt:t � '- ' -
or refwir ony sfrLcfure, prior�fo its i suonce, ofso r
HOi WATeR H;�aTep � � quiros 1ha ap�liront lor zuch permif fo file a signed stn+o-
�FLUn?slr?.;F�.::?-�iv�:, I � � � men�fFot he is hcenaed pursuont to Ni=p.roNs�ons o!tFe
GAS TE51 � �� � � Conlroctor's Cicepse Cow(Chopter 9(commanciny o-�ifh
UTILITYC:u.NOT;�li:7 ______ Section 700�j ot Dlvlsion 3 of�he Business ond ProFes�
________J.. sions Code)nr thaf ha is ezempf thefehom ond the bcsis
. ,.__ - ______�,___ • , for the alleged excrnption. Any violalion oi Setlion
FiNA� � � � �.. � ^� ��' 703i.5 by ony opplicanf!or o perrrri!subjects the appli-
t,.t.-,�a< ���,ne
----------�� - cont to a civil penolty of not more than fivv hundrad
__, � � � . doifaro(S500J.:
INDUSTF,F�. � ❑i,as owner cf fhe property wJl do Ihe work,and
WA TE.•.-�FKJ�;n��, � � � � " -'-"---�-------- - Ihe structure is no?infended or n�ferecF fa sole.
S
�'����������� , �.'� . {Sec.70M,Bustrwss and Professions Code. The Cc �.
� " � ' „ � ' � tor's L7tense Lnw does noi opply fa a�n owner of proF,rrty
"-. , ' who�6uiMs ar improws thereon, and who docs sueh
� � work himaelf provldad thaf wch improvemen�s a�e not
Intended or offered for sale.lf,hovsever.the building or
. tmprovemenf is wld witMn one ysot of cwnplefion.the
owner-builder wilf have the burden ol proving lhot h e did
, not build or improva Iar fhe purpose of safe.)
. I am exemp!under Sec. . ,
� B&P.C.for ihis reason
1 »
Date
Owne:
�T���ul�d�°�CTGF.'S NOTES