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Home My WebLink About1310A,Date Applicant 'ICE TO APPLICANT: If, after making this Certificate of ._mption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing wi+h Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forces and effect. License Number Lic. Class Contractor �.:�SC%(�Q ate rl. l-�� ❑ I am exempt under Sec. B.&P.C. for this reason Date: SINGLE FAMILY HOME OWNER -BUILDER DECLARATION reby affirm that I am exempt from the Contractor's License Law for .the following reason (Section 7031.3, Business and Professions Code): ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby offirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). to""I'T F7daPtC Tedder" AddMV I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Signature of Permittee Date r CLOTHES WASHER SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM 'I WATER HEATER I I IGAS SYSTEM OUTLETS I 1 (/)1" 31 Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Pion check applicant Name Address City Tel. No, SEE REVERSE FOR EXPLANATORY LANGUAGE CONTRACTOR k ADDRESS Ii'D 1.'0 CITY n C> )L r. �On_o�� TEL. FINAL VALIDATION DATE ?/ I / FINAL BY vt 011 131.0A t,ade.e5 I,®76.50 I 0^02-87 i WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT .I hereby, affirm that I have a certificate of consent to self 7eA867A insure, or a certificate of Workers' Compensation Insurance, CE 817 (REV. 8/881 or a certified copy thereoffj�,�.�(��` 3800 Lab . Cl. ) k �- iFU COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.�F-Iny ct E'Q 3 Certified copy is hereby furnished. zCertified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN (PRINT OR TYPE} IOUILDING ADDRESS P,Q (Yy.y t' de rtment. "go +1 NUMBER FIXTURE OR ITEM @ FEE LOCALITY _ -77i ` J6,e WATERCLOSET L p Date AppliSant CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit Is for one hundred dollars ($100) or less.) LAVATORY MAIL orlOp ADDRESS I certify that in the performance of the work for which this permit is issued, I shall nor employ any person in any manner SINK CITY J TEL. NO.q so as to become subject to the Workers' Compensation Laws. DMHWASHFR / _ — I _ ,Date Applicant 'ICE TO APPLICANT: If, after making this Certificate of ._mption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing wi+h Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forces and effect. License Number Lic. Class Contractor �.:�SC%(�Q ate rl. l-�� ❑ I am exempt under Sec. B.&P.C. for this reason Date: SINGLE FAMILY HOME OWNER -BUILDER DECLARATION reby affirm that I am exempt from the Contractor's License Law for .the following reason (Section 7031.3, Business and Professions Code): ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby offirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). to""I'T F7daPtC Tedder" AddMV I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Signature of Permittee Date r CLOTHES WASHER SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM 'I WATER HEATER I I IGAS SYSTEM OUTLETS I 1 (/)1" 31 Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Pion check applicant Name Address City Tel. No, SEE REVERSE FOR EXPLANATORY LANGUAGE CONTRACTOR k ADDRESS Ii'D 1.'0 CITY n C> )L r. �On_o�� TEL. FINAL VALIDATION DATE ?/ I / FINAL BY vt 011 131.0A t,ade.e5 I,®76.50 I 0^02-87 i WOW" 09111W A NORJ�,A — + �,. _ ._ __ INS!=QOF.'S rJ )TES - ,, `.j C. i, ZJ ✓+-'h t ;,-I'%Pi A-7'RO lvS ATE IN ____�..r _._.._._ —. —. P V�� } -.,l Ur Ek SLA _ .._- __. _ .. _ I 5 , � � L P il 7 3f1 5, GAS Fr: r � l <: n � ql <, CAS VERT y - -'- _- '-.'_ HOT t AieR HCATE^. __.._ n e.,.ui n y s!ry f P r s, 11.r .:,-i, p: rrmtro fJcosgnc.so+c- P,UbtB the provls ions of the 'in. • t- 9 TEVcomm<ncin with GAS TE _. _ Q>r tr r• r. Cc.' `rc Lo.:, C 1 9 UTILITY CQ. P—=J.�LFIEp' .tiCn 7 40 :! 3 of ti CcincsPofe - rh f e sox ^�A * reF r anc� bas j r f rFn 1 - r ycf , -tion _- FI d t�•r.L _rfr •f � TO f.8 r c c�,> rnr r.:ncfprrn, f su.:I rs rro applb -_.-__ _ __—.__._—____._-___--_--- _. u u c I =:❑ .r ,..+ r then f 7 red F r 'II d. IF ,,.. k, and r rsT vrF:J+ L - - e - - _ �sc'rc. if 6•V.-ir,+conJ o.ri Cc.de. Th, C, c r - - - - - - to s iiu. n_n fr>.: e, n. _rye• y t.. en uv.'n;r of property dc, s such fl; --t such j'—." -. r c nol rnh n:.H� r.. r. <.r�.I fa I,. If, hc:vwisrr the building or . irriv'o�, n � it sol J y✓;i i a•: y. -a:- 01 rrn,.!r. 1hc• • ov:: r.- ✓i'If , titt:�•:.n or pro, 7y t!..t ho dud • m r n>: bWlri f.-; tit.; w. of s•,re.: :..._ ... . J F. F.C. -for theaI L C, „> I-_�__ _-- --- -- NSFE TU 'S t OrF:S