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HomeMy WebLinkAbout1314A �"'��a�'""°"' APPLICATIQN FOR PLUMBING PERMIT ,I he�eby,nffirm �hat I have o cartificaie of consem�o self 78pgg�q � �nsure,o.a ceni4ica�e of Workers'Compensation Insuionce, CE 817{REV.B/89) or o certif�e�d�co�py�t�heraof�Sec.380� a .C.) P❑o�icyNa. �1LL�4L�1.Compony� A:��ur1� COUNTY OF LOS ANGELES DEPT.�F'PUHLIC WORK� + Cenified copy is hereby furnished. 1 FORAPPLICANTTpFILtW�PRWTQRTYPE� BUILOMG CerriRed copy is filed wifh Iha couniy building inapso ADDRESS � 1' n deporimenf, NUM�FR FIXTURE OR ITEM � FEE f� �,� �/,/�///��� t� IOCAIIiY W�O Daie.�-1-�� Appliqani � �(L�C�.._L�• J WATERCLQSEt NEARE57 (� CERTIFICATE OP EXEMPTION FROM YVORKERS' BATH TUB CRO55 Si. ( f] COMPENSATION INSURANCE SHOWER OWNER (Tbis secflon ra�d not b�complN�d Ii IA�work InvoHed by ��� Ih�pQrmit 4 for ona hundrad dollara(f100)or I��s.) tqvatORv ApDRE55 i cerrify rhot in�he performonce of the work fw which this . parmit is issuad,I shall nof pmploy pny person in a�y manner SiNR CITY �,n so as lo become subjecl lo fhe Workers'Compensafion Lows. / DISNWA$HER (JO CONTRAC70R �� �1�e .� e � applicoN CIOTHES WASHER qppREss ,� � S '�ICE TO APPLICANT: li, afror making Ihis Ceriifimfe of SwIMMING POOI RECEPTOR �^ .emption, you should become e�bjec� to the Workers' Ci7Y Compensarion piavisions of the Labor Code,you must for�h- '�O� �.e � wi�b com I wi�h such rovisions or �his �AWNSPRINKLERSVSTEM p y p pmrmil shall be SinTE �7 l�C. �. deamed rpvoked. WATER HEATER UCENSE NO. �7 3n «ASS LICENSED CONTRACTORS�ECLARATION DISiRICT NO. PROCFSSfO 9Y I hereby offirm fho��am licensed under provisions of Choprer 9 GAS SYSTEM OUTLETS ,�(��,\ (mmmencing wi+h Secfion J000)of�ivision 3 of the Bvsiness pUTtET50VER � " 'a�C' C and Professions Code,and my license is in full force and effxt 5 PER SVSTEM FINAI d p (� �� � pA� � �/d�-- VAtIDAT10N v license Number� ���D�o Lia Class__y1,� "� � f� S L�C nC�'�Uate��j'_(_�1,� BY A� �'"�"'. O Contm<mr � ❑ � I om exempt unde�Sec. � 8.&P.C.far thia raoson � Plan check fee » :� i ��1.G.A Dote: PIUMBWG PERMIT ISSUING FEE$ Signalure � ,� � � h o 5 TOTAL FEE Plan check opPlicanl � ��� ����5 J � � SINGLE fAMVILY - HOME OWhiER•BUfiDER DECLARATION Name ` � `-` �'�`�� �.eby offirm�hai I am exampt from the Contracror's license a��e L'�=.�C...U'j , _.w for dhe following reoson(Section 7031.5,Businass ond ' Professions Code): �iry iel.No. ❑ I,as owner of fhe property,.will do the wwk ond�he . siruuure is not intended or offered for sale (Section , 70M,Business am1 Profb�iom-fodo-J. . CONSTRUCTION LENDING AGENCY 1 here6y aHirm thot th�e is t conslruction lending agenry fa ihe pn�formance of the work ior which this permit is iasued (Sx.3t197,Civ.C.). �0 N��.,r� . Len�'s AdiY� - 1 cer�i4y�hot I hove rerod�his opplicotion ond sbfe ihot�he ► above infwma�ion is correct.I pgee ro comply wifh p71 County ordinances and Slote laws reg�la�ing Plumbing,ond hereby outho��ze �epresemarives of thls County io enter upon fhe � above-meNioned propeny for inspecrion porpose�. SEE REVERSE FOR EXFIANATORY LANGUAGE r�� _���?�..��� _-�(- l��_ - --- - oture of Psrm�rtaa Date _ _ - — - s _-�_-=_ ' _a�- - - - _ _ _ , � , � �1������; � { � <e 1 �� 2 _ ___ -.- -�.r�'��-- _ ' "'�"'_ .... ... .s � . nri n ._� .. -�. � �R"n,» rvr�ir°. , � �" rr� -I .:! � _�ru _� ��—�,,,,�e,_ -- --_ �� ��` — - � _ � ''r'� �,,.3,.... ._._ t �[r. a � ! � � i�L�dy,�I.a��s �+s.w� �-� *«�C.... � _ , �i,�r.. L _ ' � - R71GHF 1 rv.+4(; j �� . ie �� --.. ___.. ._--.. -.-' - __"_ "._._ � �.. L f f f ..,a . 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