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Home My WebLink About1829A i . 'COMPENSA710NDECLRRATION APPLICATION FOR PLUMBING PERMlT {� I herehy aiFlrm thol 1 hove a cer�lficate of consent io selt 7DA667A �insure,or o cer�ificafe of Workers'Compensation Insurance, CF 8V(REV.10/BI� U or a certified wpy thereof(s�,3et�0,�ab.C.) � CQUNTY OF LOS ANGELES BUILDlNG AND SAFETY ��YNo.4'� `�ca,RP��YS�v7'.e �{-'vn rrz.G � �S�b �"�'`,?� Cartified topy is hereby fumished. � FORAPPIICqNTTOFILLW�PRINTORTYPE) BUILDING / Certified topy is(iled with ihe tounty building inspeo- ADDRE55 /^ ! 1i n departmenl. NUMBER FIXTURE OR ITEM Q FEE `O��tt �'7�--�'I'�1�e+(�-'/ �ry %�t e� �t Dote�_Applir,pnt�� -� �� Ln WATERQOSET NEAREST CERiIPICATE OF EXEMPTION FROM WORKEHS' � BAiH TUB CRO55 ST. ^R/77 i� COMPENSATION INSURANCE � OWNER (This sacfion nwd rro/b�complN�d if thr work invelred by SHOWER ihs p�rmit b!or ons Fundr�d doliars(5100)or Ists.) �,4VAT0RY MAIL n�oaess I certlfy ihal in ihe performpnce of the work for which fhls permi�is issued,I shall not emplay any person in any monner SINK �� CITY� V � l. . � � so as 7o become subject ta ihe Workers Compensatian Laws. D�SHWASHER ^ CONTRACiOR � .�. � L/ r . Dote Qpplimnl CLOTHES WASHER qpDRE55 ,a� !��,./_ ,r""'�TICE TO APPLICAN7: If, ❑frer making �his Certifimte of Q (J� /J�Y1 � � mpfion, you should become sobjed to Ihe Workers" SVJIMMMG POOL RECEFTOR �.ompensation provisions of the labor Code,you must forih- CITY��en G�VG " i�h comply wi�h such provisions or �his permit sholl be �A�'NSPRINKLERSYSTEAh STATE IIC. /� daemed revokecl. WATER HEA7ER LICENSE NO. � � CLA55 fCJ IICENSED CONiRACTORS DECLARATION DISTRICT NO. PROCESSE�BY I heraby aHirm ihat I am licansed under pro�isions of Chapfer 9 GAS SYSiEM OUTLETS /� � r� 6 � (mmmancing wi�h 5ec�ion 70W)of Division 3 of�he Business DuitEi50VER � I ond Protessions Coda,and my license is in iull farce and effecl. 5 PER SYSTEM FINAL y{ VAUDATION License Number�� Y lic.Class C� DATE ��v O 9 11 f3`1 FINAL �,�� U Confracfor��-��'"� ��afe 8Y �L`�„ � � I om exempt under$e[. � I � B.&P.C.for ihis reason , W Plan check fee ;:� g�,G p p., Date: PLUMBING PERMIT ISSUING FEE S � � m v Jr ^ Signafure 'r � � ' TOTAI FEE � � 765C' Plan check applicant SINGLE FAMILY o �� - %�.ti�;1 T ,,,.�,_ HOME OWNER-BUILDER DECLARATION Nome � +reby offirm that I am exemp�from fhe Conlrac�or i ticense Address �C', �4��7 _rw for the following reoson(Sedion 7031.5, Business and Professions CodeJ: City Tel,No. ❑ I,os owner of�he property,will do Ihe work and 1he � strocture is not intended or offered for sale(Saction � 7044,8usiness and Professions CodeJ. CONSTRUCTION LENDING AGfNCY � . I hereby affirm that there is a construction lending agency for . the performonce of ihe wo�k ior which fhis parmit is issued � (Sat.309i,Civ.C.). l�6s IPfaB� lender's Adtleeas -- . . I certify thot I have read ihis appiication and state�hat ihe ► �above in{ormafion is mrreci.I agrea ro mmply with all Caunty ordinonces and Stare laws regulating Plumbin'g,and hereby outhorize representotives of Ihis County to eMer upon the above-menfioned property for inspeUion purposes. ��^„ . _� _ ,,,, �� r SEE RFVERSE POR EXPLANATORY LANGUAGE .� ,rY��,�1 Signalure of Permittee Date ' t 1iM�� i��M •. _ �... � �,..�� -�'-�� - - -��.ar+fr�r..��.« nF i t nrE iri5 troe�sSiGNr.7UraE iNSPECTOR'SNOTES � ONMEG�UILD-R FCI.4RI�ION LNCER S_AF N c, - �d S{/ � I h eby N�r �ihat I o e empt f om t e Cortrcct,�r'; ROUCH PLU 1l_ f � ��j ' L'ce se L� fo th fo��o g e on �Ser�ron 7031 5. qSpp.p� � `— ��f� 0 sne sa dPole so C d� -Any<ityorrounfyw'i.ch GAS VENt�_�� ' requires a permrt to construct.alfer,improve,demol sh. -or repoir ony�strucfure, prror to its issua�ce also re- HOT\4C,TP'V"+�,T a , � � '� ' �quires the appl/canf lor such permi�to H(e a signed srcf�� Z� '' pu provisions o a�U!IHiNG F�>',icr: �� -' � ' � � � ment fhat he is ficensed rsuon'to fhe f ihe. GAS 7F.:"�i y Conlractor's LlCenso Low(Chapter 9(commenci�y.•.i'h 11TILITY C�.NOT�,'I'D SscBon 7000)of Division 3 of fhe Buslness ond Profes- --.,_.�.__�� - sions Cadef or thct he is exampf fherafrom and Ihe baxis � ______ ._ � �-7 � �� for the allegec� exc�mpnon. Any violo�ion of cec/ion FinA'` . � � ��c(rr on _tront - - . � 7031.5 by any applicani for o permif subjec�s�he appli� ------ tant fo a tivif psnalfy af not more �han Nvv hundred - dotfars(5500).: INDU'T!'IF ' - - ❑I,as owner of ihe property wtll do the work,and WAStF Ary a. _ . � � � � the sirudure is noi Intendad or of4ered 4or salo. ^ . - � (Set.7044,@u�iness and Profess ions Code: Tha Cc c- • . � ' ' � � ' � for's Litense Law does not apply to an owne�oi property � � � - _ �. wfio bulfda or fmproves therxon, and who does such � � � - �� work himsaff provlded}haf such improvements are nof , intended ar ofiered(or sale.If,however,ihe building o� . . � . � � � - improvement ls sold wifhin ane year of completion.+he . owner6uifdor w111 fiave fhe burden of proving that he did nat bulfd or improve for the purpase of salo.) F I am exemp!under Sec. , B&P.C.for ihis reason � • Date Owner �—____�- I\�PcCT0�.75 NOTES .