HomeMy WebLinkAbout1683A . � ATION�ECIARAiION APPLICATION FOR PLUMBING PERMIT �
I hereby affirm that I hove a cenitica�e of consent ro selt �bq��q
insure,or a certifiwle of Workers'Compenso�ion Insurance, CEBV iREV.ID/el)
o�o ceruNed�c}o y�he� of(Sg�.�EOo,�ta+b,.../C,,�.),_r�t .�/,''�",,,�//J COUNTY OF LOS ANGELES BUILDING AND SAFETY /�� �y
P�olicyNoQl�39'�arnpany ]A'�+e + `�•s�' �y i'V'�'�/
Cerlified copy is hareby fumished.
fOR APPLICANi TO FILL IN(PRINT OR TYPE! 8W IDING / /j �( /
�." Certified mpy is filed wil Ihe ouM n I sp - ADDRESS IQ ' /7�rn/•.7�5 /
fion depa t ent. NUMBER FlMUREOR ITEM @ FEE ��A��T� (�m�, a r
WATER CLOSET J
/�^4
Dole ��PP�ant � � CRO55 ST. i/a /�Y7Q �r �J
CERTIFICATE OF EXEMPTION FROM WORKERS' Z BnTH tUB
COMPENSATION INSURANCE SHOWER OWNfR �..
(Thic�ec�ion nsed nof bs compfotrd if iho work Invotvod by MA��
H1e pormil Is for onv hundrod doflcrs(5700)or lact.) IAVqiORY qpDRE55
I tertify thot in ihe performance of�he work for which this
pe�mit is issuad,I shall nol employ ony person in any manner SINK d� CITV v� TEL.NO. 6,y
so os to become subjetl to fhe Worke�s'Compensotian Laws. f DISHWASHER S �
j CONTRACTOR i e� �
Dafe �ppli[ont CLO7HES WASHER ADORESS
�;-^�OTICE TO APP�ICANi: If, afrer making Ihis Certificate of � �4F'1
� mp7ion, you ahould become subject to fhe Workers' SWIMMINGFOOLRECEPTOR
.,.mpensation provisions af the Labor Cade,you must for�h- �,qWNSPRINKLERSVSTEM CIT ��� � •�
wilh comply with nuch provisions or this pe�mit shall 6e STATE Q^� LIC. �. �/_
. deemed revoked. / WA7ER HEATER LICENSE Ntl. � d(J J CLA55 YG
LICENSED CONiRAC7pR5�ECLARATION � DISTRICT NO. PROCESSED BY
I hereby affirm rhof I am licensad under provisions of Chapfer 9 GAS SYSTEM OUitEfS /l� e('y� ,a��
�tommencing wi�h Secfion 7000)of Division 3 of ihe Business OUTLE750VER
l L/ 1' 101..
- and Professions Code,and my license is in full force and effact 5 PER SYSTEM FINAI ! VALIDATION
License Numbar ,�� j Lic.Closs_""�L� DATE ���� '��` �pi
Contrad�i SGh 8!� �/�are ��+ FINAL �� �/ C�.
� � �� �Y �"�W I-y � K
I om exempt under Sec. �
U
B.BP.C.for�his reoson W
Plan check fee ��.� 6 g 3 p p.
Dare: N
PLUMBING PERMIT ISSUING FEE$ Q +<<� m m e c Jr Z
Signature �
TOTALFEE
� � -zesa
Plan chack appliconf
SINGLE FAMILV s .. . � ;:.�(1`
HOME OWNER-BUILDER DECLARATION Name
�`�`�reby affirm thal I am ezempt from 1he Controc�oi s License Address ��'� 5�8�
�for the following reason(Secrion 7031.5, Business and .
Professions Code): City Tel.No.
❑ �,as owner oF fhe propeHy,will do the wo�k and 1he ►
structura Is noi IMended or offered for sale(Section
7044,Business and Professions Code).
CONSTRUCTION IENDING AGENCY
I hereby nHirm that there is a consiructian lending agency for
the performance of the work for whlch Ihis permit is issued
{Sec.3097,Civ.C.).
Lendeds NPO�* —
Lend�s Adcbms� �
I cerrify that I have read�his applimiion and stafe fhat the ► -
above informotion is correcr.1 agree ro comply wirh all Counry
rdinonces and S�ate lows regulaling Plumbing,and here6y ,
tho Ye re re ,>>ives of fhis C unty�o enter upon fhe
v menl' opei�. fo insp n purposes. �
� �,( SEE REVERSE FOR El(PLANA70RY LANGUAGE
�-r
Signa�ure of Permiltee Da7e
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�_����-_-�s _ ' �.._ � _ _
�� � t � � �,�M�l� !e
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„k����o���,�s � � onTe� iNSPeC70z'S 51GNATURE �NSPECTOR'S NOTES O�AME2-BUILDER DECI,,4RATIOt�'
. . l ' '.` ._•�t s . . . .
UPJOE2 Eirtr l��',� T 'f i �''� `- A � �I hereby off'rm thm I am rxEmpr f om�tne Con'.cJw',
ROI.GH'lU \� !� I � ,y� � —' Lcense Lnw for the following reason (Se� OJl 5
���""— 6usmess ond Pro(essionr Coda)-An at c t t ch
f G45 F v"., �� " � . Y Y�� Y..
r � �— -- 1� �.—� � - requires a permif!o ronsfruch,aller improve d nol�sh.
GAS 4.fv" �'Q.�e�PQ f O�y.,SifbcfRre,f�r q(to.�15 7sYuonce, also re-
HOt U.t.i P N q . � - ;"��� q'uires the opplicant tor svch perm t to�lile a sit�nod srnro-
atu^tci d��'i }�4�� � ^^ ment fPct he Is Ncortsed purwon•ro rhe provis�cns of rhe
Gp r��T �i� � � Coniractor's Llcanse,�aw;Cha�ter 9(mm n 1 � ���<h
U7iLliv'O r�:��� ` ,. Sect�on 7000)of D'v ion J o(tha Busines d Proles
— �1 sions Code)or ihaf he s exempt therefrom end th basis
_ for ihe aNeged exertipfion. A�y violol on or Sechon
:�'�:A� �t` `����1frr oa—1,�rnnt - . . . ' ' ��-�—'�--i�--- 7031.5 by ony appfiranf for a permit subjects th�oppli-
---�--- . canf to a civif penahy of nof more ihan five hundred
. ..�.;: a '�1 �.. , '�...i .. �_ w dolfars(5500).:
INDl,STrInL ��• ' � �I,as ownar of the property���III do th=wor,c ono
N - � ���� �- r ��' q r. —`"z --`—� ihe structura is nol in�ended or nffered for sale _.
,,,,. '. . . , � ..
� ....._.._ .._� ,. � .
: , , l , ,; � (Sea 704I,Busfness and Professions Gode: ihe Q :�
�:\ .. -' • �' .". �; � .-x.: •',-..-� —�-----'— tor's LlCanse Law daes not app(y to an owner oF p*or.�ly
^ wbo 6ui�ds or imprwes therean, and who does su<h
' � � '� ��� � `- .. �j � �� work h7mself provided thoT such improvements ore not �
w , } IMended or offered for safe.lf,however,fhe bvilding or
� _., y � � „. , improvemenf!s sald wHhin one year af complefion,�he
ownerv6oilderwifl have fhe burden olprov�ng ihat he did
not 6uild or improve for the purpose of sa(e.)
. ..�(. ..� . , , �..
�n..: t��,am,exemp'underiSer.. ,
``,.. i.. ..' 1 ', ..ii _,.. .
� B&P.C.for thisreason
�.,
Date
Owner
T� � It�;'�FECTOR'S NOTES � �