HomeMy WebLinkAbout0735A (4) ros"T'°"°E"AR"T'°" qppLICAT{ON F�tt PLUMBING PERMIT
I hereby,hffirm�hol I Nqve o certificate of consent to selt io- 76A��A PW eiB7 �
sure,or a cer�iflcpte o4 Warkers'Compensation Insurance,o�a CE B V(REV.8�861
certified copy fhereof(Sec.3800,Lab.C)
Po�icy Nd:3WC605047QQQ�,d�ATIONWIDE COUNTY Of l05 ANGELES DEPT.OF PUBLIC WORKS
� Certified copy is here6y furnished. �� z
FOR APPLICANT TO FILL IN(PRINT OR TYPE� BL11l�ING
G-I Certified copy is filed with the county building inspedion aoDae55Z zZ EA$ E1 E D I E
1-� deparYmenf. NUN,BfR FIX7UREORITEM @ FEE
�ocnuTr DIAMOND BAR
pO1e 9-1-88 p,pP�i�a�'W PLUMSING _ 3 wnTesc�oseT(Touer� 6 18 ecssss*.GRAND AVE.
CERTIFICATE OF EXEMPTION fROM WORKERS � 2 BaiH 7Us 12
COMPENSATIDN INSURANCE �2 SHOWER 12 �W�ER BRAMALEA LIMITED
(Thii s�cfion iro�d not be compl�fed if ihe work Involved by ry�p,i�
1M p�rmi}is fer orn hundred del4ws(fi00)or I�s�.) �nvn70Rv 24 ADDRE55 i
I certity ihai In�he performance of the work for which ihis per- SiNK
mit is issued,I shall noi employ any pe�son in any manner eo 2 12 cirv COSTA MESA ie�.N�S�-1��1
as to bemme subject lo ihe Workers'Compensdtion Lows. 1 DIStiWnSHER (
coNTzncT �W PLUMBING CONTRACTORS INC.
D01e A�pliConl 1 CtOTHES WASHER 6 ApORE55
NDTICE TO APPLICANT:If,after moking lhis Certlflcote of Ex- Zlr+l $. DIIPONT DRIVE
em tian, ou should 6ecome sub'ect to rhe Workers'Com en- SWIMAAiNG POOI RECEP70R
a r i P arr �AHIEM TEi N4337-3972
sation provisions of ihe Lahor Code,you must farthwith comp- WwN SPRINKLER SYSTEM
ly wirh such provisions or rhis permit shall 6e deemed revok- SiniE iic.
ed. 1 wnree HenTez 6 i'�EnsE N�h26109 uass C-36
LICENSED CONTRAC70R5 DECLARA710N Di57RiCi NO. PeOCe55Eo sv
GAS SYSTEM Ol1TLET5
I hereby afflrm�hat I am Yicensed under provisions of Chapter 6 6 ,l � �`p� �r
9(commencing with Section 7000�of Division 3 of the Bus,ness 1 OUtLETS OVER �
ond Professions Code,and my license is in full forre ond ef- 5 PER Sr57En4 1 � FINAL ? �. /�� VALIDATION �"
fect. DATE � O
License Number 42b109 Li0.CIO55 C-36 V
FINAL
Con+racro�NET+' PLUMBING Dale 8-31-88 ev p
� I am exempt under Sec. lJ
B.&P.C.for this reason �--G r y��'� �y
Plan check fee ,, Q °'
�`x a � ,
Date: P�UMBING PERMIT ISSUING FEE$ lO O 6
Signoture 1 '. � i �'...[;(�
TOTAL FEE 114 O
SMGLE FAMILY p�an che<k o I cant ` � � � '
HOME OWNER-BUIIDER DECLARA710N Pp� ����
I hereby affirm 1hn1 I am exempf from the Coniroc�or's license .Name (j� j [j^�i�.,.
Low for rhe following reoson(Seciion 7031.5, Business and
Profess�ons CodaJ: Address
� I,as owner af the property,will da the ork ond the Ci+y Tel.No.
5lruclore is not Infended or offered for sole(Section 70-04,
Business and Professions Code). . ,
CONSiRUCTION LENDING AGENCY
I hereby affirm thar Ihere is a cons'rudion lending pgenty for -
�he performance of the work for which Ihis permif is issued
(Sec.3097,Civ.C.).
�a19t1�m' --
Lewler's A�Irm .
I ce�fify that I have repo lhis applicafion and s�ate thot the .
above informalion is co�red.I agree to mmp�y wi+h oll County
ordinances ond State laws regulafing Plumbing,and hereby
authorize representatives of ihis Couniy to en�er upon the
byye-mentypn�rty for inspe<�io purpos
f/ �/" �,3 _�8 SEE REVERSE FOR EXPLANATORY 4ANGUAGE
C,.
� S�gnature of Permiltee Doie
i�
. .-r.�r�.�..�,�f�r �.+�.a--��.-._,_._.�..w.�......a"_._._..._�.�.�.�.
APPROVALS UATE INSPECTOR'SSIGNA7UF@ �71S�'cCTGi4'�f�OTLV�V Q�ryER BUIL
unoEFlsi_newoP�y -F�Si�' .-�___- � � heceby affirrrv 1hW 1 am axemprt trom thr CeMrwtora
aaucrt aLu^�Eir:c � ------------_._.__�_ Licenea taw (or Nw folW�edanp rwdon (S9�EK3n 703i.5.
Bt�irrees axl Profeasrorts Code). Any city or county
.cns aipine �...`_,_._ whreh re�urres a permit to corratrs:ct, aitar, improve,
cnsver�r defnol+eh or repair any strueture.prinr to its issuartee.
HOT v:Area H�arer� ---- - also repuire&tlre apqicant fpr sueFr permit to tile a signed
�rwc+s,r.�Fixrur,es �� statemsnt thet he is IrCensed pursuant ro the provisarss
- � ��..�_. of the Contracror's Cieenee Law(CAepter 9{oommer�+ekw
,c��1EST ! ? with SesEbn 7000)of DWiafor�3 oi the B�siRess and Pro-
��,¢uri�.irr co.NOTisiEo _�.w�.._ tessions Codei or thet he is exem,pt theretrom and the
h6sra for the aUe�Bti exemptiors,Any wolefion of Section
���� � --- � ------- 7037.5 hY anY appl�e�x hx a permit euA(ecfa the apoti-
� a�e .ti+nt canr to a crW/p�pp ot rrof more than iive hundrer!
� _ �_.___,..._.__ �s;3500or+rwroftha
"INDIISTFIAL �Y'M���1fK WOIk,dpd tM
§WASTE AFPFAVfeL ` 811UC1UI6 it fqf IM�6C O!OIM7BC!fOf 8AY8
�
($8C.70$4.BU9M/BSS 3Aff P/066.9$rOFS GOd&:7FIB f�+Ofl V�-
--- tOr's LicBti96 I�W dt�S/IQt 3jlply t0 3ti OWhB!Oi plOp8liY
- wMo dui�s or improws theieo�t,and who Wes such work
himself pxwided that�improremsnts are ncat infentl�
ed or of/nred tar sefe If,tpwerer, the btiiiMAng or im-
____-- ---.--.� — piovsment ia s�lci withkr one y�er of comPple?/on, ihe
OWRBf-bHl�@f W7��(i8Y@(h2 bf71dBR Of pipyliH)I772t YIE d10�
nW 4uild or im�Grqve!br the pte�pose ot s91�.)
— ---'-----`-�-- I 801 6XlR'tPt U11fj9►S6C.
� 8&P.C.forthie rea8ort
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