HomeMy WebLinkAbout0749A (4) hTION D€CLARA710N qppLIGATION FOR PLUMBlNG PERMIT
I hareby,a#f�rm rhat i ha�e a cernfica+e of consent io self in- �aA��A vw ais� �
sure,or o certificare of Workers'Compensation Insumnce,or p CE Bii(REv_eie6�
cerlified copy thereof(Sec.3800.Lab.C.)
poucy t�oJ WC�_ 00,�7cE�9�(��yNATIONWIDE COUNTY OF LOS ANGELES DEPT.�F PUBLK WORKS ,
. � CerRfled copy is hereby iurolshed. � -•
� FOR APPLICANT TO FlLL IN(PRINT OR iYPF� BUIL�ING
Certified[opy is flled wifh fhe caunty building inspec�ion NUMBER FIXTURE OR ITEM � FEE ADDRE552/{229 EAST BARKER DRIVE
departmenl. — tOCplliv
Dare9-1-88 a.ppl�mntNEW PLDMBING__ 3 WATER c�oser(Toueri 6 18
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' Z BkTH 7UB 12 Ce055 S7.
COMPENSATIONINSURANCE SHOWER OWNER
(Thi�seetFon nr�d nef be tompia4�d if tho work involv�d by 6� �,�,Ai,
fh�psrmk is#or om hurrdnd dollore(5100?or Iw�.) �AVATORv nooaess 1 AIRWAY AVE UITE N
i ceriify Yhot in the performance of rhe work for whi<h�his per- S�NK CiTv TEL.NO.
mit is issued,i shall no�employ any person in dny manner so 1 Z 1
as to become subjeci ro the Wo�kers'Compensa�ion laws. oiSMwa.SNER
CONTRACS �
Doie Applicont CLOTHES WASHER 6'
ADDRES$
NOTICE TO APPUCANT:If,ofrer making fhis Cenificate aP Ex- SWIMn�ING POOL RECEPrOR �
emptian,you should become su6jecl io ihe Workers'Campem CITv TEL No.
sotion provisions of the La6or Code,you musf forthwifh comp- �P,WN SPRINKLER SVS7EM —
ly with such provisions or this permif shall be deemed revok- , SiqrE UC.
Bd. 1 WATER HEATER 6 I LICENSE NO. CLA55 _
IICENSED CONTRACTORS DECLARATION DiSTRiCi NC. PROCESSED BY
I here6y aff�rm 1ha1 I am I�censed under provisions of Chapfei GAS SYSTEM OUTtETS � 1 �
9(commencing with Sec+ion 7000)of Divis�on 3 of ihe Business OU71E75 OVER �� ei.�U�p•
ond Professions Code,and m license is in full force ord ef- 5 PER SYSiEM FlNAL a
fe�t � DATE —�7�� VALIDATfON
LicenseNumberd9Fi70� LicClass (�-36 �
U
FINAL — �
ca�o-ocro� NEW PLUMBING Dafe 8-31-88 sv O
� I om exempt under Sec. U
C
B.BP.C.far rhis reason Plan Check fee \ - r� C�� :�
Dae:�.. r :_l'%...
PLUMBWG PERMIT ISSUING FEE$
Si natvre � �
9 TOTAL FEE j � � (;^,,.�":
SINGIf FAMILY Plan check applimnf -
NOME OWNER-BUI�DER DECLARA710N . , , .'� � _
I here6y affirm thot I om exempt from Ihe Comroctor's License Name �
Low for 7he foilowing reason(Section 7031.5,Business and ['< �I 1''.-". _
Professions Code): Address
� I,as owner of�he properry,will do ihe work ond the Ci�y Tel.No.
sirudure is not infended or offered for sale(Sedion 704C,
Business and Professions Code). .
CON&TRUCTION LEN�ING AGENCY �
I hereby af}irm thai rhere is o mnslruUion lendiqg ogency for �
the performance of�he work for which this permit is issued
(Sec 3097,Civ.C.).
h�D�
Lendar's Addrass
I certify rhot I hava reod ihis applicaiion and state tho��he ►
a6ove information is co+recc 1 agree�o comply with all County
ordinances and State�aws regulating Plum6ing,ond hereby
auihorize representotives af this Counry to enter upon ihe
e-m lioned properry{or inspeUl�o ,purp��oses.,,..,
���� ,'Sl � _ �� SBE REVERSf FOR EXPLANfATORY IANGUAGE
� ignaWre o�Permivee � Oat�
....__��__ -°-•��
�� �,.,._.-- �
arFFova�s oare 1�}5PECTOR'S SIGNA7URE � � i:,F;�t'O i ES ������L
UNOEfluLA�1N/0RK `jfl�,_ � � ����`�*��.•4Y�A�=`M+w^��M 1 hY1M6�8ffklfl t%�I 1 8Ri Bltpllpt fRllq}!Yi L'01f(Iap1pP'D
l . . �ioenw taw for tM f ' rmp6a(3ee[ipr 7Q?1.5,
�Rou6H PLun;L:RC, ' ` - _._'------�..._._ BUStnBBS 3flU Pl01&4&OI�e Cods). PmY City or County
GAS PIPiNv � . yy�}j�h �8Q{!j{gg a permk te�oortetrust, aMer, imProvQ,
�GAS VENT �y' dplllp�O!I9pBt/37IY 9ffliCtl/f9.,qf10!f0!f$i�(ly�pq,
F HOT N.'ATER HEATEft . ------------ 3IS01BQl71186 tIlB 8�II�C271t lO�S'JCh pBifRlf tQ SIJ6&Si�;Bd
�v�un�.ar.c Fiaruk�s statemafrt th6t he is l�ense�!pursuan�to the provisions
of the Cen�ree!vr's Ll�ense Law(Chapier 9(com.mer�eing
c<.�7E5� ,��� ._.____._.._____._�---._,._..�_____ wJth Sflction 7ppp)ot Otvieicn 3 of fhe 8u�+rrecs ancf Pro-
r�
�UTIUTV CO.kOTIFiED .._�____......_......_.______ _ tessicns Cotle�}or ihei he is axempt ihersfrom antl the
basis ia the alleged axemptiw+.Any vWletian of Saction
�Finia�� G�atsr ow�3ronE ---- �[Ioba aa�aopNcw+t hrr a R�mit sub�ee[s tli5 appN-
perreity of noi more than h've hundrea'
� ------. dollers f$5tI0i.:
iNDUS7R!AL � ❑I,88 OWF1Bf Of SM pfOPBF4y WHI AG thfl M60Nf,3pd ip!
WASTE APPRCYkL � ^ 11f/f01UlB 1�IIB!IM&IdBC Of 04�8l9C fM BlIB.
----.� (3ec.7044,Brrsrn�s antl Professia�s Coae:7he Contiac-
-- -- tor's Licerrse Law dees not applg to ar�owner of property
who D�ei(ds or improvee thBceop.ar�wpv o998 SucFr work
--�--_-- himeeff provitled that sueh improrAm�rts are rrot intend-
ed a offeretl for seie. !f,hCwerei,the building or im-
. �___.____� praveme�rr rs sold wlthin one yeer ot campletion. tYre
owner-brultleF wil7 hati+e tAe bure�n of prowng that ne diC
� nor 6u�d or imp�ove for the Wroose�sel�.)
I em exelnpt Under 38C.
--—�—' B 8 P.C,to►tRie reeaem
�_���_____..---�_.__.,� 68te
---_______.___.�n.— Owner_
� 11�F��C S