HomeMy WebLinkAbout0748A (4) � � � N DC�CIARATION APPLICATION FOR PLUMBING PERMIT
I hereby,bfffrm thot I have o certifico�e of consent ro self in- ����A PW nf67 �
sure,or o certifica�e of Workers'Compensotion lnsuran<e,or a CE BI7(REV.6i86)
ceriified copy thereof(Ssc.3800,Lab.C.)
Policy No.73WC00504�Q,Q�iShyNATIDNWIDE COUNTY pF LOS ANGELES DEPT.OF PUBUC WORKS
� Certified copy is hereby fumished. � � � �
FOR APPLICANT TO Flll IN(PRiNT OR TYP�) BUILDING
^� �y Cert'rf�ed copy�sflled w�+h�he�oo�ry6uuding insped�on nocaess24251 EAST BARKER DRIVE
"� C�eparfinent. NUMBER FIXTURE OR REM (.i` FEE �OCAu?Y
Date 4-1-88 appl�ca�tNEW PLUMBING 3 "i^TER noser�ra�eri ( 18 Neawesr
CERTIFICAiE OF EXEMPTION FROM WORKERS' Z BATH TUB 1 Z CROSS Sr.
COMPFNSATION INSURANCE� OWNER -
SHOWER
(iha seNion n�rd nef be eemp6T�d it ilr�werk inrolred by MAIL
fYw p�rmif Is for on�Iwndsed doNw�(S10�or(eu.) � tAVATORY qo�RE55
AY AVE. S E N
I certify ihat in Ihe performance oi Ihe work for whlch ihls per- SiNK '
mit is issued,I shdll nor employ any person in any man�er sa � iz Cliv 7EL NO.
as to become subject to�he Workers'Campensmion Lqws. � o15HWA5HER
� corvrkacro��W PT.TTMRTh(; ('�NTRAf.Tn
Dote Applicont CLOTHES WASHER qDnRESS
NOiICE iU AP!'LICANi:If,oftcr making this Ce iiflcote ot Ex- SWiMMiNG POOL RECEPTCR
emption,you should 6ecome su6jed ta Ihe Warkers'Compen- C',ty TE�.No.
sa�ion provisions of the Lobor Cade,you musl forthwith comp- - �qWN SPRINKLER SYS7EM —
ly wNh such provisions or fhis permit shall 6e deemed revok- STA7E iiC.
ed. 1 WATER HEATER . 6{ �ICEhlSi NO. CLA55 _
LICENSED GONTRACTORS DECLARATION DISTRiCt NO. aROCE55Eo er
I hereby offirm that I cm licensed under provisions of Chppter GAS SYSTEM OU71E75 y O
9(commencing with Sec�ion 7000)of Division 3 of the Business oU7�ET5 oVER L ���"�C"��-
and Professians Code,and m license is in iull farce and ef- 5 PER SYSEM � �,,
fed. Y F�N 7_3��v7 YALIDA710N �
DAT�� O
u�e�se�v�r.�ber 42bI09 Li�.Clo:: C—�fi
FINAL V
Contractor NF.W PL.L7MR�I�G Dare 5-31–RR eY – �
O
F
� I om exempr under Sec p_(i%[ r� f'�, u�
B.BP.C.for rhis reoson Plan cheek fee . {: � _, �. :. ;: �
Dute:- PLUMBING PERMIT ISSUWG FEE$ - ��
Signoture � °� � C.c t'i.'
TOTAt FEE lO$ .
SINGLE FAMILY ` � � �� � � � �
HOME OWNER-BUILDER DECLARAiION Plan check appiicon�
I herehy affirm that I am exempt from the Connocror's License ,p,�PTe [%i i f;—._�,
Law for the follawing reason(Sxtion 70315, 6usiness and
Professions Code): Address
� I,os owner of the properry,will do rhe ork ond the City Tef.No.
siructure is not intended or offered far sole(Sec�ion 7044,
Business and Prafessions Code�. ,
COtdSTCltJCT19P1L1'A91Nf Af�CY �
I hereby affirm thol�here is a consiructlon lendinq ogency tor �
rhe performance of�he work for which rhis permit is issued
(Sec 3097,Civ.C.J.
Lsw¢m+a IVtmi —
Lender's Adeh�s
I cerrify that 1 hove read rhis application ond state thar rhe �
pbove informo�ion is correct.1 ogree to comply wilh oll Counry
ord�nances and S+are lows regulaiing PI�m6ing,pnd hereby
a fharize representa�ives of this Counfy to ente�upon ihe
�e- ��iioned praperty for inspe<tion porp��..
�' � �C SEE REYERSE FOR ExPLANATQRY LANGUAGE
1_s�
Signature of Permiltee Date
p, _... ._� ��-. �.e,_..�. - .�.
i( APPROVALS DAT'c IP}6PECTOft'SSIGNATURE �" C}��+ � �r��TE�
�uwa�nsLnewoF�a 7�1,� (o____ � ....� I harebY aHhm Mat i am�4 hem tpe Caqe�qlar's
FOUGH FLLIAI�ING �f � ,;� "� --- ._..—._ Liouue law la tM PoIbwMD re�an fSBotiun 703J.5.
GAS PIPiI{� Btl9NtB� amf Pro�na Code). kny cJty or county
— _. --- whkh requuss a permh to cor�struot. �. improve,
GASVE4T , f— qemp;Jsfi or repeir any sHueturo.prior!O!15 198U8fiE&
�HOT Y':ATC x H�ATER � / �� ------ also req�eire�ihe appllCant forsuc�permii to ti/e a signed
PLUPo",^IIVG FIXTUR�S t statemeiat thet he is IiceutaeC pyrsuant to i7e Arcvisbns
�u,:s resr oi the Ccv�traoisr's Uoetra�La�v(Cirapter&(ce,�rmencing
� �~` with�ti�7009}ot C1ivJslmn 3 ot the Buslnass and Pro-
.uriuTv co.n�riFi6p� j��� —_ __�..� teasbns Cort�a ttret he ie exempf th�er5fram and the
� �� basis tor th,e aNeged exempticn.Any vrore!ior ot SeCtion
(---- -- --------- 7031.5 py auy applbent tor a pefmi;SU�IectS the apR1F
�F'�''_`�^ ret�r o�: �anf ��4 v cant ro a avM p�eVt►�ot not more then R'rs hundred
� � dc!lars($6AQ)•.
i�iousr:,:a� ❑I,�aaN'�oF tda P�hY wiY4 Oc tha wuak�etM t!w
wASTE pPPROVAL ---.— BtrtWlU[B 16 nOt IM1tBild9d OF Olfared 1oP BW.
--•—�—�--�— (Sec.7044,9u9iness anaf Pro(�ssiorns Cotle:Tlre Contras-
— tw's Licen�Eaw dbeo rrot aPP�f te an o�wrer of Wo�ertY
wha builds or lmprmm fhereda,and who d�oea sueh woik
.,._ hims�f proaided thef 9aoh lmprpvetrtenie ate nof rnt9ria�
sd a ofleFed fbr sale.!t howexer,the 6uMdirrg or im-
provement is soM wiphh+one year of completion, the
ownerbnildei wH!hflve H�6urden oF prprin,�that be dio'
. —.�._ rmt 6t+aM ot irnpiovs/0�MB At�IPo�e W s!!&)
�� I am exempt UndB►Seo.
.�--_�_..______.___.___.� B&P.C.far thla reaaatt
-___�__.._..__�,.....__._._.,._�__��_ pgt�
�_ _ O�nrnet
INS�'EGTBR'S t�OTEB