HomeMy WebLinkAbout0727A N 6CCLARJcT10N APPLtCATtOM FOR PLUMBING PERMIT
i irseeby,bf%rMi thuf I Mere a cer'rt�lmte of mnsenl to self im ��'��6 D7W a:07 �
sure,or a certiFlmfe ot Workers'Com ensation Insurance.or o 76Ab67A
P CE 817(REV.B�93}
cef�ified copy thereof(Sec.3800,La6.C.)
Policy t.1o.73WC00504���yNATI02iF1IDE � COUNTY OF LOS ANGEtES DEPT.Oi PUBLIC WORKS
� Certified<opy is hereby furnished. ��
� FOR A7PLICANT 70 FILL IN(PRIN7 OR 7YPE� BU�LDING
Certified copy is filed wifh tFe county build�ing inspeoion ao�kE55 I
departmenl. NUMBER FIXTURE OR ITEM �i fFE LC3��ITY
9-1-88 NEW YLlJifBING 3 wareR aosEr�ronET� 6 18 DIAMOND BAR
Date Appiicant NEt,RESi �
enrH rue caoss sr GRAN➢ AVE.
CERTIFICATE Of EXEAhPTION FROM WORKERS � 2 12
COMPENSATION INSURANCE 2 sHowea IZ ow"ER SRAMALEA LIMITED
(Thia s�aion nsod rwf ba compi�tsd ii M�work invotwd by M�,�
tAe p.rmH Is fer w�.hund.ad dollnrs iitoo)o�I.ss.) �nvaroRr � 24 r,00e�ss 1 1 AIRWAY AVE. SUITE N
�cemty rho�r�rhe perfo�ma��e of rhe wo�k ta�wh�ch rh�s pe.- 2 siNK 12, am COSTA MESA rei No.850-1001
mit is issued,I sholl nol employ any person in any monner so
a;10 6ecome su6je<t to tha Workers'Compensotion Lows. 1 DISHN,�nSHER Fj'
I mtirRAcro�EW PLUMSING CONTRACTORS INC
pa�e qppi��a�i 1 ctorHes wASHeR 6� nooaE;s 2141 5. DUPONT DRIVE
NOTICE TO AP�LICANT:If,after making thls Cenificote of Ex- Swi4nM�tiG vOOi keCE770e
emplion,yau should he<omesubje<tio the Workeri Compen- CiTr �AHI� iEl.NO,g3�-39�2
sation provisions of fhe Labor Code,you mus�fonhwifh comp- �qwN SPR�NKLER SYS7EM �
ly wilh such provisions or this permit shall 6e deemed revok- � STa.iE uC.
ed. 1 wnrea HenTea 6 �cense No.426109 ciass C-36
LICENSED CONTRAC70RS DECLARATION DISTRICi NO. PROCESSED BV
GAS SYSTEM OUTLETS
I hereby offirm lhot I om u�a,,,�a u�de�p�o��:�on:or cnoPre� 1 6 6 ��,���
9(commencing wilh Section 7�00)of Division 3 of the Business 1 aU7LE75 oVER � 50 _
fe�,Professions Cade,and my license is in full force and ef- 5 PER SvSienn FINAI VAUDA710N 4
OATE Q�
License Number 426109 lic,Clo:s C-36 ��'3� U
FINAL d
cootracror NEW PLIIMSING pa�e 8-31-88 eY ��— o
�
� I am exempt under Sec. w
�;.Ci �G l hi
e.&v.c to�ih�s��:o� plan che<k fee �_ 4
oa�e: ► t;e . � o ..: —
7LUMBING PERMIT ISSUING FEE$ ],O SO
Signarure TOTAI fEE f o j � (! !':r,
114 00
SINGLE FAMILY ,Plon check p li
HOME OWNER-BUILDER DECLARATION PP��p�� � '� �� I �:���'�.,..
i hereby affirm fhal�am exempt from fhe Contrac�or's�icense Name (i�. i �"U�°
Law for the foilowing reoson(Section 7031.5, Business and
Professions Code): �Address
� I,as owner of the property,wiii do fhe ark ond rhe City Tel.No.
structure is no�Iniended or offered for sole(Sectian 7044,
8usiness and Professions Code). �
CONSTRUCTION LEiJ�ING RG€NCY
I here6y offe�m tMor ihere is a mnsiruction lending agency for
ihe performonce of the work for which this permil is issued
(Sec.3097,Civ.C.).
bm�c�'s I�e�e
Lendar's Ac}de�s
f csn5ty rFat i hove read this opplim�ion ond s�o�e ihar fhe .
abave informotion is cwrect I agras lo carnply with all Caunfy
ordtnemees and Stare laws ragulating Mumbing,ond here6y
aulhorize represanfatives of rhis Counly fo enter upon ihe
o�q epry oned property far inspecfio�n purposes .
// J//���1 ;f. ?'�� SEE REVERSE FOR EIfPtANATORY LANGUA6E
�.�rd/r.•r —U—�—
Signoture af Permittee � Oare
K• � APPFOVAIS DA7E IPi&PECTOR'SSlGNRTIIRE ��ise���~� ����!�LCIO �:t?�TE.�',��~_.r� "�ry � '
�uNaeRsu,ewoar �_ �-----�_._' �._ . _ ..�_�� . � �`atfhm tMt�em exam{n hom Nr ooMractw'a
ROUGH PLUM6ING Licsrae lAr for ths fdPowi�rweon (SBCtior, 7031.5.
� Busirress arro' Profeasbns Code). Any city o�county
£�ns air�nc �T� - _�_..�._.:._._ whicR reQuiree a A�ma te oanstrust. alfer. improve.
�y GAS VENT tlepwli�b or repek anY structure,prlor to its issua�ce.
S NOT WATEF HEATEF ,�,__�. i� ---- alsca req�ires the appliceni iorsVrch permrt fo iile e srgned
9{g(glp)gyft th8t he is 1k9I/360'pt�r5U8Rt to flte A�aViSi0n8
/
PLUI:IEING FI%TllRES � _ of tf78 L�ORiffi6fflr'3 LIQfMIBB L80Y(C�PBF 9(COflIRiB6lCiflp
cns r�sr with SecFbn 70pp)ot OWiebn 3 of the Bu&irress and Pro-
j UTILITV CO.NOTIfIED -- �By3i0AS CpO@)O!fF181 hB!B 8YBf71(it th2reirom antl ihe
p besis for the aUe9eo exBm;etion Any viofation ot SaciiOn
V �+ c7 ----- 7D3?.5 by arry applio9Flt iOr a petrt�it subjects thr�aiQpli-
�Fir�A` Gn�Ar on�3ront canY�o a aiVR pbrratty of noi mqe th8n frvs hund�etl
-- dedars(.&500)..
,iriousTRia� Q!,m orrnar of tt�e pmpetty w7P�do t1w wak�antl tlw
W ASTE APPAOVAL --.-- ShWtU+B i!Iql 111M�Btl q'OffB(�tl fpr etk.
{Sec.704a,6usiness antl Professions Cod�:The Ccntrec-
� — tor's l.icert�Law does rrcx app�y ro an oMrwr ot propeny
who bra4ds w improv�ihereon,an41 who does such wotk
.—.--. himee/f proria'ed thet such improven�enfs are not intend-
ed a oi�red fw sele.!f.howerer,tiie lwwildding o�im-
�.:_.___� provemenr ia sodtl withln orre yaei ot completion, the
owner-6rrifd�wiH1 heve Me barden ot pioWng thai he�G
net btrilG or imptc�¢for the pwpoee of sals.l
I aaF exBmpt Under Se¢
_��,___________ Q g R.C.tor t�is ree�n
--.----- Date
-- —_.____...___.____..__._, 0wner
�u. Ih1,SF'ECTO g NE7tE�