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HomeMy WebLinkAbout0537A c��nrf�n�cLaxaxrow �e,�.�a � h��ehy afF.�m tha< < ha�r a�r«;f,�a�r of�o�sen�to s��r =E a��,z-ao, APPLiGA'!'tON FdR PLUMBfNG PERMIT �'f j insUre,of a certificate nf R'orkers'Cnrepensatinn Io-surnnce,nr . �� a cect;fiea oapg tAereoe(aac.3�t16�h ) • . u����� C�UNTY Of LOS A{�1GE LES BUI LDtNG AND SAFETY PolicY N�f n ComFanY � � Cer[ified copy is hereby furnished. FOF4 APPLICANT TO FIL4 W IPRINT OR TVPE) BUILPING � ¢''y � NUMeER FIXTURE OR ITEM • FEE ADDRESS J(�� �,[: '� _ CertiCied copy is filed withi iIvhe county building inspection P .,� � *1'����'C.� WATERCLOSET LOCALITY � ��� Date ApFlicant y_� �NEAREST BATH TUB CROSS ST. � CERTIFICA7E OF EXEMPTION FRObi WORKERS' �� . G �WS CObiPENSAT[Otd INSURANCE SHOWER OWNER ,r� MAIL (This seCtio� need ttUt be compietw{ if t118 woFk incolved LAVATORY �qOORES� C by the pernti[ is foc one handced doklus ($100) ox tess.) SINK cirv 7e�.N� � � �� [certify that in [he performance of the wurk for whicli[his � D19HWA3HER � �� permit is issued,1 shall not eMploy uny person in eny manner CpNTRACTOR . . ± 1� __ ,� so as to becorne suhject to the Wnrkers'CornpensaRion Laws. CLOTHES WASHER ADDRE85 � �h ' � U Uate Applicant _. _ � �� L= SWIMMING POOL RECEPTOR NOTICE TO APYLICArT:If,after making this Certificete of GTY � '� . � TEL.NO. t�Tj �:xemption, yuu shnuld become suhject ta the 4{'orkers' LAWNSPRINKLERSYSTEM STATE LIC - Compensatiun provisions of the Labor Code,you must for[h- yyqTER HEATER LICEN9E N � CLA � wi[h curnply with such provisions or this permit shall be _ � deemed revoked. GAS SYSTEM OUTLETS DISTRiCT WO. PR � @Y L[CF.NSED CONTRACTORS DECLARAT[ON OUYLETS OVER /f�/ ,...,� � 1 hereby affirm.that I am licensed under provisions of ChaDter 5 P R SV9TEM - ���tlt'>`-�' 9 wmmencm%w'��h Section 7000 of Division 3 of the Busi- ��� [ � - FINA� ness and Ycofesswns Code,and my�liee is i (ull ffo,rce� d �'-�'��'�rl����-<-=!���`�r"�. '�..L�.'f� oATE /� �.� �l��.l�/kTI�N effect. �• ����V� ��� ll'�`I`�! License Nu 6�— Lic.Class _ FINAL � 11'�j/yj�� �Bv '�LL� An, 7J.�.�\J"�\ Contractor�'�7i�L1�Y4d�C�.�ate�_ . � � I am.exempt from the lieensing requiremertts ns I am a ���1 Ch9E�E f92 licensed srel�itect or a registered pmfessional engincer p�UMeING PERMIT ISSUING FEE$ i" ''' acting in my profcasional capacity (Section 9051, Bus- �_�^' inesx and Professions Code). TOTAL FEE '''� / i ' C� Lie.or Neg.No. Date _ 6PIao cheek applicenc - HOb1E OWNF,R-BUILDER DECLARATION Name �I hereNy afYirm [hat 1 am exempE frorn the Contixtor's Atlareas f (:�,;:7 F� License Law for the Yollowing reason (3ection 7031.5,Busi- City Tal.No. . ,, , _ ness and Yrofrssions Code): ' `� �� I,as ow�ner of the property, am ezclue'wely coMrectiag �. - �7��: with license� cuaFxactore to conSEruc[ tNe i ` i c projxt ' (Section 7044�Businass and Ncof�seions Coda)• . + ,. I i, . _ CO£iSTRUCTIOfv LESrD[NG RGEIVCY � i,f.�—�_,j I Irereby afTtrm [Rat thnre is a construction lendi�,aQency fur�[he performaece of the-wock f'or whieh this permit is I6Bl��9116.��/i CFV.C.�. 110�l���Rh— . b.W�O'f A�R—_ I certiYy tflai i have read this applicafion und state thai the ubo�e information is correct.I agrae to comply wiih aH County SEE REV tiRSE fOR EXPLANATORY LANGUAGF. � ordinances xnd State laws regulating Plumbing, and hereby :k�{ represe ta[i -r f this County to ter upon the ab ' a� � f �wsReefiae f ';�'{��� ���� �FiPrdUF 'O 3M1fItBO �� . r. ,a,i _ _ ; yr : � �, ' . _ ..�_ � a —..�-�-.—__.K..�...,_ __ ����!- .. . ' . . ' �i , i - ' �,y � � ....., ... .� �a� �.,.... .^ .., .� .�. , AYf'ROVALS DA7C IM�C�ORS.2GN.e,7U�'.s-'. _e�._.a .._._.__....._. � .. . . _ . . . : .- . . . .. . _— _ ' � ____ JfJDP f LF ,�iJFI�� . . . . ^ . , , , .., `— —__--_ �OUG'PLUh k31'vG � � � ' ��� — _ — .._ ._ _ _— � � ,s. •� �AS PI I G � .� � � . .;� -J• � _. _.._ _'_— .' __ __— —__ '.. ...._.__ .._.._.._ .. . ' �111��ICP 1 . . : _ . , ' ' � . ' , , ' '_. —�— �._—, ��!�T14'1Tlh F�i:fTGF � .' "'—__ _.._._.... .._. ._ ... . .. . . �. . . . .,. , , , '".. — --.—„_ ' �__— �_. . .. . ...LUR�ita'i.�FI�:TUF�3 ' . ' :� . . : . , .. • . �: ...._ .__.. —._ —___..—_'—__—_ ___ �_.__.__. .. _. .. ....... ... . . ....,.__"_. __._.... .. . .., . m . ,� ,. . . ,. �C.S�EST . - . . �- . . : � . . .. �... � � i. .-. :�. �. _"_ ...._. .__.._ ...__..—_...—_.—_. -...-- .... _ - _ ,. . . 1TILI�I'CD.FdF3{'IfI1E@' . ---'_.__... ...._ _..... . . . . . . . , � __ _ .__'_ _— .__ �_ . . I . '—. ___'— '— ._.—_- _�L_—._".._, —"_' � �—_. _,_....._._ ...._._. ......... .... .. .. . - i ra n i �+�w.er► �a�o�` ' __ � _ .-- — -- --- --- _. - - -- – - --.— ___—----- ..,. �d O l,{P,T F I h L ' . . . .... - .. {l:FN.F11' 'rf6iVAL ' . . � . ,—._ _' _'___. .... . _ _ ... . .. - > , �t •. ,. . 9 . ' . t . i ' � .. _ & �. � _ �...�_ _�.__—_.._.__.._. .... _.... _............._._. r•.�e�c.To��s raorEs