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. �. .� , .. ._.,�. ..� .. . .._...:._.�._.�.�._.�.... ....._.__ � .._._•--___.�...._.�� . _.� � "'°RKERS"�°"^PE"5"T'°"°E��RAT'°" ' pppLICATIONfOR PLUMBfNG PERMIT � I he�eby affirm'Ihat I hova a cerrifimre of conseM to�self,. jbqyb�q ' � . . . � . . . � � '. � . insure,or a certificale of Worken'Compensalion Insurance; CE 8V�REV.10�81) -- . , U, or a certified copy thereoi(Sea 3800,LabrC.} ': COUNiY OF LOS ANGELES BUILDING AND SAPETY �� : Pollcy No. . . ,Company . ' .. �,. . ' ' : ' . , . -. .�� . . , _ . . _.. . _. . � �� ' I ' � -Sj j Cerlifiedcopyis,herebyfumished �, ��,��. ,.' . , � . /❑ � ��.' � , � ' . . FOR APPLIGANT TO Fllt IN(PRWT OR tYPE) . BUILDING� t Certified copy Is filed wiih"the coon�y build ng�nspec- � noo2ess ' NUMBER FIXTURE OR 11EM� � �� fion dep8rlmenr... 'i.. : . . .Ca iEE LOCAIITY , � �Date�lAppLSant � � ..�� . . P - . .�� WATER CLOSET. . � - � � NEAREST � . . . ' I , CERTIFICATE OF EXEMPTION�FROM WORKERS' � . , - BnTH TU8 � � � � Ce05S SL� � � ' �'��� � � ' i � � '� .'�'COMPENSATION INSURANCE'� � ' � � . - � py,R.�g� � . .. (Thi�s�cfton n��d not ba complN�d ff th��wark Inrolvod hy � . SHOWER � � _ � � ihs parmit h For on�hundnd dollars(5100)or 1�s�.) � �AVaTORY � ��� � � ' � ' I�. . ,, ' ADDRE55 ` � ' ' � � I cenify fhof in Ihe perforinance of�he work�-for which this , . . , , . � .. . � , , � permit is issued,1�shall not employ any person in ony manner � � SINK .. . � . . � CIN ,���TEL NO.'�... , � �, -.so as Io betome sobjecl to 1he Workers'Compensotion Laws. . _ DISHWASHER � - - - � � � � . . . . � . - COMRACTOR � �`, � .. Dole�" - ' �� `°PPlicanl' �� �' �� - � � ' CLOiHESwASHER � � ADDRE55 � �/ NOTICE�TO APP�ICANT:�If �ofler making-��his Certfficore of , . � . � 7 ' '�� C>�/Y�/�i� � �, ' �-Exemption; yoo�should become-subjecl io`Ihe�Workers' SWiMMMG POOI RECEPTOR� � . . . �, ;� ' Compen5ofi0n provisions of Ihe labor Code,y0u mVS�for�h- , �AWNSVRINKLERSVSTEM- ' " ��TY J��j � TE�NO�� J , ,, � ' wiih com�I wi�h such s',permit�shall-be � � � � �� �' SiA1E � IIC. p y� piovisions or thi � .deemed revoked. - � � � '�. � � � � ' � WATERHEATER "�� �' �,. ��'� � - �-"��CENSENO. CW55 � - �' � � � � � � . LICENSED CONTRACTORS DECLARATION .�� ' . � - DiSiRiCi NO. OCE55E�eY � ��� I hereby affirm thal I am licensed under provisions af Chapler 9 . - � GAS S�STEM � � OUTLETS - p ' . . . ' (tommencing wlth Section 7000)of Division 3 of ihe Business . , pUTlETS OVER.- � � /� �'0.�� �ond Professions Code,and my license is In full torce ond effecr. � 5 a�rt SvSTeM�� " FINAL��� � ' / DATE � VALIDATION � 'i ,License Number���/� ��Lic Class� � . � � � ' � � . � . , ;� �{�f�Q��/,, ����r,� �j fINAI � � Contractc%IJeL71.'^�"��_Dare���� � � . . � � � BY. . � V aI am exempt vnder Sec. � � � . �, � . � ' l .�a �i i . . . . , _ .. , _. ,. . ���� � . . . . , �w : , '. :'. . �. . . � . �; s.aa.c.for�hts reoson _ Plan check fee r' . !' - � � �ale � . . �� . . ' .. . � � � �CLUMBING PERMIT ISSUING fEE S � � � � �� � ' �'� SignaNre� . . ' � � . . . . . . _ . . . . . � . . . � TOTAI FEE� . � a � ' . � . . , � . �" .�' � �� � !�� :. ��.�� ' ' �" Plon check appticant � �� ' . . . ' ' - . . - . . �. :� ' '� . . , ' � �', SINGIE FAMILY �. � . ��4�6 A, ` . �1 � HOME�OWNER BU�LDER DECLARATION . Name �-- � � - � ' ' � � - � � � I hereby affirm tha�I em exempr from fhe Conhacror's License � � . � ,.. � , . . Law(or the follawing reason.(Sectian 7037.5,-Business and �-� Address � . . � . .. #��� �. •5.�,'.� Professions Cade. � .'. � ,- � � . ' � .. . . . . ' ' � , �'I' ❑ ) . . .. � ; � , �: CiIY . .TeI.No. � � - 4, . . . . . -� ' -l� ` � Q.r7� � ', I,as owner�of tha property,�will do ihe�work and Ihe � structure is�nor Imended or offered for sale(Section ' �� -�� � �� ' • ' •� E+J�.�c�i '. � 7 7044.Business and Professions Code). , � � . ' . ... . - , � -�F.�. . � �-' � . . _ ... . .{ � . i���, , �CONSTRUCTION IENDING AGENCY, � - � • . : :� . � � . ' - - E � . . .. ... � � ��Z� O-.S 4 • � I hereby offirm ihdr there is a consrruchon lending agency for �-- �� ��the performante;of the work for which Ihis permil is issued � � �. . ... � . ,� � . ._ . :.� . . � . .. . , ; (Sec.3097,Civ C.).: � �p � � � � � . � . �. . ; . .�_.- . ; -� . . , . . iI i. . .'.. _....._..:. . : .. .. : � i ,' lendePs Name ' ' ' � ' � . I . . � . ,. . , . � �� . ..� . �... .,,... .� . . � � � , � , . I'L � I certfs ha�trl have read Ihis�appl�miion and sfaie that ihe .�. .�. .. � . � :.� - : . .:: .�i . �.I . � . . � .. . . - � � - �.. . � . � i t G Y ��.� above mformofion is correct,l ogree ro comply with oll CouNy ..� . . . ' .. �� . ,.�' �. .. '. . .. .. . ��. .. .. ... . . ... - , � . . i t�! ordtnonces and Sla�e laws reguloting�Plumbing,and hereby � . ' � . _ • i��.' - � �.� .�� �. � � - � � . � I ' ; ..�- '. � . , " -authoriz represenioiives of th�s Co�niy�o eroer vPon the .. . � ..�i .: ... - �. -- E ...-..- —.. . - � � . . f - 060 - eMione � perfy fo��ispectlon pwposes.� �. ' - - � • � e `" � � �� � �k " , � . , , � ; ^ �/ SEE REVERSE FOR EXPLANATORY LANGUAGE � `�'! , oG"-�_15 . . � � �• ,, „ � � - . . , ' � - .�.. , . � � Signature of P rmiltee� � �� • Dafe, - . � ... . ... .. ' . . ... . , . . ' �� f ' . . . - . . . .. . . :� . ' � ' � , � . . � , ' . �� �._.. _ -- . . _ _. _ _ _ � . : �� INSPECiOR'S NOTES ' � OWNER-BUILDER DECLARATION �A77ROVALS DATE�. ���INSPECfOR'S SIGNANRE � ' UNDER SIAB WORK ' I heraby affirm that I am exemp�irom tho Controctor's i ROUGH PlUM01NG'�" ��n '� License Law for ihe followin j reasan (Se[Non 703L5, � GAS CIPING , ��( � Bos(ness and Professlons Code):Any cify or tounty whlch GAS VEM _ � requlres a permlf to consfrucf,aRer,Improve,demolish. , _ � ar repafr any strvc�uro,prtor lo Its Is�vonca, also re- HOT WA7ER HEATER " � ' . . , `qulres fhe opphcoM for such permlf ro bfe b signed srofe- ' FtUMBING FIxTUHES � . monf fhal he Is Ileensed pvrsuanl to ihe provisions of ehe �, � GAS7E5T �� ���Lj.�,J� � - - Confroclor's Llcenso lew(Chopter 9(commencing wBh UTILIN CO.NOTIflED �� � Section 7000)of Divis(on 3 of!he 6uslness and Profes• slans Code)or}hat he Is oxemp/therefrom and the basls c� � for fhe alleged exempflon. Any vlolatfon of Setlion FINAL ��(e�ore .Yiorst� � 7037.5 by any appNconl for o permR subjech�he appli- � cant to a c(vll penafty o(not more Ihan Ifve hundred I � � . . , dolfon(3500f.: � INDUSTRIAI � � - �' �� - � ❑I,as owner of ihe property will do Ihe wark,and wn5ie Aa7ROvq� � � . - the strucrore Is not iNended or offerod for sale. � . � � � (Svt.7044,Business and Profess7ons Code: 7he Contrac �i ' , � . � , . � . for's Lieense Law doos nof apply to an owner of properry � , - . . � . " � �wFto 6utlds or Improvos iborwn, and who does such j - , . . '. - .... . . . . . - � .. ., `, , work hlmself provlded fhal avch improvomenls are nof i . � IMended or ol/ered 1or safe.1(,however,Ihe bul7ding or � � . , � , . . , . � � tmprovement Is sold wflhfn one year of complation,thc ] � � . � � � � - ownar-builder wi(1 Fave ihe burden of provinc�fhaf he dld � , . , . , \ � � � nof 6uild orlmprovo for fho purposo oi salo.) t '�' i1 ' � 4k M1`� - _ I om exempt under Sec. , , � y. . B 8 P.C.for this reason � r Datc �� Owner N � . . ., . . . � i. � ' ry'. WSPECTOR'S NOTES G�,. , � ;, �� � i — . . . � „ �- . . . .� . 4� �4 � P � . � , . . _ . . . � � � � � . � . , ' ,. ' �{I � I{. ,( - ' ' .. `.'y.�i 1 . . , _� . . a�i � 1 . . _ . . . . . 4 I i,