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HomeMy WebLinkAbout1425A (8) WaRKERs'�°^^PENS""°"°E«^RAT'°" APPLICATICIN FOR PLUMBING PERMIT I� .I.here��pffirm that I have a cer�ificate o4 consenf ta self 20A026�OPw8/87 , , C I � 'rrcyre,-RA,a certifica�e of Workers'Compensation Insurpnce, 76A667A „ � „ , , , , , �� .ZN�a cenified copy thereof(Sec.3800, b.L•) y, r - • � � � Ll ❑ Y�G,D�y,��� �P� ff- � �i;L' COUNTY OF LOS ANGELES DEPT:OF PUBLIC WORKS Polic o. on �''"��CR�4 � :, ', . . _. . ' _ Cenified eopy is hereby(umished. ' �` � , . i '- FORA7PUCAMlOFltLIN(VRiNTORTYPE) BWIDING . Certified copy is filed with the co�nty b�ilding Inspec- ADORESS� , tiOndepart N. �rl ♦ � - � � iNUMBER �FIXTUREORrtEM � �;�-FEE `�`�TM , �� d !� � WATER CLOSET i . - ' � IQ � Date Appliq � `�V � NEARESt- • �. � CERT ICATE OF EXElJ�PTION FROM � ERS'! ', �'�, BATH TUB �� � U� CRO55 ST. COMPENSATION INSURA E' .. -�� SHOWER � � � ,�d1 � OWNER� 'S (Thl�i�aion n��d nm b�eompl���d 11 ih�work Involv�d by � ��� - fh�p�rmi}I�!or on�hundnd dollart(5100)or I�n.) �•! LAVATORV ' (fl nDDReSS� p � I certify that in the performonm oi the work(or�.which this � , . permh is issuad,I sholl not employ any penon in any manncr SINK � � � �j� dT�� �� � TEI.NO. � so as ta hecome aubjee�to tha Workers COmpeMalion Laws. DISHWASHER,. . .� � / � � COMRACTOR� Dare epplicpM ' � CIOiHE5WA5NER [J� NOTICE TO APPLICANT: If, after making Ihis'Cerlificare�of , A�DRESS � Exemption, you ahould betoma sub�ecf to Ihe Wo�keri � SWIMMINGPOOLRECFPTOR ' CITY TEI.N ,�� CompBnSatlOn ptovleionb of the Lobor Code,',you must forfh- LqWN 57RINKlER SYSTFM � � wtlh mmply�with,such provislons or tAis perml�,ahall bo STniE �� � @ . uC. , deemed revOked. I� . !.'� '� � WATER HEATFR � . UCENSE NO. ' CLA55 '� � IICENSED CONTRACTORS DECLARATION '� � � �IS7RICT N0. PROCESSEO BY , I here6y affirm thot I am Iicenead under provisions of Chapler 9 GAS SYSTEM � OU71E15 ,, S •l Q y�.,. (cammancing wifh Sectlon 7000)of Dlvlsion 3 of iha Business OUTLETS OVER , '� and Professions Code,a^d my Iicense is In full force an8 effetl. 5 PER SYSiEM � � FINAL � � p� r � DATE � � ,� ALIDATION a License Num6e�T17y�Lit•Clas � � U . . � . � FINAL i I :, � � �� Controct v Date' � . . BY '� ,i� O a - ' ' � 1 am exempt under Sec. .� i W 8.8P.C.(or this rwson P�d�ChBCk feB I ' � � Z '' ���e � PLUMBING PERMI�ISSUING FEE S ' � � � Si nature � U `� �� . . . � 9 . TOTAL FEE /CS . � I i I , -�� Lt P.S A . . ... . � . . � '.' � Plan check applicant , � " . . � . . �� �, �, . �• • • " °5 . SINGIE FAMILY � � HOME OWNER-BUILDER DECLARATION ' Name � � � � ' I • � � S 5 Q I here6y affirm Ihal I om exempt from tha CoMraclor's License ; , . ' � � � . Low(or the following reason(Section 7031:5,Businesz and Address ,. , •• � � &v O� . Professions Code��' ' '� I °,: , Ci�y 7e1.No. . � • �, ' ❑ I,as owner of the property,will do the work�ond the � '� � � � � � � . 4 I I �� . �9'�7—�'� ' � xtrucWre is not in�ended or oifered fof sale�,�5ection ' �, � � ��, � 70aa,Busineas ond Professions Code).' ;� � � "� � "' j� � ' '..i , -. � � CONSTRUCTIONlEN01NGAGENCY' � . '. f , I ., , ; I hereby affirm that�here is a mnstruction�lending agency for � , I - the performance�o}�he work for.which�his permit;is issued � ���, ��, (Sec.3097.Civ.'C.). - . �, �. � � � ' i � � � I ( I, ,; �, � r ! i Lender's Name� � ' � � �^ � � � ' . . , P i { 4 I I ; � � lender's Address �' � � . '� . �. � t , ' I ' "� . . . I',aertlfy that I haJe read this opplimtion and state thot Ihe : � � I r�� � i� ' � above informofion,is correct.I ogree fo comply with oll Couny ! ' i � ;. � � ' I �. . ordinances and SIo1e laws regulpting Plumbing,and hereby : ( � � �!, i I � , � avthorize representotives of this Coonty to enler�upon the : I r � � �, S , E; �. . „above-mentioned'property for inspection purposes.' SEE REVERSE FOR EXPIANATORY LANGUACE � ' il � .E' ''^3 � I i � Siqn � erminee . . i Dote . . ' .... �. , . , . � i. . ' ' i - , � ,� � I . .. � . . _. ....._._ s_:..,_ �: . . :.F'vzOVALS Cl.TZ �INSPEC7 e' SIGNATUa� � � INSP[CTO^n'S NO�ES � , O�AiN'c�-6U!l�!.P.JFC!.!'.R„ii0"! . ' UNDE�.SLn3 WORK � � I he'e5Y affi'ni Ihctt I n•"�cvCmpr from In['Con'�r:'c%.: ROUGH FlU.uB!NG ,.'� '� �ti - ��U� 1_._„ Ucensc Lnv: fo� fha io��o�mirg r eson (Srction 103J 5, � c Ga5 PiP�NG��-'' � '• � .^ '��•�'` �-�� -' "'." . .. . ... - . . . . Dusiness and Pralessims Codsl.Anyc:ty e�covrz�y.}1h�<h � GASVEM �'. .��"\ -•t-i \i..�:�.�,,. � 'y .. ' . . � requiresopermirtoconsirucr.allcr.lmprovc.�ler+of:sh. �"� aCr¢pair c�ys7ucWre, prior�.tF-i{s.lssunnc�olao r �, HOT WAT.R HEA7ER ` - „ . . - -� -.�,-qurreiYhB�ap��ffcant7or:sucfi perri��116(+1�a s r�ned stnfe- F.U!JF9hG.�%TU",ES - � ���-" '..•`-:1� � ment fhet he Is IRensed purzuont ro i!�tiprov sions o��hc G/+5 TEST ��.µ � � Con7redor's Lfcer.se Law�Chepter 9(rommoncing�•�irA fJTIItTY CO.NOTiP�ED' Secfion 7000f ol Ulvision 3 0/fhe 8usiness ond Profes- ' . � \r sions Code)or/6at hc is eznmpl thernitom ond fho bcefs . f ..`. �.c/� . . � ... ." `. . • . . .. � \ . /or fhe alle.4ed uxempllon Any vielvNon of Ceclion ���'��- C'��(r�on Jro�Y�~--' ��..'.\'.:��'...� � . . .. \ � 7031.5 6y cny appbcont for a perm�7 su6jeUs iha eppli- ��� - � eant to c eivi(penaliy al nol morc fhort livc hundred � � ',��._. �'-'� - do�lars($500J.: INCUSTRIAL ,_ �` � ...� \`�� ❑I,as owne:o`the GrCperty v.l:l do t!:o�aarG,and �i...STc aFF7^Vt��� .,:w`� � .�.•':y;��>. ' _` 4� , . the shucturo is not in!ended or of fcred fo,-_olc. � - (Sec.7044,Pusiness andProlc.-sJor.s Code: TheConfrcc� � �"'�:.':.`'::�'�'`'i�� . . ��`�� .,�':'� -_ — lor's Litense Low does nol apply to r.n o'.vner n!prnperly �� _`:�� ,- . �--�- � � wh0 6vilds ar improves thereon, end who docs sucb ' ' " - ��',1 �`'�`�•`-' • work himself provlded lho�such improvemenls arc no� , - - - - �� �,�-� - intended or oHered for sale,!L 6owevcr,ihc bu'rlding or . . - . . - � . improvemenf ls eofd w7th7n ane yev �oi comple�ian,the � �- - � � � , owner-buifdar wil!have�he 6urden of proving f;:ot he d�d . , -� nct buifd or lmprove lot Ihe pvrposo of safo.) ' . . � � � ,_ _.• 5-;: .•,�,�i,r� � . ' u���1` �.(am_x.:mp �nn S^c_�_� . _ , i,. '. ..,^. . \� _,,,` ti - � . � � - 'B�P.G�for this rcason , . .Date . .. Owne; INSPECTOR'S NOTES --- � � .:� `-. �' -.j��> _\�:' _