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Home My WebLink About0767A rcn[KSCOMPENSA710NDEClARATION � � APPLICATION f OR ALU)YI�ING PER�II �1 I heraby„offirm thot I hove a trnificale of consent to seif in- �A��A�°�B7 c � cure,or a tertifimte of Wvkers'Compenso��on Insuronce,or o LE B V(REV,ei86) � � � � 1 I carYfied mpy thereof�Sea 3800,Lob.C.) ' �� , , Policy No73WCDOSO4�@��`1ATIONWIDE � , � COUNTY OF LOS ANGELES DEPT.OF PUBtIC WORKS � Certifiad copy is hereby fvrnished. L07Sb PLAN k � TRACR+2578 FOR A7PLICANi TO FIIL IN(PRINT OR TYPE) ' BUILDING � .Certifiedmpyisf'iledwithlhecountybuildinginspeciion nDoae55 � [leParfine�L , � NUMBER FIXTURE OR REM (d FEE �«A��tY DIAMQNU B�- � pa�p�-1—$$� APP�i�a,JdEW PLUMBING 3 WATER CLOSET(70I1E7) b IS NFAREST , CERTIFICATE OF EXEMPTION FROM WORKERS' � 'L BATH TUB ],'2 GRO55 5T.GRAAID AVE.: , . .COMPENSATION WSURANCE � � OwNER BRAMALEA�LIMITED . . (Tbi�s�et(on n��d no/6r eomplN�d tf eh�work 1nvolJ�d by Z SNowER 12 �` � � � 1M pnmi�b for on�hundtid dollan(SIOO)er leaa.) 5 �avAroav � - 30 nDDRE55 3151 AIRWAY AVE. STJITE N �1 cerlify ihpl in fhe perfarmpnte ol fhe work for which ihis per- . mi1 is issued,I sha�l no+employ ony person in any manner so �1� 9NK � 6 CiilC�$TA MESA TEL NO$SO�IOOI �as io bemme subject ro ihe Workers'Compensarfon Lows. 1 015HWASHER 6 coNraaa�IEW PLUMBING CONTRACTORS, INQ. - Oote App�icont I - CLOtHES WASHER ADDRE55 2141 S. DUPONT DRIVE �10E TO APPLICAN7:If,ofter making this Certificoie of Ex- SW�MMiNG POOt RECfPiOR ion,you should become so6jx�to Ihe Workeri Campen- CitvANAHEIM� TEi.No.937-3972 su�ion provisions of the Labor Code,you must forthwith comp- �p,WN SGRiNKIER SVSTEM ly with such provisions ar ihis permit sholi be deemed revok- STAtE LIC. � Bd.� � �� 1 WATER HEATER 6 ucevse No.42b 109 C1A55 C-36 LICENSED CONTRARORS�ECIARATiON '� OISiRiCt NO. PROCE55E�BY I hareby aflirm thal I om licensed under provis�ons of Chap�er 1 - GAS SYSiEM ( OUTLE75 O / ,` 9(commencingwith5eclion?OQO�otDivision3oflheBusiness � � 1 OUTLE750VFR � � 5 7ER SYSTEM and Professions Code,and my license is in full iorce and ef- FINAL ��Jl V (DATION p�',� � O Lcense Number 426109 ' �;�.C1O55 C-36 �ArE a � 13EW PLi1MBING 8-31-88 FiNAt Q �Conhacfor pote BY � V � 1 am exem t�nder Sec. W B.&P.C,forthis reazon s C 7�7� y Plan check fee ` �,� �� 5 z . �P�e� - PLUMB�NG PERMIT ISSUING FEE y lO SO � , Signmure . � 707A1 FEE . 1].k �� • � 1�'�� . SINGLE FAMILY . � � Plon cbeck applicoM • ` � � 4'�� HOME OWNER-BUILDER�ECIARATION I hereby affirm ihot I om exempt from Ihe Coniractoi s license Name . D 4.� O—S S . y^.Fo��he fo�lowing reoson(Secrion 7031.S,�Business ond - � � - � . nsions Code): � . Address � - _ - � 1,�as owner af ihe propeny,will do the work and the �'�Y � Tel.No. strudure is nof intended or oifered lor sale(Sedion 7044, ,,, � Bosiness and Professions CodeJ. �� ' ► � - � CON$TRUCTION IENDING AGENCY � � - � � I hereby offirm Ihol there is a construdion lending ogency foi . . � fhe performonce of the work for which Ihis permit is issued � � � . - � � (Sec.3097,Civ.C.). - �- Lender's Name � � . Lende�i Address � - ' - I terrify thor 1 have read this applicotion ond sro�e thol fhe � ► obove information is correct.I ograe ro comply wlth all Coonly. , . . � ordincnres and S�a�e lows regulating 7lumhing,and hereby � � aufhorize represeNafiras of Ihis GouNy lo enler upon Ihe . �o ve-� ��oned properry fo�inspeNi n purposes. � - � - � � �� ,�� SEE REVERSE FOR EXPLANATORY LANGUAGE Signoture of Permirtee Dafe � � � � APPROVALS OATE �INSPECTOR'SSIGNATURE INSPECTOR'S NOrEs � �� OWNER BUIIDER DECLARATjON , uNOEa sue woFlx � 1 hereby aNkm that I am exempt.from the Contreotor'e ROUGH PLIIMBING ' � � � � UCBI7!! LiW for.tfw totlow{rp reaeon(Sectlon 7031.5, casriaiNc�� ZC �� - � 8uslness and Arofessbns Code). Arty oify�oi counry �� -"� �',�� , � which repui�es a permlt to-con9tiuct, alter, imprave. cnsveNr � � - � � demolish or rspalr any structure,prlor to 1ts lssuance, noT wnTea t+ealeR� also requrres the app7icant lor such permit to file a s7gned a�uMaiwG fixruAss � � � .. statement thaf he 1s licensed Aursuant to the provisrons .--of the Contracior's License Law(Chapler 9(commencing cas resr wrlh Section 7000)of Diutslon 3 oi the Busieess antl Pia uriuTv co.NoriFiEo ' iesslons CorlE)or that he is exempt tberefiom and the , - . � _ � . .�basis for the alleged exempfion,Any vfofation of Sect/on FiNa� . ' 703i.5 by arty applrcartt for a permit sUbJecis the appli- �'nta.an `��onf cant ro a civii peoalry oi no�more rhan five hund�ed tlollars(5500).. IN�U57R%AL � .. � . � . . .. � ❑1,8B OW116I Of tfiB p/0p6RY Wlll d0 thB 1YOfk,8fitl 1h8 WASTE APPROVAL. . � - 31NCSU�B is�Ot If11611d9d O7 OfTB�Bf11Dr g810. � � . fSec.7044,Business and P�ofessions Code.�The Contrac- ` tor'S LlcenSE Law d0es nor apjNy to an owne�of p�o�3/ty � - � , ' � _., - who buiJds or improves fhereon,anCwbo does suc� ��k �� "� � hfmsef/providetl that such improvements are not h�..,nd ed or ofiered fa sale.1/,however,the buifdrng or im- �� - provemeni is sold witbin one year o/completion, Me � . - � . . � owner-�uilder wr!!have the burden of ProvMg ihat he did nor builU or improve Jor the purpose ot saJe.} � .. . `' '" �" I em exempt under Sec. ' 9 d'P.C.for thls reason Date Owner INSPECTOR'S NOTES --.