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HomeMy WebLinkAbout0768A (4) ""'" APPUCAt10N FOR PLUMBtNG PERM13 ^ ,wve o ce��ifico�e of mnseN�o self in- ��26 D�W ai87 � 76A667A e r a certificare of Workeri ComDensorion�nsurance,or o CE 8�7(REv.8�8d!� - . � � .cer7ified copy rharoof(Sec�3800,Lab.t.) � v6licy r�o.I3�1C005042AQ�,yNATIONWIDE COUNTY OF LOS ANCsElES DEPT.OF PUBLIC WORKS ��Car�ified copy is hereby furnlshed. . � � �i2S78 � fOR AfPLICANT TO FI(L IN(PRINi OR iY7E� BUILOING � Cartifiad mpy is filad wilh the munry 6uild�ng iaspeUion AODRE55 T YP1 (�T$YN W111' ()eporimenl. . NUMBFR FI%TURE OR ITEM EJ FEE ��AGTY � oo�e 9-1-88 nf,PuccnrNEW PLUMBING 3 WAiFR CtOSET(iOILETI' ( �8 NEAREST BATNTUB � CROS557. � CERTIFICATE OF EXEMPTION fRpM WORKFRS' � Z . - COMPENSATION INSURANCE� �� - SHOwER � OwNER � (TMb s�dlen n.�d naf b�complp�d if 1h.work involr�d by ,�ii � � eAe p�rm�t b for en.hundrrd dollon(SI00)or Iras.) � UVATORY � � nDDRE55 � 1 ceeify lhdf in rhe performance ol fhe work far which this per SiNK mit is iuved,I sholl not emplay ony person in ony monner so 2 - �.Z ��Ty COSTA MESA 1E�.No.850-1001 � os fo become subjec�ta fhe Workers'Compensation tows. D�SHWASHER � � . CONTRACTO Da�e App�ico�� CLOTHES WASHER . . ADDRE55 �Y"TICE TO APPUCANT:If,ofter moking this Ce���f�cme of Ex- - Swi�MniNG PDOL RfCEPtOR � � . ,iion,you ahould 6ecoma subjetf to�Me Wo�kers'Compen- CiTY TEi.NO. sa�ion provisions of�he Lobor Code,you mus�fonhwinc�omp- IAwN SPft�rtKtER SY4Ent — � ly wi�h su<h provisions or this permit shall be deemed revok- STAiE uG . ed. � � � � WAiER HEAiER � LICENSE NO. CLA55 � . � � IICENSED CONTRACTORS DECIARATION � biStR�C7 NO. 7eDCE55eD BY 1 hereby atfirm tho�I am Ycensed undar p�ovisions of Chopter GAS SYS7EM OUitE75 � p 4{om encing ith5ection7000)a(Division3of�heBusiness OUiIEiSOVER u ' and Pro1e5Sion5 Code,ond m litenxe is in full force ond ef- 1 5 PER$YSiEM �. 50 F��yA��r/��1� � ,7. . fect � . Y . � DAiE �y VALIDATION a Licensa Number f+767 09 Lic.Class- r-�F 7 O .. . � � � � FINAt / U 6 Conrrocior NF(ej PTtiMATRC Da�e A—'il—AA BY O [] I om exemp�under Sea �O 7 d&p a 8.8P.C.for�h�s reason � ` �`�' Plan check fee ' �• �• _ � DO1e� . . �PWM0ING PERMIT ISSUING FEE S � •� ��O O . Signa�ure TO1At fEE � ••� � �,(i�c�i ' . SINGLE FAMIIY � p�a��heck opplicont HOMEOWNER�BU)l�ERDECIARATION - O�� O"SH 1 hereby offirm that 1 om exempr irom Ihe Convoctoi s License Nome � �v fo��be foilowing reason(Section 703L5,8usiness pnd � � iess�ons Code): . � Address � . � 1,os owner af rhe property,will do the work ond ihe ���Y Tel.Na . struclweisnorinlendedorafferedfarsale(Se<tion7044, . . . Business ond Frofessions Code).� . � � , CONSTR�CTIOM LENDING AGENCY � . � � � �� 1 hereby aHirm ihot Ihere is a cons�roUio��end�ng ogency for � � � . Ihe perfo�monce of�he work for which�hrs permi�is issued � � � � - � (Sec.3097,Civ.C.). . lenderi Nome ' � � � Lender's Address . . � ��I cenify thof 1 hove read�his opplimtion and stare Ihat ihe . � � � dbo.a�nformativn is corred.�agree to comply wirh oll Counry ord�nances and S�ate lawe regu�a��ng Plumbing,ond Mere6y �' - �� ' ovrhorize represantolives of this County ta enter upon�he - obqy e-menr/Q d propeny for inspeclion poses. � � � /� /���,p ,�3.Rg SEE REVERSE FOR EXPIANATORY LANGUAGE .d_'�_���GS Signarure of Gs.mirree Da�e APPPOVALS OATE INSPECTOR'SSIGNATUflE � � �NSPECTOR'S NOTES . � � � OWNEfl BUl�ucn W..__ UNDEflSLA6WORK -� - - � - 1 h9fgby Btikin tMt I 8111 BXBRipt ifqn tIW C0111(BCtOr'8 ROUGH PLUMBING LiCenBe tiW tof M6 f0110witlp 18980n�SBCt/0!7.7Q?�.5. cas PiaiNG '� � � �� � -� � � � �-��� � � - . �Busrness and Prafessions Code). Any Gry or county , � ����� ��" � ��� ��- whfch requlres a peimlf to constroct, alter,1mA�ove, cas veur � . � � � ��� „ � � � � � . . demolish or iep8ir any structure,prior to!ts issuance, HOT WATER HEATER also requires the applrcant for such peimit to file a signetl vwnneiuG FixruRes�� � - . � � . � . sfatement that he is licertsed pursuanf to the p�ovisJons �ot7h8Cont�BCtor'SLicBrtSBLaw(Ch8pt2r9(CommBnc/ng � cns Tesr � � � with Section 7000)o/Olvision 3 of ihe Busrness antl Pro- urain co.NonFiEo �� � �essions COUe)or thaf he is exsmpt there4om end the _ �. � � . . . .. .,�.basrs�or.the alleged ezemptiar.Any vlolation of Section � cry 7031.5 by any apWicant�for a parmit sublects lho,appll- FiNAL �� � �Gn'fa.on"�ront . � -� � � , -, canf to a civil pBnafiy o!f)Of rtrore than live hOndrBtl , . . � � . .. , .dollars($500).: . . . INDUSTRIAL � ❑(,88 OWflBf Ot 1119 pfOpBf�y wlll dOIhB WOIk,elld th¢ WASTE APPROVAL� ' ' � . ' StRlCillf818 f10i If12B(IfIBd O!Of/BfBd(Of BflIB. -- � ' � . _(SecJ04a,BusinessandProfessiOnsCOde:iheCOrtfrac- . . . . �� .�. .�. _. - .� tOr'stiCB715@L8Wd08SnOtapplyt08nOwl18rofp700'!ty _ , . . . . - . �. � whobaildsorlmprovesfhereort,a+rdwhodaessucL F � . - �� - � �Aimself provided fh8t such improvBmBnts are not immid- � . ---� -� - � � , -� etl or o8e�ed lor sale.fl,however,the building oi im- �...,.. . '. ... . .. .... .... . . . . � - � � - provemenf is soiQ witnin one year of completion,the- , � � . � � owner0ullder will have the burden of provirrg ihai he did - - . . � �noi 6ulld or Imprave tw the purpose ot sale.) . :.. . .. , . . . .. _ ' : _ I am exempt under Sec. - 8&P.C.fo�thla reaeon Date . owner INSPECTOR'S N07ES ,