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Home My WebLink About0764A �"`�KERS'`°""PE"SA"°"°E""R"T'°" APPLICATION FOR PLUMBING PERMIT {} 1 heraby„aifirm rhat I have a cartifimte of conaent ro seif in• �A��p PW 4i8� _ aure,or o certificate of Workers'Compensafion Insurance,or a Cf 817(REV.ei86' , f I . �cerfified copy thereof(Sx.3800,Lob.C.) � � � ' � L Pdiicy No.73WC005042ia��hyNATIONWIDE COUNTY OF lOS ANGELES DEPT.OF PUBUC WORKS••, � Cerriiied copy is hereby furnished. . � 1 42 $ . FOR APPLICANT TO FlLL W(PRINT OR TYPE) BUILDiNG � Certified copy is(iled with the county bvilding inspection nDORE55 depGrtment. . '� � . NUMBER FI%TURE OR ITEM (a' FEE �ocaurv DIAMOND B Dare 9-1—$8 nPPnco��NEW PLUMBING 3 WATERQOSET(TOILET) 6 18 NFAREST � .CERTIFICATE OF EXEMPTION FROM WORKERS' z . BATH TUB 1z CkO555T. GRAND AVE. � COMPENSATION INSURANCE SHOWER � OWNER LIMITED . �(TAb��ction n��d not b�compi�t�d if rM work invoiwd bY Mqa . th�p�rmit Is fo�on�hundr�d dollan(SI00)or bss.) LAVATORY - AD�RESS I cenify thor in�he performance of the work for which this per- - mif is issued�I shall n0�employ any person in any monner sa 2 SINK . 12 CITY COSTA MESA 7EL NO.$SO-1 OO1 ps io bemme subject io ihe Workers"Compensa�ion lows. � DiSHWASHER 1 6 coNTRacro I Da�e Applica�r C�orHE5wn5NEe ADORE55 2141 S. DUPONT DRIVE ICE 10 APPLICANT:If,aFter making this Certificate of Ea- � 5yyi�,,,MiNG POO�RECEPiOR . . iion,you shoold become subjec��o the Workers'Compen- CI7V 7E1.NO. sarwn provisions of the Lobor Code,-you must Forthwilh comp- �qWN SPRWKLER SYSTEM l�1AHIEII 937-3972 ly with such provisions or ihis permif shall be daemed�evok- STATE UC. ed. . � - � WATER HEATER - UCENSE NO. [tASS — � UCENSED CONTRACTORS DECLARATION OISTRICT NO. PROCESSED BY � I hareby affirm fhal I om licensad under provisians of Chapter GAS SYSTEM OUTlETS J� 9(<ommencing wilh Sadion 70W)of Division 3 of the Business OUTlE75 OVEH � � and Prafessians Code,and my license is in full force pnd ef- 1 5 PER SYSTEM 1 5� F�Nq� �/ �1 lDAT10N Y fecL � � DATE � n' � License Number 49fi109 Lic.Class r—�6 � U - � � � � FINAL r � eonr,octo� NEW PLUMBING oaie 8-31-88 Bv o � i am ezemp�onder Sea � � - W� � B.BP.C.for rh�s reason Plan check fee ► ��7 4�I � y 2 �� Date: .PLUMBING PERMIT ISSVING FEE 8 _ �• • • . o'"j 1 Signature . . �. . . . TOTAL FEE � I • � � G,G C � � SINGLE FAMILY . p�a��hack appliconi . . _ . � HOME OWNER-BUILDER DECIARATION ° 1 1 L.CO� � I hereby offirm fhar 1 am enempi from rhe Conrrocror's License Name � I�for the following�eoson(Section 7031.5, Business and � - � • O E.� O—H H i asions Code): Address � - � I,as owner of the prop¢rfy,will do Ihe work and Ihe �'�Y � � Tel.No. . � � struclure is not inrended or offered for sale�Secrion 7044, , . Business ond Prafessions Code). - ' .. - , - � CON57RUCTION LENDING AGENCY . � " � � 1 hereby pffirm that ihere is a constr�cfion lending�agency for � � the performance of the work 1or which�his permit is issued� �. � (Sec.3097,Civ.C.). � .. � lender's Nome � Lender's Address � � � . I certify that I hove reod this opplicafion ond stme thar the . � � - . - ► � obove info�ma�ion is correct.I agree to comply wilh all Counfy . ordinonces pnd Slate laws regulating Plumbing,and hereby � - � authorize reprosenm�ives of ihis County ta enter upan ihe . � aby�e-mgq lioned property for inspecli n purposes. � �/ [/�.�� ,�, 8 SEE REVERSE FOR EXPLANATORY LANGUAGE $ignafure o(Permittee �Dafe . � . APPROVALS onre wsaecTOR�s sicNnTuae iNSPECTOR'S NOTEs � � - OWNER BUILOER DECLARA'f�ON . UNOER SLAB WORK � . . .. 1 116fqby 8}��RII 1h9f I MIl B%9111(7�IfWfi lIW COflIfSCSOrB ROUGH PLUM8ING Ucenae Law fa the folfowinp-resaon (Section 703i.5, cas PiaiNc �- �� - � . �. . 8usiness and Pro�es§ipns Code). Any city or county whlch requfres a permff fo consfruct, alter, improve� casvervT � _ ,.a � -� � ' ' demolish or repair any structure,prior to its issuance, Hor wnTea neareA . _ . also raqufres the appfiCant/or such permti ro f!(e a srgnetl aLux�oiNc vixruaEs - - . . _ � . � � statement that he rs Ifcensetlpursuant to ihe provislons cns resr of the Contractor's License Law(Chapter 9(commendng with Section 7000)ot DivlsJon 3 0l the Business antl Pro- urtutt co.NoTIFlEo � (esslons COC6)or that he is exempt iherefrom and the Das/s for the al/egetl ezemptiort.Any violatron ot Section FiNA� , �031.5 by any appllcanf tor a permli su6jects the apdi- �fe.on�ront - cant to a civil penalty of not mae than five hund�ed Uollars($500).: iNousrain� � . � �� 1,as owner ot the property wi11 tlo the wak,antl the wnsTe napqova� � � � atructure is not Intended or aMered for sate. (Sec.7044.8usinessandProfe5slonsCotle:TheConirac- � ror's Llcense Law does not appry to an owner of pro��ty who builds or imA�oves thereon,and who does suc, •k -- � - - - - � himself provlded that such lmprovements are not irt,ond- ed or oNeretl!o�sale.!f.Iqwpver.fbe bul7ding or!m- - provemenl is sold wlthin one year of completion, the owner-Duilder w81 have the burden ot proving tbat he tlid not Duild or Improve for the purpose o/sete.) - ' - I am exempt under Sec. - 8&P.C.forthls reason Date Owner INSPECTOR'S NOTES _ , �