HomeMy WebLinkAbout0763A (4) """"`"5""°"°E""R"T'°" APPLICATION FOR PLUMB[NG PERMIT
I hereby„affirmLlho�I have 0 cartificale of consent b se�f in- ����A PW a�g7 - �
sure,or o cerfifimte of Workers'Compensa��on Inswonce,or a �E 01l(REV.Bi96) � � � � �
tedified copy iherao£(Sec.3800,tab.C.j . � . � �
Po9icy No.73WC00504�Q�yNATIONWIDE COUNTY OF LOS ANGELES DEPT.OF PUBUC WORKS
� Certified copy is he�eby furnished. �. .. �� - 4ZS78 .
FOR APPLICANT TO iIL(IN(7RINT OR iV7E) BUILDING .
��Cenilied copy is(iled wifh 1he county build�ng inspec�ion ADDRE55
. , dapottment. . � . � NIIMBER FIXTURE OR ITEM (`i FEE ��qLITY '" � �
WATER CtOSET(10�IET)� DIAMOND ��
Date 9-1-88 aPPi�ca��HEW PLUMBING 3 6 18 �RossSST. GRAISD AVE. "i- •-�''
- CERTIFICATE OP EXEMPTION FROM WORKERS' � . Z BATH TUB 1 Z
� GOMPENSATION INSURANCE � SMOweR . OvrNER
(Th7s s�ctlon nud iwt b�compl�Nd IF tha work fnvolv�d by Mqi� ��
th�p�rmit is lor on�hundr�d dotlan(5100)or{naJ 5�. LAVATORY - 3D ADORE55 Ajjtj�J Y
� I certify that in�he performonce o4 the work for which rhis pe.- SiNK . .
� mi1 is issued.I sholl noi empioy ony person in any manner so Ciir C�STA MESA TEL NO.$SO�IOOI
as to become subjecl to 1he Wo�kers'Compe�solion laws. DISHWASHER
� . � � � CONiRACTO �
Do�e � � Applicant � � 1 CLO7HE5 WASNER ' � 6 ADDRE55 �
ICE TO APPtICANT:IF,after making�his Cerrifico�e of Ex• SWI.MMiNG�OOL RECEPtOR
� iian,yoo shauld bewme subjed io�he Workers'Compen- CiTr � iE�.n10.
Sation provisions of ihe Lobor Code,yau must forthwifh comp- �qWN SPRINKLER 5v5TEM —
� ly witb such provisions or fhis permil sholl be deemed revok• � STATE tIC.
-.•ed.�� �� - � � � 1 WATFR HEATER 6 � U[ENSE NO. CLASS _
�� ' UCENSEO CONTRACTORS DECLARATION � DISTRICT NO� PROCESSED BY
1 hereby affirm tho+I om licensed onde�provisions of Chopler GAS SVSTEM OUitETS �
I 9(commencing wirh Secrion 7000)o(Division 3 of Ihe Business OUTlE75 OVER
fecc 1 s aea svsreM 1 50 AIIDAT1pN a
and Professions Code,ond my litense is in full force and ef• FINAI /—�✓ Y
� � � DAtE 't7 l O
License Number 426109 � Lk.Ciass C-36
U
NEW PLUMBING FiNA� i Q
� ���Contractor Oate 8-31-88 - - BY � O
F-
�. I am exemp�under Sec. � � w
a
6.8P.C.4or�his reason Plan chetk fee �
� Z
� . �Da1e: �p�UMBING PERMIT lSSUING FEE$ -
Signature . . - � TOTAL FEE 114 , �'U 7 C'.'J F{
- � SWG�E FAMILY plon check opplicont . #;o
� HOME OWNER-BUIL�ER OECIARATION � ' � �
� .�I h eby affirm Ihot I am exempt from the Conlracror i License Name � ,;� �.(��O
for ihe following reoson(Sea�on 703I.5,Buslness ond �� �
� ,essions Code): Address � � 1 ,� �-.C'G`
� I,as owner of Ihe property,will da Ihe work ond fhe City Tel.No. '
, srruc�ureisno�inlendedorofferedforsale(Section7DA4, . . OPi� �'sC> .
8usiness and Professions Code). � - � � � -►
� CONSTRUCTION LENDING AGENCY . -� � � � �� -
I hereby o�firm Iho�Ihere is o construction lending ogency for � .
Ihe performonce of Ihe work tor whith this permit is issued - -
(Sec.3097,Civ.�C.). . . .
lenderi Name . . �
lender's�Address -
�cenify thor I have read this opplicofion and s7pfe Iho1 1he . � �
above informalion is mrrecf.I agree 10 comp�y wifh a�l County � � �
ordinances and�State iaws regu�ming Plumbing,und hereby , , . � �
ou�horize representatives of Ihis Counly 10 enter upon Ihe � � � -
� ob ve-m r'�oned propeny for inspeclion purposas. � - - �
� �� �� ��J , SEE REVERSE FOR EXPLANATORY LANGUAGE
Signofure of Permitree � . Date � �
�
APPROVAIS OATE INSPECTOR'S S16NATUpE INSPECTOR'S NOTES � � � OWNER BWLDER DECLARA'�ION. .
UNDEP SLAfl WOAK �f- - . . ,i .. I I19(9D�/fl1fIRIi�M9f 1 iT 6%YTQt(f0f11 N1B CdlfflF.tOYE
ROUGFIPWMBING . LICBlIB! lsw fw the.tollowlnp reaaon�.(SeC11o� 70,41.5,
� - �8usiness antl�Arotessions Cotle). Arty clfy a couniy
cns riaiHc �� � � -� � � -�-� � - �� ��---��- �� - � �-� whlch requfres a peimfl ro Construcf, affer, improve.
cnsveNT - � � � � �� - � . - - � �� - � .demo7isA or repalr any siruCiura,p�lor to hs lssuance. �
HOT wnree Heatea � . also requires tbe appfkanf for sucb perm(i io fife a slgned
PwuaiNc pixruaes �� � � - � , . - statemertf fhat he!s Ucensed pursaant to the provisions
_ of fhe Confractor's Licease Law(Chapter 8(commencing
cas Tesr - � � � � wfth Seciiort 7000)ot Divislon 3 0l the 8u5Jness and P�o-
U71LI7Y CO.NOTIFIED fessions Code}or tAai he is ezempt there(rom antl the
. . .. , � , . � � . ,. . basls/or ihe allegetl exempikn.Any violathn of Section
7031.5 by any epplicant./or a permlt sub/ects the appiF
Fi"a� �'nfar o�`�ronf ' cant to a c1vN panalty o/noi more than Ilve hundrev
doflars(Y500).'•
INOUSTflfAL � . � .. . . . . . . . ..� ❑�.8B OWRW Of ihY pfOpQlty WIII[b 11p 1YOt'�(,9IItl thB
WAST[APPFQVAL . � BINCSl1fe Ig f10S IMBII�Of OI16f6l�10f 83I0.
. � � � �- � . _ (Sec.7044,8uslness and Piofesslons Cotle:The Conirac-
; ' ror's Llcense Lawdoes not apply to an owrrerofR�"^r7Y
� � �- .. � �" � .whobu7ldsorimpmyesfhereon,sndwhodoessuc rk
himsefl provitled lhat such improvements are nor Mrand-
ed or oNeretl lor sale.ff,bowever,the bulldfng or Im-
-� �-� � � � �� �� �� � _ �-� -� provement fs soltl wlthln one year of comPre2/on, the
owner•bu1ltler wl!!�ave tbe 4urdeo of proving that he dkl
- - , � . - not eu/ld or Improve lw the pwpose o/sale.)
`. 1 am exempt under 3ec.
B&P.C.for thia reason
Date _
Owner
INSPECTOR'S NOTES
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