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Home My WebLink About0770A (4) . "'°RKERS•`°'"PE"5''T'°"°E""""T'°" APPLICATION FOR PLUMBING PERMIT I hera6y„offirm thot I hava a cenifiw�e of conseni to self in- ��A�7ADPW 4�87 f�j �sure,or a cerrificate of Workers'Compensation Insurance,or a CE 8n(REV,9i66� � . `I I � ceclified copy Iheroaf(Ssc.3800,Lab.C.� � � � � � � � - I...J Potky No.�3.y�I!'nn50G2A��yNATTONWII]F. COUNTV OF LOS ANGELES DEPT.OF PUBLIC WORKS � Certified copy is hereby fumished.�� V25�$ FOR APPUCANT TO FILL IN(PRINT OR TYGEI eUIIDING � �� Cerfified copy is filad with the coun�y building inspection A�DRE55 Z/{'LZI. EAST BRYN ATHYN WA departmenf. ' . NUMBER FI7(TURE OR ITEM - ({J FEE ��L1TV . WATER CLOSET(TOILEi) ' , � Date9-1—RR ApplimNNRW PT.iiMRTNG NEqREst - CERTIFICATE OF EXEMPTION FROM WORKERS' BnTH iue Ceo55 5T. � � � � COMPENSATION INSURANCE � SNOWER � � OV�NER .(This��Nlon n��d nof b�cemp4t�d Ii th�werk fevolv�d bY �� .. � Ih�p�rmit ts for on•h�ndr�d dollon{5100)or I•u.)' - tavniORv qooke55 : I cerli(y fhat in the performance of�he work for which this per• SiNK . . . . mit is issued,1 shall noi employ any person in ony manner so CITr TEI.NO, as lo become subject lo Iha Workers'Compensation Laws. DISHWASHER - ' � CONTRACTOR Date � �Applicont CIOTHES WASHER ' AODRE55 f'�ICE TO APPLICANT:If,ofter making IhiS Certifitote o1 En- � SWIMMING POOI RECEPTOR ! 'lion,yo�shouid become subject lo the Workers'Compen- CiiY TEI.NO. . S��ion provisian5 af the Labor COde,y0u mVSI lorthwilh Comp- �AWN$PRINKLER$YSTEM — ly with such provisions or 7his permit shall be deemed revok- STA�E � l�C. � ed. � WA1ER HEATER LICENSE NO. C1A55 . �-- - L�CENSED CONTRACTORS DECIARATION DISTRICT NO. FROCESSEO BY . I hereby affirm lhat I am licensed under provisions of Chapter GAS SYSTEM OUTlETS - Iv �� 9(commencing with$eCtion 7000)of Divisian 3 of 1he Business OUTlETS OVER ��777 � f n�d Professions Code,ond my license is in full force and ef- 5 PER SVSTEm FINAI /,�7�` V LIDATION a DATE �% � license Number/�9�1 Q� Lic.Class C—$( . . � U I FINAL � Conrrocror NEW PLUMBING Dare 8-31-88 BY o �07ZOA � , � I am exempt under Sec. � . , � `� 0. B.BP.C.for�his reason . e • c o Plan check fee � I • 1 0 8 D 0 Z �� Date: pLUMBING PERMIT ISSUING FEE$ � Signat�re � • � � O F,�l Q c=.� . . . . . . . TOTAI FEE . . SINGLE FAMILY � � � d H.� G—S S � HOME OWNER-BUILDER DECLARAtION Plon theck opplicont � . � 1 he�eby aflirm thot I am exempi from the ConhaUor's License Nome � � ' �i for the following reasan(Secfion 7031.5, Business and � � � � � , �, � iessians Code): � . � � , Address - � � � I,os owner of the propeny,wiil do the work ond the �'�Y � Tel.Na � � - ' structwe is nor in�ended or offered foi sale(SeUion 7044, . , , � Bus�ness ond Professtons Code). � , . ► � � � CONSTRUCTION IEN�ING AGENCY � - �� ' � � � � � I hereby affirm tho�Ihere�is a constrottion lending ogency for � ' � , , � � � ihe performance of the work for which.lhis permit is issued - � (Sec.3097.Civ.C.J. . . � � . � lender's Name - - � � .� Lender's Address � � . � I cerfify ihaf I have read this applimtion and smte thoi the . � ► � above in(ormation is mrrect.I agree lo comply with oll Coanry � � � ordinances and State laws regulaiinq Plumbing,and hereby � . � - � - - - � ao�horize rapresenta�ives of this County to enler upon the � � � � � o ve-me toned proparry forinsped' purposa � � � � � � - � � 1 SEE REVERSE FOR EXPLANATORY LANGUAGE � Siqnarore of Permiltee Dofe . . ', �� APPROVALS DRTE INSPECTOR'SSIGNATURE INSPEC7oR'S MO7ES OWNER BUtLUER OECLARAj10N LIN�ER SLA6 WORK � � - ,..�. ,_ . I h9f9by 9}}Ifrtl (Mf I ilil 8%irtlpi hOrtl lM COIItf9C(Or8 u��.a uw ia tM IWlowlog �eason{secuon �o3t.5, qOUGHPLUMBING . � -$11S(lIBSS 8Otl'PIOIBSSIOlIS Code). Any�ciry o� county cns aiaiNc � - -- whkh requires�a permlt to construct alter, improve, cns veNT demolish or repalr any structure,pNor to Its issuance, NOT waTea r+eqTeR ---� also requires fhe aAP��cant fo�such permit to lile a signed a�un+ewc FixTunes � � � , � . . .. - statemeni thaf he Is!lcensetl pursuant!o ihe provisions of the Conhacior's License Law(Chapter 9(commencJng �as resr with Sectkn 70D0)o!Dlvislon 3 of the 8uslness and Pro- UTILITY Ca.NOTIFIED fesslons Code)or thaf he Is exempt therefrom and the basls for the alleged exemption.Any vlolatlon of Secflon 7031.5 6y any applicar+llor a permlt subjects ihe appli- F�NA� - -�-�'nle,on��ront � �- � � . � � � � � . cani to a clvil penalty ot nof more than live hundred • dollars($500).: INDUSTRIAL . . ..�. . .. . . . ❑I.as ownar of the property wqt do the wak,dntl the wnsre naPaavq� � � � • atructure Is not Inlendad or offereq fa sele. {Sec.7044,Husfness antl Professlons Code:7he ConVac . tor's L/cense Law does not app7y to an owner oi pro�riy who Dullds or ImA�oves thereon,and who does suc 7k hlmselt provkfetl that such Improvements are r>ot n,,,,nd ed a offered for sa(e.If,hoWever,the buflding or!m- - - provemeni is soltl wltb7n one year o!completion, the owrteabullder wN!have the burden o!proving that he ditl not bu7ld or Improve/or the purpose ol sele.) 1 am exempt under Sec. 8&P.C.forthla reasoe Dete _._ _ Owner INSPEC70R'S NOTES . , • , ,j 1