HomeMy WebLinkAbout1807A (10) ""°" >'""'" , APPLlCATION FOR PLUMBING PERMIT
ac i have a cafiYcate of consent[o self �e�V t�+e �
� insure,or s certificate of Workere'Compensation Inaurence,or
^ a ce:fifieJ copy t�errut(Sec.3800,Lab.C.) COUNTY OF LOS ANGEIES . BUILDING AND SAFETY
� Policy No. Company �
� ❑ Crrtified copy is hereby furnished. FOR APPLfCANT TO FIIL IN(PRINT OP TYPE) BUIL�INO
� NUMBER FIXTURE OR ITEM • FEE ADDRE9S S }1 .
CertiPied copy is Flled wifh/he counry buiidlny{napection
' �1eD��ment. - WATER CLOSET LOCA{.ITV r}� 6."� c,^
Ihte Appiicant N AH ST. /,a ���
' BATH TUB CROSS ST. �� (d
CERTIFICATE OF EXEMPTION FROM WORKERS' �
COMPENSATFON 1NSURANCE SHOWEFl OWNER ����}:�JT9 Z h' 7
� (This seCdon need not be Completed if the work invohed LAYATORV - ADDRESS 'Y � �
by the pmmit b Im one hundred dotlara (5100)w Iw.) g�NK . f /'. O
CITY TEL.NO.
; I certity thet in Ihe parformence of the work for which this DISHriASHER ¢
.. permit ia issued,I shall not employ aay person In any manner CONTRACTOF Q
so as to become subjact[o the Workms'Compansation Laws. CLOTM83 WASHEFl ADDRESS �
� Dete � Applictnt SWIMMING POOL RECEPTOH W
N0T3CE 70 APYLICANT:IF,aPter making fhis Certificate of CI7Y � TEL.NO. �
'� Exemption, yau shouid become subject to the Workers' LAWN SPRINKLEH SVSTEM 2
STATE IIC.
� Compensation provislons of tha Labor Code.you muat forth-
with compiy with suth provisions or this permit shall be WATER HEATfH UCENSE ND. ClASS
' deemed revokeJ. GAS SYSTEM OUT�ETS O DIS7RICT�. ROCESSE BY
LICENSED CONTRACTORS DECLARATION OUT�ETS OVER
, 1 her¢by efiirm that I em licensed under provnions of Chapter 5 vE Ft SYS7EM
' 9(commencfng with SecBon 7000)oC Division 3 of the Pusi- FINAL /' !'�„(y� Y1q��DATION
! nebs and Professions Code,and my license ls in fWl force and �ATE (p^ b d
� effect. _ .
FINAL
� License Number Lic.C1ass gY �
i Contrector Dete � � �
� I am exempt From the licensing requirements as I am a Plan check fee �
licensed architect o� a re`islered profesaional en¢neer p�UMBING PERMIT ISSVING FEE S '�
acting 3n my pro4esaionat capacity(Section 7051,Bus�
iness and Rotessions Code). TpTAL FEE � . �
' Lic.or Heg.NO. Dale Pi�n cMck applic�nt \� �
� HOME OWNER-BUILDER DECCARA'fION Name - ('(� •..at T , .
� t hereby affirm that f am ezempt frnm !he Contrec<or's ACdreas (`^ L��, t'�J��:�jygL/ ,,�' :� ���A
- License Law fw the foliowin�reason(Section 7031.5,Busi� City �H.-. i vj�'T�I,No. �� .��j � ' .e•� �
??n..e,,aIIbandYrofcssionsCode): ��4 � .
�. I 1d 1,aa owner of the property,am exclusively contracting � �J o�(� 2..�i(1
��'� ith licenaed contractors to constroct the Droject
. (Section 7044,Business and Protessions Code). � �� ?�(;-�i, �
COAt57RUCT10N LEPfD(NG AGENCY . � E 1„G 7�-E T
1 h¢reby affirm thet there fs a construction lendi�a`ency
,� for the perlo+mance oC the work For which thiu permi[ts .
isaued(Sec.3097.Civ.CJ.
Lendar's Name � '
Lender's Address .
I certity that 1 have read this epp�ica[ion and state thal the �
above information is correct.1 a¢ree to comD�Y'A'«h ail County gEE REVERSE FOR EXPLANATORY LA13GllAGf: � �
� ordi�ances and State lows ngulating PlumbinQ,and hereby
authorize reprosenfatives t this County to enter upon the �
'. above-merttio ed property or lnspection purpoaes. � .
!s� ��`7—��
, 3igo�i e of Yermittce Date .
/
ni��nova�s ~onTc i�sr�croass�cN�,rur�� �Ns�ECTo�t•5 NOTEs OW'NER-EUILDER DECLARATIUtv
ur�o[r,:;Lt:a worsK � - ���,- , __,_ _ � � I hcreiiy afGrm that 1 am ezempt P�om Ure ConUactoi s
FtOt1GH PLU.'.1E1ING' � �` :'—'y� .
y -� - License La�v for th^ follawing tesson/Secrion 7031:5.
GA5 PIviNC, ��_ � r1��������I���� , . . . . -. , . ' - B�tsiness and Aofcssiotts CodeJ: AnY cit�� ar eount),
GA."i'VEJ�`7 . r � . . � w�htch reqraimc Q perinit 10 constnict, al�e�, improre.
HCTvfP.7CR HCnTER�✓�—, � � demolish,or rep,ir mi��struet�ur,yrior ro irs lm�ance,
- � - olso reqvires Nre apy(icanr Jar such permit ro fi(e a
���urar;��ic�ir.x!a=S - - � ' � � .si,eraed .cmteme�a! tirar he�is licensed yurn�ant to the
�:s7esr /�"/�� � � � pro�•icioxs oJ tl=e Contrnctor's License!n}c/Claapier 9
. �7iu'v co.r:o7iFteo�r - �(comm:neing�wiEh Sectrurt 7D00)of Diri.rfo�t 3 of the
��— . . . , , . . , . , Be�si�ress and Professians CodcJ or d�ar he is exernpf
' 1{ierefro�rr an�J 1l�e hass for flic plleged excttiPtiorr.�1i�y�
�iN�L . �sr�en ox �don.t -- . -. . - ' .-violcrion of Secrion i�3f.5 6)'anl'applicanr fura yernrir
. � - � aub%ec7r dre opplicmrt io a civi[penofty oJ no��nore Niarr
iN�Usr�It��_ � � � . � � ' firehundreddollars/S500J.: � .
rinsT[.avar:ovqL - � - �❑I,as o�cnet of[hc propcny�sill do dic�mtk,and
�...�- .- � �� -the stmcture is not intended or offercS for sale.
._ _ . .. _ _ . - �� (Sec. 70�4,Gu:Ines.v m�d PraJcrsions Code: The Can-
�� • � ., � ._ � � �. trecror'r Limnsc LeK�dnes n��apply ro an owner oJ
- -- - - - - � � propen�•a�d+v LuitCs ar Lnpro�es thereon,niid who doer
' . � �� �� - � �sncll�•ork himsclf prooided d�at se�Ni lrnproren=enfa
, - �� -- � -�-� � �- - � ' are not irtrendrd or offereJ for rale. Ij.howerer, rJ�e
, �. -� ' � . , . , 6ttifAi�tg or irnprOt�evnen( !s solA within une year of
� , � mmplefiwt. !!�e ownerbuilder wi71 hace tlee b��rden
. . � .. -. . - . . . . . . .. .-. . - , of provi.^.g tknt 7te did not b+�i1J or imprar_far fiie
, .� - - - . purpore of sale.! . � , . .
__ 1 nm exempt undcr Sec. ,
i __ .
` II&P.C.fo�this reason
.. ._. . . - . Date �
• Owner
INSPECTOFi'S NOTES ' ,. . . � " . , � � . �