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HomeMy WebLinkAbout0982A (5) � _ ___ ___ _____--------. _---�-----�---------...------ -- ---._..�._ _ ...__.._. . .--•- ._ . .._......._,.,.;_._.�_:._._.____..:.___�. ._____..__.__---_-_--- ._ • WORKERS COMi�EN5A110N DECtARATION /'�PP�LIGA�'I.(�1�1��:F�3R�PLU11N$l:t�l� P�R11�lIT �j j I herOby a�/bm itros i ho.s o cen��fe ot-eo�m ro�eH �ap6yA inwrQ.or O�tOrtNiWt�af 11(4rlcp C�n�prqNtan ItuurA�� G£85R(pEY.IW8}I - L� o.w cerntied c&py�ht�reqE l�sc.��o�r:C) C.OU.FIIX�E'LD$ANGELES B(11LDING�ANb SAFETY ' ����FP�1��2..c�rn,Fz�tncm�: I.ndemnt3.�y . 1i6.;3./ - I: ❑ cs,�,ned max u heTebr f�vrrrishea. - _ - __ t rCR nvv,uc+�Nr ro fn�av�panvt aa rrvEt A� � � � Ce�lllipd CpPy{f flk�witb lli0 c4117��Y�nU1B1�6�.�3Pe�' N� FRFIYRE OR IiFK1 @ .. . tron dlfF�rlmNtlY. - - � .. � ....lpfRi.lry . - . 4''q ` t Dcre 1 f)�/'�,./R�`i qpQ �" . e . . . . _... .wetEx�aosEs -. � F — : . �cu�oF�,ar�cH�aax�acrcar�es�_ ,Q eAr�►ue Colima/I.emon p eann� u�arnisuRnrr� �� ow.�a Pze,Sley v� So. Ca. i (Thls witbn�d rtef 6��gmpTatid�f.�F�wark7nvoWod by ��i �h►y�nnTf�s.lpi on��undnd�Mfan-(�140)�or IKs.� �mo�. _ �� ' I cenN�iha�in d�D p4M�p5emed ef ths work fae wMeh rAis . - . - perrtth is qsued,I�hGIY natamP�D4�aM PO�on inp�Y monner � 3�NC (� — arr . �1tl:�O eo aa fo 6eeome;ob�an W�he Ntorken�Gompemctlon lawa. � .. -. ���� � ^ COHTRACTOR �IG Date _aeplimnt CLOIME3 Wl�SNER ' (� _ . ' .- - � �; NOTICE 70 APRK/1NT: N�. a1R6r makirp tRis Cer1i{loote of �s ' - . . I �"^�.�p�ion. �n �fiquld� @Ornme subjecr to /he Worken' S1N1YNMtNG-KIOt RECIFfOR GIfV � � tH.,NQ � � ,x�nauon prorrsioea,a4 the ldwr Cade,yau arus+fonh- �qy,�,�gp��NKIER SySTEM � . a...��comply wink such{SGKiaions ar �his permiR�haN be StR . . " deemed revnked. watERtffaiER � � u���. - S+` -. '. IKfNSED G�1TiLACroRS oE[tARnnON � �amaer Nes: � . .. o er � �' IkerobYaH7rmrtiatl�mnttcansed�underpravisimaofChop�er9 ��t9srsrEM WnE7s �� Itommencing�vith Section 7W0)of Oiviyqn 3 Of�N�e ByAiness OU OVER � . _ - - . ' and Pro[Cpioro CadC,ardmy Ikensp ia in fulllarcp qnd�eHect. S �SFhF FINAt � . �� ����� VALIDATION � yLieense Nurn6er �'.�G���L�.Clau ^�_ - . � � v ` c,�,,,�,,.R.C.R. F�"lt?u3�x��* I0/7/85 ` evw"` o '( � ❑ I nm exempl under�56c. . � � y 1 y 8.8P.C.fm rhia ramon . , � Z PIQn chBck fee ooro: R.UMBING f'EBMkT ISSlilf�lf3 FEE S ' � siqnonne � � �.C i�i;2 r, TOTAI FEE� � G - Plan check aPPltount ' � �; •. � « .. SINGLE FAMItY - I, HOME OWNER8l71tDER DECIARATYON �me I ` � ' �.^� . I�� I,hq�aby affirm tha�I am eaempt ftom the Centrqdor'a 6iceme ._.. `_ .- . . � o � for the iollowing repecn(Seu�on 7«l1.5,Bus'rneas ond ��� �' ' ' � - � ��'�� J1 iss�om Code). � Ci�y � Fa.N 1 ','!l. r� '� ❑ I,rn Owner of Ihe . -.- . - � . . - properry,wi41 do ihe wmk and ihs '; atrucnne is m��mended ac offe�ad for wle(Seetion . ., � ' } 7044.8uacneas and Craieniam Code). CO�u57RUGf1AN�4ENOlNG AGEN6V � � � ,��� I hereby affhm Mw�fhere-ia Q mn�fmctWn tendlnQ�agertry ior � �. �he psrformornce of�he�woGk for whTrJ�this pOrmit is issusd . . . .- (Set.3071.Ci�.C.). � � ' . C�Y� 4enders Namn � � � � 4ender's A4�esa ----— I . . . I I cerMy fh�I have mad.thia appifcoti�ond state ttwf ths ► �. {� aEo�e infarnntion is oorrats.I aqrne ro w�lY vuif6 all Coumy �� o.dinances end Srate Iwva roguioang Vlumb��g,and hare6y � . J� �ap�wlwyr�raprsseneyo�res QF+h;s Gwoiy rp e�Tqr �pan �t+e . . . . . . �� �4���1��X ,t� ��mvo�+w�vw�Y'$'1 Zl85 S�E�t�BSE�+PR�Xk4AtlATCRY LAF[GDA�E° ,� Signature of ParmiRse Do�e �. �� � � _ . _ _ __ ... . _ _ _ _ __. _. _. _ APPROVALS pqtE i SSu3NA7Uti� �����5 NOTES OWNER-6UILDER DECLRRFTION � UN�ER SIAB WORK . -� �-� ' I hereby aff�rm ihol I e exem�t(rom ihe Con�re_�cr's �. ROUGH PLUMBWG License Law for ihe following revsan (Secfion 7011.5, GAS PIPING � � Buslness ond Profussions Code):Any ciry or county wY�ah � GAS VfNT . requiraa a permif fo consfruct,olfer,improve,demollsh. ��� or ropalr any strutturc, prior fo Its Issuance, also ra HOT WATFR HEATff2 � � ' �qutros fha dpplieont lor such permi!io file a s/gned slato- I� PLUh131NG FIXiURES � � - manf}hvt he Is licensed pursucnf to Ibc provisions of fhe ly GASTEST ' Con�:oclor's Licensr,!aw(Chopfer 9(rommencing v�lth UTILITY CO.NO71FIE0 � Secflon 7000)o�(Oivlsion 3 0�ffic Business and Pro�es- , sions Code)or thot he is ezempl thcrclrom ond fhe bas7s c7 . � � � lor ihe alleged exempNon. Any violafion of Secfion � FMAL - . - . �f�r nn _}�onl '' - � , 7031.5 by any applican�Por a permit subjects Ihc appli- eanf to a Nvlf penclfy of not more lhcn five hundred . dollars(S500J.: ��I� INDUSTRIAL � � � �� � - ❑I,as owncr of fhe property vrill do thc work,ond � WAS7E AGFROVAL the s�ruclure fs nol intended or af�cred for sale. - � . - (Sea 7QS1,8uslness and Profess(ons Code: The C�•cc �i tor's LRense Law does nol appfy fo an owner ol�. I`ty I � � � � wbo bullds or improves }hereon, ond who docs svcb y - . _ � . work fi(mse8 provlded thaf such improvsmenls are no� � . � � INsnded or offerod lor sofe.I(,however,ihc 6vlfding or � . ' • improvemanl 1;sold withln one year of tompleflon,}he � ' � - � - owner•6ulfder wtll have fhe burden of provfng lhot he did i �� not butld or(mprove lor the purpose of sale.) I I I am exempt under Sec. , F � - . � � B&P.C.for this reason I ir , Dale � Owner i � INSPECTOR'S NOTES '— i