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HomeMy WebLinkAbout0537A _ _ _ _ � "'°RKER''�°""�"�,T'°"°K��"T'°" � APPLICATION FOR PLUMBING PERMIT �!'� - I hereby,oFfirm thoi 1 have o certrfica�e of consenl lo self �6ABB7A � 'I l I insure,or a cerlifimle oi Wwkers'Compensofion Inaurance, CE B17(REV.SJ88� � � . U � o�a ten�l�ed copy thareof(Sec. b. .) � � � � . ; �/7¢�r�pp t'7 � COUNTY OF t,OS ANGELE5 . � LIC WORKS 'P�olicy No(/�1Z1_Company `d C w•X � � Cenffied copy is h�reby furniaAed. �� FOR A7RICANT TO FlLl IN(PRINT OR TVPE) BU0.DINp�,� Cenified coQy it filed with �y buildin in e - �� , rion epa en1. . NIIMBER FIXTURE OR ITfM Q ffE LOCAIITY � �/ � � WATER CL06ET � ��, Date a ppplitonr - '3 f n . ��Ssr. �'� 1,t/,p � � . F CERTIFICATE OF E%EMPTION FROM WORKERS'� � BNTH 7118 �, � COMPENSATIpN INSURANCE �WE� �,� pWNER �� � � (ihis union nNd not b�compl�t�d M eh�work Inwlr�d by � . � � th�p�rmN Is/or on�hundr�d dotlan(S1D0)er bf�.) IAVATORY ��L I ca��iFy thot in�he performonca of fhe wwA for which Ihis � ��� � � ' perm�i is iuued,I shall nor employ any person in any manner S�NK � CITY v jN� �/i�f/ . so os to become aubjact io the Workers'Compensofion laws. D15HWASHER - / I . r` ' ' � /�i CONTRAROR ISL�e'r �I4�I'�D!/✓E � + �PPlicanl ClO7NE5WA5HER ADORE55 O�('Is �NFey d��rer Y NUTICE TO APPLICANT: If, ofter makinp rhis Certifico�e of � /! � E�emption, you should becoma subjed lo Ihe Workers' SWIMMINGPOOLRECEPTOR �/ n , Compenso�ion provisions of 1he labor Code,you m�sf lwth- �qWNSWtINKIERSYSTEM ��TM��� G� y0 fl� ' [9.3�'.i�Q � ith comply wilh sucA'provisions or this permil shall be S7ATE IIC. �7 / . deemed revoked. � - � WA7ER FIEATER ! fQ ���EN��.3/3 a�3 CIASS`—�b � - LICENSEO CONTRACTORS DECLARATION . �� DISTRICT N RtOCF55ED BV ��. I hereby offirtn fhot I om licenaed under provisions of Chapfer 9 GAS SYSIEM OU7lET5 �� ' (commencirp wi�h SscNon 7000)oi Divi�ion 3 of�he Business 01/fLET50VER - '� ord Profeations Code,pnd my Ifcense is In full fores mud offea. 5 PFR SvSTFM FINAL ? DATE "'� �'�`,� ALIDATIpN O Licence Number ��36 g3 lic.Goss ��J� �/�/� f� / U � / �lQ� a � Conhactar//��/��°'� �°L�V•Dote � �+ BYA` „%�y U -❑ 1 om exampt under Sec. � N ' . B.BP.C.for this�enson Plan check iae ► � � ? ���� � PLUMBING PERMIT ISSUING FEE S .�� SignoNre �`O�-rj�j.'�A TOTAL FEE V cS C7 �r—.. Plan check opplicam �•• • • �5 SINGIf FAMILY I • � O�S D , - HOME OWNER•BUIIDER DECLARATION � Npme � � 1 heroby offirm tHot I am ezempt from the Conrracror's Ucanas qddren � � � � - • � � - ° � ��S�� ' low for.the followinp raaaon(Section 7031.5,Bwinaa ond . � Profeaiona Cods): City Tal.No. � Q��7`�,�] � ❑ �,as owner of tbs popsrty,will da the work ond�he � . � � atructura Is nor In�ended w offarod for aale (Sec�ion . . . � f � .. 70a,Bosins��and Rofesslom Code). i � CONSTRUCTION LENDING AGENCY - � � � � � � �/� � I heroby affirm ihat there Is a comhuctian IendieQ appncy for � , ihe performanc�of ths work fo.which�his permit is iasued - � - (Sec.3097,Civ.C.�. � lsndar'a Nome � Lender's Addrea� 1 c�nify lhot I M�s reod�his applicotion ond atofa 1Ao1 fhe . . � ► . . obo�e iniwmotion is carec�.I oproe fo comply with all Coumy ord�nonces ond SbM laws requlotinp Plumbinq,end hereby - '�. awhorixe r�pratenro�i�e�a�this Co�nry io anear opon the � � � i a�w ionsd r p r impedion por o»s �� � � � n� SEE REVERSE FOR EXPLANATORY LANGUAG£ J � �� S�ynolura ol FermlRse Do�s � � ,� i �L..' � . . . „ . ... � . . .� c 7 , . 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