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HomeMy WebLinkAbout1569A (9) __. ....._.. _ _ . . . __ . . _.— _ ._. _.___. __..._ ._.. . _ . ._ __. ; � WORRERS'�]NPENSAi1dMpECIARRY�ON ri,PPLlCA;i'I�►.N FOR.P�:LJMBING P�RMIT � I herehy afftrm that I fiore o eer'uAaote oi comen�te salf ay�y�p 338/B Y �irqure.m�o certk£imie qf IN rtcen'CamPenaatian Inswcnee, CE Bls(9EV.IWSt) . on o un�ffed rnAy rheleoP 15�ee.389�mb.C.1 Ct5l1NTY OF L.OS 1►Y�IGELES� � BUILDI�IG AND6AfET�Y ' � eotky�il:7'11UG� co�vo�r ��'s Flmd ,, ❑ CertHbd•a�PY isAeraby fym'u6ed. - . . . -.- � . .. roR,�iuwr m cut w�v�,r arsr�i ��28 . _ �� � CanHtrd coPY��fiYed wAh�he eauMy butltling' pee- . . . .._.. . . � f10D<IOR�tMeM p N . itl[FU12�E�i 17FjJ� Q � . FFE - -._ 4o�e ��-.�.APNkeaa""`•. �.T N. .� eWstERaOSEr � .. .1� . .. I�nutr � � � EERTIF �7M�N�IJ�INfitl�CE RKERb` . $A'Miq6 ,.. �SF. �D'nd B8T B�.'VdI YC�&I1Cl AV@. � RhTs t�tlfan n�d n0i��<4mp[�ts�I R�h�work r�tFotr�d 6y '.SH4wEft �25�. O.f $O. �i3�. th*p�tmTi Irfbr OKi T�bndndw�olle�r{3100)or I�a�t,) wvw�prt� � (E((J� jy�jy� � I cerfi(y IFot in the pp�atrr+q�d�he wark 1rn x[faich�h�s - i� ROm+N h hiSlrAd FahLUnof-dmpl0y aery pOnon in q�mormer � .'fD — �'TM IQ BP,3C11 � �540-0500 va w to become�nblett ro dke�Warkua'ComperoNlon Laws. � a�+� .,'�o ooNrawc�oRR.G.R. f�ltmbing, Inc. Da�e e�pikc`n CtQilfESvtAS�f j . ' rEmce m.�rei�cartr: rt, osra, morri�a�6w ce�mKme�t A0°'� 12785 Ma li.a Ave. lmpt'ron, yau �4rp�ld beeoms suhMeef b the�WVnrfceri ���p�'���R toa'i�^JVUan ptprjllo�S ot fh6(Dbac CVdO.Ya'musf fanh- �E17Y • i m.No. II� WVY�aSPRINI]ERSY5IFM ` wiYh compiy �rtilv�uch pfovyfom pr tAis permit ahall be STA7E 3g1542g t�C. L•�3b � fleemed uumked wnn¢r�cSEir �r �� c�ss �p GQNTRACTQRS.¢ECLARALON � DISTRKT MD. 8Y ' I hOreby A��em�.0 I amGcen�. v�,pr Rroriaiwro ot Chopter V „f" 4aSarsTE6� ��,Z ani�xs � Q . . ' (cummeeprny.r�SeoBon 7QQQD a6 OTrisiqn 3 oi��he Bv�inass pl1t(EtS CVER . �' an99rofestfomfdQe,atd�mrliceniei�'urfullfbrceandeRea. -i�R'gYSTFM p � FINAL C-35 VAi1DAT10N � ' ���e nn�E 386428. uE.c�� nar� ;��.gy � � com.ano�RG`R 15l:umbi.t�_�a�e 215�,[84 a��""`, �C �.�,/' c`'i m. � I am e:empt urrcter Sec. d H ' B.Bp.C.tar ehia reofon �P�On ch�t�t FQ8 � '. ' . � Qme: PLtiM81N('i PERN{IF 1SSUINCi fEE i � ,�j Siqnoture_- - rax�a� OD �} 5 6 9 A Plon eheck oppikuM SINCIE P/tMILV �;. • . . .,rj � Nf.MAE OWfYpLBU�IQER DECIARATION Nome � C� ^�veby offirm thot I pm sxemp�hom�he Connac�or's lieense (� -- �I •G 7 7.n� .. w far tha Fallevrery r4oson�Sernon�qi1.5.B�sine�s o�d ��°n �+o� � � -'��AV2. - . ProfesaionsGode?: ,CIty �,�Sfd2 ie�.No.�7 � O "« �7���� � ❑ I,as owner of the properry,wtq do ibe work and�he . 0 2.i 5-8 4 .; atruehire ia nm inqsed�d cg oHerAd fw wie(Seeian � � 704t,Busin�a vnd F.ots�iona Cede). CJQryS7RUCTIDN lET]D1NG aGFNCv �� I hereby aHlrm fhqct fMqm ia o cnn�Mucqon Iendlnq ogeney for � rMe�rerformpnce of�he work for which�rhia permir ia iasued . ISec.3097,Gir.C.J: � LertderiNome_�t��n ��'"�fir_.$r�17� � . LendRr i P�dresa �`��r�� -���. � � . . . �.. I cenliy+Nor�have road��+�s a{7plica+ion and xto�e iFw+�ha � a6o.e i�armo�ron o coroe�.I ag[6a ro mmply wah afl Gounry . �, oed'v�ancas ard�Sid[e Iqws.Oguld�lnp PIum6�np,ard here6y . �: ourhwiza v6pre�rntptwer oi r6�a Cnun7 ro anrer upon�he � aEovp.+nenIIqned'�operry for inyppnlnn purppset. . RCR bv����� J6I8G s�����Bs_������et�7oaxc�r[cv�7� l; S�qnaNro of Po�mnl pcfe i � nPaRovnts oATe vos�crar s�oNnrua� INSf�ECTOR'S NOTES OWNER-6UILDER DECLARATION • RE UNDEeStABWORK I hereby affirm thot I om exemp�from thc Controc�or's j ROl1GH PLUMBING p . License Low for the folbwing reoson (Secfion 7031.5. � GFS WPING � - Businrss ond Frolessions Code):Any crfy or rounty which � GAS VEf�1T raqulres o permn fo mnsbuct,alter,(mprove,domolish. � HOT WATER HEATER � or�epalr any slructure,prfor fo ils hsuonce, olso rr - qvires/he'opplicanf for sucb permi�fo(ile o slgned slatr � PLUl+SbING FIXTURES � ' � ' mon��hat he Is Ilcensed purzueni fo Ihe provlsions of fhe � GASiEST - ' � CoMrocfor�s Lltanso Low(Chopfer 9(commencin�j with �r � � Secfion 7000)of�ivls7on 3 0l fhe Business and Profrs- UTILITY CO.NOTIFlED . slons CodeJ or fhat he Is exempl iherefrom and fhe 6asis �� - lor fhe alleged exempflon. Any vlola�lo� o� Sec�ion ���' c7 7031.5 6y any appl7con�!or o parmit sub�ec�s Ihe appli- i FlnIAL � . Gn1c�on yronf � � conf fo o civi(penaf}y of nol more�han five hundred . aoiro�5�ssoo).: INDUSTRIAL � - - ❑I,as owner of the property will do thfl wo-k,ond WASTE APPROVAI � �he Structure is not intended or offered for sale. - _ , (Svc.704f,Buslness and Professlans Godr. 7he Co ^ . - for's licrosa taw does nof app7y fo nn ownc+�ol properfy �� - wlfo bWlds or improws th•roon, and who daes such . . � . work hlmself prov7ded Ihat soch 7mprovemonfs are nof . � frttsnded or affered for sale.If,however,the buildinr�oi ; � � _. Improvemenf It sold wlfhtn one yecr o(completion,Ihe '� - �' � � � � awnsr•6u11d�rwlHhove fhe burden of proWng Ihof he did � � � nof bulid or Improve(or iho purpose of sa(e,) I am exempt under Sec. , B&P.C.for this reason Dale � Owner INSPECTOR'S NOTES