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HomeMy WebLinkAbout1344A (7) ' �� WORKERS'COMPENSATIQhf DECLARATIOt�'� ��:- �eAseow � �� � ;�� � � �� I hereby.effi[m that I.have a'carSiflcete'of consent to ieif �e.,���•.a, `APPLICATIQN F4R I�LU MBING.��PER�MIT , {�� .� � , ".i inaure,os e cerrificate of Workers'Compensatlon Insurance,or �.-.. .. .. `. � ��.- �� _ � a cettt[ied oopy theteot(Sec.3800,�tab.C.l", '� �I,'OUNTY OF GOS ANGELES . � BU1l.DtNG AMI�SAFETY.. ` � � .� � Palic"y o. CoPn anY 7l°-L�t�Y��� ... ;. , . ;. . . :. . . . _. � .. p�,f 8 io.� �� � Cer{fied copy is here6y furnished. � � �. �� FOR APFLICANT TO FILI�IN�PRINT OR�TYPEf' � BUII,pINO � � � � ;, . .,: .. �. - . �. . � � ADORESS ��� ..�l�l .., I Certtfied coDY����ed with the co�unty,building Inspectbn NUMBER' .��. ��F�XTURE OR MFEM�. � • �� FEE ,L,1 . ���2� - .WATER CCOSET LOCAUTY �e�j�APDlicent��+�+ �� � � � E R ST �. . . � .�� . ',i { ��I. . ...: . . . . BATM TUB � . � �� CROSS ST.�. . ' .. ��' . �� CERT►FICATE OF EXEMPTiON FROM WORKERS' ., �, ' � �� i . � :. COMPENSATION INSURANGE, -� - - -� SHQWER � � �� � � � � OWMER� � �wF � � , � � �. .�. ' '� . ;. LAVATQRV :. MAIL �. . ! r (Th1s section need not be compfeted if the wotk involved aobRess by the permit'is toc one hundred doqus(5100)m less.} siNK , ��7y � re�.No a � ��I:certity that in�the performence��of the�wotk for whlch this � DISHWASH@R� � � �- �" � � U . permit is issued,t sha11 not emD�aY any person in anY manner � � � � -� C6NTRACTOR � � � � . '� � I � -so es to become subject.to th<Workera CompensaSion Laws. .�CLOTHES WASHHfl � � . �..(� �-��� 1 -� � Q ' , � � ADpRESS �bate Applicant � �� � �� SWIMMING�'OOLRECEPTOR ` V �NOTICE TO APPLICANT If efter makmg this Certificate oP �� CI7Y TEL.NO.�p:�ry a. e Extmption, you sfiould 6eeome-�eub�ect to !he Workers' � ��� �AWNSPRINKIERSYSTEM � y BTATE� .. , � UC. � �� `deemed revoked.�h such provisions or this permit ahall�be � � � WATER.HEATEH .�-, - � � UCENSE.NO.�� CLA55� � ?� �� � Compensallon provisiona ot rhe Labor Code,you musi I. '�-- � � .- � GAS SVSTEM�� QUTLETS � � ��iSTRICT N0. .CES D 8Y , � � � LICENSED CONTRACTOR3 DECLARATION '�,� � . OUTLETS OVER� � - � � � �� �� � - i ` . '. F -1�Nereby atf'vm thet I am ticEnsed under provisfons ot Chapter � 6 PEq SVST£M� - . . . � i , .. . . �9{commencing with&ctlon�7000)of Divisiort'3 ot the Bus{_ . FINAL 1 -- � neas and ProPessions Code,and my license is in fu11 forca and �p� DATE ��."'� VALIDATION I ,_ �efYect. _ .. . .., . . . . . . , O Q C—�� FINAL � $� � !��Licenae Numbe ` u Lic.�Ciaas ` . .� � gy.. . . . �J�� / qv t � � Contractor,J�_S T�� Paro 'I'��b "G7Z_ . . . , �- . � �' ; �. s � I am exempt from the�licensirig requirementa as 1�m a ��� PlBn ChCCk f80 �- � � � . � . �. � � � � � � 1{crosed srchitect or a xe¢istered professional engineer pLUMB WO PERMIT IS&UING FEE$ �j} , . , . . �.'�acting in my pro4essional caP%�ity(SeMion 7051,Bus- ' �iness a�td Prafessionn 4ode). ' � 7p7AL FEE D � � �� Zte.ot Reg.No. .� Date .. . � Plen ehack ePPlicnnt � � � ` ,. .. ... I . � NOME OWNER•BUILDER DECLARATION ..- Nema � � - -i �� I�hereby afC'vm that.l am exempt from�the Cantractor's � � Address � �� � � � - - � � �. � . � �� . �-�,�License�Law for the following reason(SecHon�.7031.5,Bus1•,� .� Clty ��-��� - � � �. -��.-T�I..Na:�.��� ... � � ��;- � � - � ;, 9: ness and Professions Code): � � �� - � , � , . .� ����a.��L A � � � � & .. .. � . :_ �.�� -.. �� � , . . . , . r.,� I,as owner ot the property,am exdus[vely aontractina ..��, � , -� �� � #��� ��,�� . !�, .with licensed mntractors to construct �the project , . . .� , � , (Sectio'n 7044,Business and Profeuions Code). � .. . .� . .. �� .ri ZJ� CONSTRUCTION LENDING AGENCY .•���2 5�� I hereby aftirm that ihere is a coestruction lending agency . � . ' - � � � � . for !he performance of lhe work for which�this permit is � �� i�sa�a cseo.3ov7,ciY;c.>. 0 i.2 7�8;2 ���Lender's Name _ . . .. -.� . � � ;�- .. � .�, .. . � � ' .. . (k .Lertder'9 AddFeaa� . . .� . .� . .� :. . . ... . . . f.� I certity Shat I have resd Shis application�and��state that the � , � � above infarmary'on ls conect.�!aSree to somply with all County�� , , ��gEE�REVERSE FOR£XPLANATpRY LANGUAGE' � � - � � � ordlnancea�end"5 te law; regulating PlumMng, and hereby + `suthorize renres tatives af thi unty to enter�upon the � t. above-me ion P i ctionpurposes.� .� . . - . � :� �. � . . � . . . � � � � . . . .i. . . '� .� `Zy,—��, . . � .. ' , . . � � � aft.''e ot Perm'tee - M1 Date � � �� . �� ' . � . �-.. �� � .. � , � . .. . � . - �� . . . . r. . . . � , � , . .,.. _ _. . _ _ _ __ _ _ __ _ _ ,- -._ _ .. , _ . i � � � w •1t �""� _...�.,- � . ..•.-._. . _ �,a .: . . , ; �'���•'� .�.._ . . .I�.�.�r.r=r.R. .i�.h � . APPROVALS DATE � INSPECiORSSIGNATURE '�INSPECTOR'S�NOTES'-� ' '� ' ' �� - ,QWNER-�,UILDER�I�EGL.ARA�TON �� UND�R SLAB WORK _�r G -_ i'. - . �.��� .._-..�. -.�,, ' , � -� . FiOUGH PLUMBING ���' � 1 hel0by eSf"tml that I a�il ex¢mpt I';/ml HleCAnh�,cto:'s !. � GaS,Pi�+fvG � . .� . . .. _ ... - ......Licenx�ESw for-the follo�6ing reasOn fStMipn T03{;S, . ..„....... .... .......... .......w.:... . „.,_..,.. .... . „ ... ._ ..-:.�. ..-........ . . ....., :...,. ;'�, .' ' ..' " ... Business�end Aofes.�oA.s,�Cddef: AnY_�cttY or,county .i , - GASVENT �,,��': �..... ,.,r;:"�'- ,�_�:� . .� _-,.., ..,;.__ _'._'.:.: _'. :� _" .._....�. ..:�.�'.:-'._ -. . . .- which�requtres a pernvtt to eonatruct� olter, imProve, NorwATea HenrEa . • , , + ���at me�rthat86e dsjlfce,ns�dr eurajkmrt m�the i ,' PLUM61NGFfKTURES�... _ �'..-.. .... � �� " � ` � p .. �. GAS 7EST � � :-�� .:;.:'� I : ;. .,....r'..'.' � ...-� provisians of the Controctor's Lieense Lew(Chapter 9 �. � ....._....__..- ... ...._. .. . �7ri�t7vco.NoriFiEo ,_�:., , .�..., .. �__.� .--._� � ._. ,�.._._.. _.__. __ . ... . :... ..__.. ...,� .�cnmmenctirg`with Sectlon�!740BJ;of.Divistion�9�bf rhe � ____ _., ... . .. .._.. ... , .,;._ ..` ... ..._. . .�._ ... _ _� . . :.. ._� __. ._..: � Busfness and.Rofesstons''CodeJ oi��ihuf he es exempr � ' �' ,, '� , . �. ,., ' ����� ' , , lherefrom,dqd the basts for,th¢alleped exemption.,,4ny ' FiN.a�-. __. .L''�g,y"�::d��r'� :� . .:., ,.-.. ! _ , violptiqn aj.,S,ection 7037;5 bYanYQPPIlcantforaRPimit ',: . ,:,: � ,-�..,�,� .:�� ..-.-,. . . .�..,.' � ="��.__. .. _. � . .. . .. . . : �.��:' . . ' ,.�°� .subJects the aPPlicant to a civi!pennity af not more thmr - ..� ... _.. •---_ . ._. . ; - , . . � INDUSTRIAL :, - o�� �''^` ' '�� r - � � '"�� � � - � Ve01 a ownerTof t aO��opert�will do the WASYE ARPRRY-AL ._ . ..;< �_....... . . .....: .;�. ,Fi , P' : N . i , _ ....� _ . .. Vllozk,�2fld - � ' . � ., ,. �- �the structure is aot intended or offe:ed Poi sale. � ��, . . -. . -,... �- ' .. �_- .`�...'`. . ....".. ��� `` ..... ' �� � ... -., � �Sea 7044, BusMess and Profe.vsiona Code: The Can• ..__ . .._- •- � - - _ . _ .. . � ':. r,s� d.-r ��; ? i ":..:._ ___. `: " __�,rracror's Lteenae l.uw dceq nnt QPA{Y,fo an awner,oJ . . . ,_ _:; � , -� � . ' ro r[Y M' buif or ini r'o es th reon and w5p dper � ��.-, :p.pe ho ds x e .. ,. .ba. .` ,,. ',_. . .__... .,. . . :.. ._.. . _ .__. -aueh,woFL hinrself P�vided.rhar such.improvements :, ...�..... ,..: •_ �.=..i ..,• .:." r . �.� . .; � . . .� ,� � ed�or olfered Ior,.sa(e. Ij�,howeuer:��the � ... . . � ,..... ,..._._... . .. . . . � ere;xot.intend � - - � � ,� , , , ,, butldtng or improvemenJ is sold withrn�one ryear:�of . . .. _ . ; -", .. _.,-. �„ ..., . . , ..�.:�. . :' �'�>.. �.� ..�i .. .�f�. �__.. _. .._ .-. . _ ._-. . ._ . .�. .. rom�ktlon. the�. ownervbutlder,,.will. have..the burrlen �' ' � ' � ''' � : ' oJ�.proving that.be did not butld oc improve for t6e � �.� . ._. ... �, .__,..� -.- ..--. ' . . . . , , � . � _ �.,�• , { .i. � � .t-:.:, .._ . .. . . . Rurpose,ofaa�e.'P/.�,. „ , , , ,1 � ' . e un �. . _ . a i' �� � .. , . . ,,.3,.• - am xem f der Sec. : _ �.._. _ , , ,:� , ,. , ._,_ _.__ __ _ :., _ ! . �. . :. _ _H 8c P.C.for this rtasou'. k .' . .._� . _..."'_ ,.....__......., _ .... . . . . � ' �i � . �. , . .,'' � ,' 'a � a. .. ., � :..'. . . .. . . . .. _. . ,� � , � - . � . ^ �:. .. .. � .._. ' .. � . � . . , � . � .... . A . ���: . . . �..... ... .:. . ._ ... ... . . ... .. .. . . , .. . . . ' ' .. ' . . .... . . �.,.: �.. ,,, . . _ _ .... . . .. �. _ .: : . . . �.. :.. ... -. ... .� ..._. .... ' . � . � . _ . , . . . . . , , Date , '' , _ _ _ _ : f ,., __ � _---...' Owner _ , , , „, � -: IN$PECTOR'S NOTES �� � � ' ''" � � � � . , . :... ,,� ;i,: ..,,�., . , .; . � . , . , .:. , - � -� �,: .. , , i ., . .. _ �.� .� . ..,... Gti; , : .. .,.�.. ,:. . _ � , � ': . . . . .:. v� . .. ... . , �.: � j � ; . C�•.• w • , � . :�.- . �.;�. ; ._._ , � G„s . . � . . , „ �. ., . _, _ . , ; . �... . ,. . . . . � - � . -:� .:,.:.��.,.�,. -. .- :":. �-iT,.'>'�.'. � . c� ,� . . .. . . . . ..,, . ... ... . . �.,.. � . . .. .,.i- �., , . . .,,. . � ..�-. ._. . . . . . .. . . . .. . . .. . , . � . _ . . . . .., � . .._. .._..._.._. ..__...._._ .._ . ..._ _ ..__., . ;.:,�._. i ,, ' �. . � - � - � ..�� - � .� �_�--- ___�.._ . _... .. . ....... ._� ' � :.�:�. .' . . . � . . � . � , ✓ _ \ � �. . � . � . - . . . , - }'. ,. . . ..� ..... � . . , . . . . � . . � . . , � . . � .. "i . .