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HomeMy WebLinkAbout0821A (4) � � . . ... _ � �aWOR1C� P At10N DECLARATION reaeerw . � +� I hereDy affirm that 1 have a certificate nf consent to 9e�t �s.�,�=-.o, ��APPLICATION FOR PLUMBING.PERMIT . �p �nsure,ot a rertificate o}Workere'Compensation lnaurance,or . . _ . � . ' ' � . � . � ,'e certifed pZ 2h roaf(Sec.3800,I.ab.C.) . 'Ea L►�r�L.� ' COUNTYOPLOSANGELES BUILDINGANDSAfETY ; Policy Nv. �Company . � � �'r"Q Certified copy�is hereby furnished. � FOR APPLiCANT TO FI��W{PRINT OR TYPE) � 9Ut4DING� �-��r i f � t Cert �ed opy is[11ed with t caunty bu' n ectian NUMBER . FIXTURE OR ITEM • FEE pCALITV d.�`,,,r�n � �' �e� Applicent WATERC�OSET NEAREST ' rr"-�� � � t � - � � BATHTUB � CRO55ST. ( uP� M� �fJp. � CERTI ICATE OF EXEMPTION ROM WORKERS' ! COMPENSATiONINSURANCE SHOWER � QWNER ' � � �AVATORY MAIL �/� .; (7'his aection need eot be sompleted if the work mvolved � qo�ReSs ���7� � � a a by the permit ia [ox one hundred doHazs�(SI00)or less.} SINK c�Tv t ��,(sjd� 7EL.N . S'�"j �1 p 1 certtfy ihat in the performance of the work fot which this �ISHWASHER Q � permit is issued,I shall not employ any person In eny manner CONTRACTOR �K�(��'� S . O so as to 6ecomesubject to the Workers'Compensation Lews. CLOTHES WA5HER . 1^ ..- F" �i ADPRESS � t �ate ADPlicant - 1 � �`'� �` O � W � SWIMMING POOL FECEPTOF a b �,"/�,7r� p� + NOTICE TO APPLtCANT:�If,aftei making this Certificate of CITY TEI..No ��y ��� y I y Exemption, you shouip becoma subject to the Workers' - lAWN SPRINK�ER SVSTEM ' STATE o,,,/� LI0. z � Compensation provisions ot the Labor Code,you must forth• LICENSE NO. 3a V7�� �—s 3 '. �� with compty with such provisions or this permit ahall be WATER HEATER � CLA55 T deemed revoked. � GAS SVSTEM � OUTLETS � DIS7FlICT NO. PR CESSEp BY V LICEN5EDCONTRACTORSDECLARATION . OUTLET60VER � � d� % I�hereby aftirm that 1 am licensed unQer pmvisions of Chapter 6 PER SYSTEM /// . - F 9(commencing with Section 7000)of Division 3 of the Busi� - FINAL ��rl�} VAUDATION � p nesa and Pmfessions Code,and my Iicense.is.in full force and 1 � � pa DATE u` . f effect. � � - 3 FINAI � ; LicenseNumber �sro473LiaCless gy �L��� . � � �{ = Contractor LA1LF.3 i� Date � � , � � I am exempt from[he licensing rcquirement a8 I am e Plan check fee . ' licensed architeM or a regietered professionat engineer pLU4neiNG PERMiT ISSUING FEE$ �� � acting in my protessional capacity(Section 7051,Bus� iness and Prafeasions Code). TOTAL FEE Q � � � Lic.or Reg.No. �ate Plen check�epplicant . 1 HOME OWNER•BU[LDER DECLARATION Neme - . . � �Q$2,�,��a � � { I hereby affirm thet [ am exempt from the Cantrac[or's Addrass �1��� � �5 , License Law for the foilowing reason(SecNon 7031.5,Buai- Citv � Td.No. � ness and Pro(essions Code): (!�-�2 D.5 0 � 3 I,es owner of the pro0�r�s,am ezclusively contvacting � � - _ �� � with licensed contwctors to construct the project . � •��.•?�5 G.�� �, (Section 7044,Business and Professions Code). . . - - � .�.,�,�5-S.� � i � CONSTRUCTION LENpING AGENCY . . � . �-� � �� � � ��� I hereby atfirm that there is a construc[ion lending agency 1 Por the performance af the Wark for which this permit is - , ,. , � . , � issued(Sec.3099,Civ.C.). � , � � � , - Landax's Nama . . .. ... . . Lender's AdBress _ i certify that!heve tead this application and atate that the - . . � . � . ahove information is correct.I agree to tomD�Y with aU County SEE REV ERSE FOR E%PLANATORY LANGUAGE � �� � - - � � ' ordinances and State laws�egufating Plumbing, and hereby authorize representatives oP this County to enter upon the � . � � � s4ove-mcnt' ned prop r y P spection purposes. r � - �� � � �� �� � i � ,���, �r//1��6°/ , S nature a m�tee Date � � � . � .: .. .. .,, . .. S .. ... � �� .;��. .-:., '.��. .,�.�- . .. � ..: . ,... . . . .. ... ... . . . . ., - ... , .. , � �. . �APPROVALS OATE IN�EGTOHSSIGNATURE � � � � ��NSPEC70R'SNOTES� � � � � ; "('�}y���.�7'�„�'�'. .. VNDEF SIAe WORK ......:: . �.,s=...� �,... �.- .'� .., �.= aOUGN P�UnnBiNG u � � � ' � 1 hereby afficm tliat[am exempt ftosnthc Cdntractor's� ' � �--- License-Law for the�folbwing�teason(Section 7037:5, GAS PtRING-.......:*-. _/ -.� _-••-. . .. -..,. .-- ., �. . . .. - ...--� ......... .... � Buslttes5�and Professions.CodeJ:Any city.or County; �. cas�.�EN7 a.t�,-"'.' i-?w,�;, ' � � �� . . .:.. .:.'` ';. . . . . which requi�er e permit'to Eonstrucr, alter.�rmprone, y y � 4_ � �.'.. '. . . . . . .... ., .HOT WATER FiEATER � �� '�� � �.'� � � ' � '� ' .11e�ho(fsh��or IepR�Y'any sfluCfu/C,:pl'lOf t0.it5�.195u(mCe, PLUMe1MGFlXTURES "..'. .�. �� .. •�`� '. �:;.:� . .. � ' . �� � .. - , ,. , 9Is"o,"requere8 tNe.RPPlicant for Su[h p¢rmit:to ji(e-a � � -' ' "slgned�,•stqtement..'tNat�he ra_�tcensed puYsuqyr'��.ta�,the GAS TEST '�� � � � . . � � prnvisions df Fhe Coniracror's License Law(Chapcer 9 � UTIL�TY�OO.NOTFIEO ,'.s �..".'. ��'�. �.�:�;- ..:...� �. ���.,� ....f �'./C071menCireg-WiYh�'.SeCtlorr 7Q00J-�Of�DiviSioH 3 of the , �. � ,�.,' . � , . �. . , . _..._,. __ ....�:. . . . .. ..��- ... ..._ � . ' � � Business�¢nd�Professions�CodeJ-ar th4t he is exempt � . . . , ._._. ..�� . . .__. . i ,�� , � '� � � `� � , � ` therejrom,and rhe basis for rhe a!leged exemp�ion..Any F1NAL '' �'' ...� �.� . .. . . ... ���hundred� , '�� �.ry1��L�Oh �}90�tt viola[ion of Sect�on 7031 S 6y Gny appftcnnf for p permit -. ', `. .�a'( ��1� 6+., t , .. . . ,. . 1 ppl+cant ta a civtl penalty ojnot mbretharc . INDUSTRIAL`J t t,�l . � + e do!lars,($SOOJ .,.. . � : �� ASTE APPROWAI � ��- ` � .. . O�I,as:owner�ot the prope�ty vnll do the wotk,and I � - . .. I � _ � . .,the shucYuxe�s not mteaded or offeced for sale. �. � :' :.:.,..l ... ...-i:, :� . - :.�4-„ :; .- -. � ..�� �� - (Sec. 7044, Susiness and ProJ'essrons Code: The Con- � '; ..� . . . � ..� :�R ,..�,. � ., �� ., . " ,.. ', ... . . � . ._.. ..iracroi's Licertse�Law"does�nof appfy�ro 8n owner of r� , ...i...._ '�. : . ,. , .�. .. ._.. . . . :. . . ..._ . ..... .� .._ . __.__ . . i . i � _� � . -� � ; rtir_. . ,. . . . . - ,� ��. r. .: '-. .�._'�.,f�., ```..�..�.:.. "�� ....-. . ' � .. . . -�. ...: ' �rehnot ie en bui7ds or improves ihereon,dqd who don . � : .� .. ' ,imse(J'proytded�thar aueh�improvemen{s . - . n ded or:ojfered for,saie..!f, however, the i , �� '� � � ' � � � � - � � - � "� ��- �" buildittg or improvement�is safd witNin one-year of . . .�� :.�. , -�;. : -, �' .; .- ���� � r ^e - •' �" � � � � ' � compler�on, t7�e ownerv6uifder will hpve the burden Yr_i ����_ �} �:.__ __.�___... .-�_�__ . ...... . ! . . .��� _ � � � i� af Proving rhar�he did not build ot�improve,for the � , : ; .�. . , . , �� ��. . , �, , � .: .. , � � ; �purposeofw7e.J� . . ._ . . ,-.e. �.�1 . c : �. '�., � .. " ..�., ,. .. . .. _ ,.. 3 ,,,. , __...._ , i t:.,: •'" I am exempt under Sec. ' , � ,;, . �_ __,_. _.,... . . ___.. _ .:.... .,. i.B.&�'�C forthis�easdp '°, •-r' �. ' __ _'_ _ :... . .. .. __ _ _. __ _ _ 4 ,._, , , i � ._ � , s , ,, ; . . .. . . _ ,,- . .. Aa�e �: ' ; .., ; � ., . __.._. ...._ ... ... _ Owner � '. i >� ...'INSP�CTOR'S NOTES - ` � � � � �� . . .... .�. . . . ... . . . .._ .. ..._._. � . �.i - . �� - . . . - ... ,_.. - . . ! . .. ,.. , . ,. �: � ::.... . ,. � . . . � . .�. �,.-,.. .;�t . .. .. . . ... . �. .., . _ . � .,. . � .. . � ... . , .. . . .,.. . . .,. -� , � .... . � . . . . � � . , .... . .�:. - i . . � . i t '� ._ . . �, : . _"-._..._. . . �., .. .�.. .. � �: . . . . .� i ..� . . . . t . . � . . � . � �t ,� .. , � . � , .. � �'� � .��. . �. . � �t �.,�". �,i . . ., •