HomeMy WebLinkAbout4607AEUMSATIO DECLARATION
rusaw
FOR PLUMBING
..
PERMIT
I hereby affirm Mat 'I.hove a' certificate of consent to self
cRe/rl=-•el 'APPLICATION--
insure, or a certificate of Workers' Compensation Insurance, or
a certlfeed copy -thereof (Sec: 3800, Lab. cJ -
01 8282 Frenncat T17denm ty Co,
- ,.COUNTY OF LDS ANGELES
- BUILDING AND SAFETY.
orco. Company
y
,
t
t ❑ Certified copy is hereby furnished.
- FOR APPLICANT TO FILL IN (PRINT OR TYPE)
BUILDING
-.
-
ADDRESS 21010 aArpinq
SPaiTw Rd.
Certified copy is flied with the county building inspection
NUMBER FIXTURE OR ITEM FEE
d P e t.
WATER CLOSET
LOCALITYritaillCifid
—
Dat Applicant S & K Lr1i1d5CRL7E
-
N AREST
- BATH TUB' - -
,.
CROSS ST.- in1
& j.?.lnClil].IlEd
CERTIFICATE OF EXEMPTION FROM WORKERS' -
-
I ._ .COMPENSATION INSURANCE
.. SHOWER "' - -
OWNER I Pgriderosa
Rom.
'-
(This section need not be completed if the work involved
- LAVATORY
MAIL I
ADDRESS 2082 Business Center DY. - i
" by the permit Is for one hundred dollars ($100) or less.)
SINK
-'
CITY -.. YTVIIIE
TEL. N0975'^1:85
O
I. certify that in the performance' of the work for which this
-- DISHWASHER
-
CONTRACTORi..,ridsc=-
t'
permit is issued, I shall not employ any person in any manner
-, so as to become subject to the, Workers' Compensation Laws.
- CLOTHES WASHER,
ADDRESS
-
0
Date - Applicant -' -
- SWIMMING POOL RECEPTOR
0 - -
T: after making this Certificate of
'NOTICE TO APPLICAIf,
CITY . 0
TEL. NOE 92
0.. -
Exemption,become subject to the Workers'
should ec
`
LAWN SPRINKLER SYSTEM
-.-1 0
STATE
LIG.
y
Poon,
nastily provisions or the Labor youper must forth-
WATER HEATER
-�..
LICENSE NO.
CLASS -�
?
withh provisions or this permit shall be
} comply nuthis
y 'deemed revoked.
GAS SYSTEM OUTLETS
DISTRICT NO,
PROCESSED
i LICENSED CONTRACTORS DECLARATION
OUTLETS OVER.
I hereby affirm that I am licensed under provisions of Chapter
S PEA SYSTEM
i 9 (commencing with Section 7000)of Division 3 of the Busi-
nese a
news and Professions Code, license is in full force
- -
FINAL
DATE
VALIDATION I
t: _. and my and
�✓
I. License Number 309219 Lic. Class C-27
BY A
-'
t Contractor S&K IRrldSC6LDWte 12.1-sn'
`
t
a ` ❑ I am exempt from the licensing'requirements as I am a
Plan check fee
_
licensed architect or a registered professional engineer
- PLUMBING PERMIT ISSUING FEE $
` - i
" `acting in my professional capacity (Section 7051, Bus.
E mess and Professions Code). -
-
- 1Q 0Q ,.
.. TOTAL'FE6
- 04 6 Q 7 A,
- .. _
'U
Lic. or Reg. No. Date
Plan check applicant
#a•
HOME OWNER-BUILDER DECLARATION
Name
.. `f • Q 0 Q _
tr I hereby affirm that I Am exam t from the Contractor's
Address -
'rr- ,
a-• • �- -
I Q 0'�
n (Section. 7031.5, Busi-
P License Law for the following reason
:. City T.I.-Tei.. No.
-
.1
mess and Professions Code): -
1 2.0 'J v Q�
1, es owner oPahe p;operty, am exciuetvelY contracting
- :,-
.
^
§ - with licensed contractors to -construct the project
(Section 7044, Business and Professions Code).
_
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency
for the performance of the work for which- this permit Is
I
I issued (Sec. 3097_, Civ: C.).
ame
( Lender's Name—
Lender's Address
Lender's
';- I certify that I have read this application and state that the
- - - -
above Information is correct. i agree to comply with all County
ordinances and State laws regulating `Plumbing, and hereby
.gEE-REVERSE-FOR EXPLANATORY LANGUAGE -
authorize representatives of this County to enter upon the
`
-
-
-' property for inspection purposes.
-
_gAeZC15Rqned
Pres. 12-1-80
'gnature of. Permittee -. Date
{
'INSPECTOF?'S NOTES"
APPROVALS DATE INSPECTORS SIGNATURE
.OWNER-�LIILDEIZ,,vpA fH
UNDER SLAB WORK -•,.., .; .. ,,
.�,-. ....-.
Y. .. :.
I hereb affjiro:that lwam exeinpt Cro thE'ContiiCYois
ROUGH PLUMBING
' -
,
-- License Law- for the following reason (Section 9031.5,
Businede): An c' ar.
Fope�to. Comit
GASEir .._ ,• ;_.,,, "'�-.
t
.� `_....,_' _c.,' ' _
whichssgnd purity
to
r any
HOT ATER HEATER
- -.demolish,. orrerep structure• prior to ts issuance,
PLUMBING FIXTURES -,.
i.. : , ...
j ,! ,.-.
also requires the applicant for such mit to file a
4 PP Pe!. r
et8ned`-dtatsment•,that:::he is ,licensed pursuarrt...to;the
GASI,rE87
provisions of the Contractor's License Law (Chapter 9
UTILITY C.O. NOTIFIED - -... -,
"
menand with n / af'1)ivisron 3 of the
7000
r.
Businesssicit8 'Code) - or that he is exempt
FINAL— ".. � ,�, pyy ., .
_ _ �jy - -
- *._ _ _.. I ._' ._ _ ____ _..-
,, therefrom and the, basis for the. alleged,exemption.. Any
_. violation of Section :7031.5 by any applicant forapermit
subjects the applicant to a civil penalty of not more than
hundred dollars ($500).: .
1ND�TRIAL -APPROVAL-r n",
AS E .. .. .� `-'. - •.
:.five
I
; �- ---
Ll [, asownef:of the property, will do the work, and
*' ..
the structure is not intended of offered fez sale,
(See. 7044, Business and Professions Code: The Con-
_
Tractork License Law do eq not apply io"an owner of
,. .. ... ..
prope/ty ,who builds or improves thereon, mtd,who-does
_
'
such work himself provided . thatsuch improvements
•<, _-� � -„ '
are not intended or offered for sale, (j,. however.. the
_, - _
';-
impropement is d within e year of
buildingcompletion,
j �•,;;; `, .-. _., -...
cro a burden,
he ownerbuilderlwillrhave,t
,°'E'.
.of proving that .he, did not, build or improve for,, the
purpose ofsale.).',
I am exempt odder See. '
W&' P.C. for this reason'!
Date
_ Owner
.., INSPECTOR'S NOTES ::•
r.? . , .-: s - -.,