HomeMy WebLinkAbout4607A (16)EUMSATIO DECLARATION
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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 -
�. 8282 Frenncat T17de22¢� ty Co,
- .COUNTY OF LOS ANGELES
- BUILDING AND SAFETY.
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oscoCompany
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t ❑ Certified copy is hereby furnished.
- FOR APPLICANT TO FILL IN (PRINT OR TYPE)
BUILDING
" -.
-
ADDRESS 21010 Lillin
Rd: '
Certified copy is flied with the county building inspection
NUMBER FIXTURE OR ITEM - �' FEE
d P e t-
WATER CLOSET
LOCALITYntaitCilid
Dat —
Applicant S & K Lr1i1d5CRL7E
-
N AREST
- BATHTUB - -
,.
CROSS ST.- in1
& j.?.lnClil].IlEd
CERTIFICATE OF EXEMPTION FROM WORKERS' -
-
I ._ .COMPENSATION INSURANCE
.. SHOWER "' - -
OWNER I Pcnderosa
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
-
CONTRACTOR
-
f'
permit is issued, I shall not employ any person in any manner
�.,t
- so as to become subject to the, Workers' Compensation Laws.
- CLOTHES WASHER, -
ADDRESS
O
Date - 'APD1lcent-'
- SWIMMING POOL RECEPTOR
T: after making this Certificate of
'NOTICE TO APPLICAIf,
CITY . e,
TEL. NOE 92
0.. -
Exemption,ec
should become' subject to the Workers'
`
LAWN SPRINKLER SYSTEM
-.-1 O
STATE
y
prion,
nastily provisions or the Labor youper must forth-
WATER HEATER
LICENSE NO.
CLASS -�
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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 ie in full force
- -
FINAL
DATE
VALIDATION I
and my and
effe
�✓
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 $
`
" `acting in my professional capacity (Section 7051, Bus.
E iness 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,, _
-
sf I hereby affirm that I Am exempt from the Contractor's
Address -
'rr- ,
a-• • E -
I 0 0,,
P License Law for the following res on (Section. 7031.5, Busi-
:.. . City T.I.-. No.
-
mess and Professions code): -
1 2.0 3 w 8 0'1�
I n I, as owner of the property, em exclusively 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
I -
for the performance of the work for which- this permit Is
I issued (Sec. 3097_, Civ: C.).
ame
( Lender's Name—
Lender's
Lender's Address
';- 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 tepresentativaa of this County to enter upon the
`
-' a - ned property for inspection purposes.
-
Pres. 12-1-80
7gnature of. Permittee -. Date
{
'INSPECTOF?'S NOTES"
APPROVALS DATE INSPECTORS SIGNATURE
.OWNER-�LIILDEIZ,,vpA fH
. .... .:,,..
UNDER SLAB WORK -•..., .; .. ,,
.�,_.. :.: .,..-.
, ".:'...`•'`
,. ,- ,. :.
: I herebY. a€£istl:that lwam exeinpt fro `ffipContiiCYois
Rp UGH PLUMBING--
.,
License Law- for the following reason (Section 9031.5,
GASPWING .. ,.. .: .......... .. :...... a,-:
w.,<.w ..... ......,-..,-..:.. -. .,. .. ,....,... . - .,__.
Businss and Pa Code): An c' ar.
Eir .._ , • ;_.,,, " '•�-.
t
GASHOT
.� _.... ,_' _ c. ,' _
purity
which perm
r any •
ATER HEATER
prior to its issuance,
structureto
- -.demolish,. ormuirerep
• - '
PLUM1 ING FIXTURES -,.
i.. : , ...
j ,! ,.-.
also requires the applicant for such mit to ale a
4 pP ipur
-
o
-- tt8ned`-dtatsment•,that :�:he is ,licensed pursuarrt...to;the
GASI,rE87 . " ;'L .,T. T_;' • '
,.• ' :'[ ,, s `
provisions of the Contractor's License Law (Chapter 9
UTILITY CO. NOTIFIED - -... . . --, �
"
men withSection/ af'lhvisron 3 of the
n 7000
�
Business and 'Code) - or that he is exempt
FINAL.._ pyy �hltiriF '', -•
- *._ __..I ._'.__ ____ _..-
therefrom and the, basis for the. alleged,exemption.. Any
_. violation of Section :7031,3 by any applicant fora permit
' ' '- • --+
--
subjects the applicant to a civil penalty of not more than
hundred dollars ($500).:
1ND�TRIAL -APPROVAL-r n",
AS E.... ,,
.�
:.five
_
: • 1, as owner:of the will do the work, and
O property,
• `- : ;-' '.
The structure is notintended or offered fun sale,
'_._. .____... —.: __'i ✓.:. �-;:.. :'.. ,_.,--. l . !.._ - ._.
... (Sec. 7044, Business and Professions Code: The Con-
i _
Tractork License Law does not apply to"an owner. of.
x
;property •who builds or. improves thereon, and,who-does
:.such workhimself provided .thatsuch, improvements
are not intended or offered for sale, (j, however..the
•
building or improvement is sold within one year of
'.- -• ;:�---- - - - -
-completion, the.owner-builder will have, the burden
.,of pr9ying that .he, did not build or improve for, she
purpose ofsate.).'
-- __
I am exempt odder See. '
W&' P.C. for this reason'!
Date
_ Owner
.., INSPECTOR'S NOTES ::•
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