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HomeMy WebLinkAbout1576A _ _ � ._�. ___. � � . ._ .r_� �,�..�v � R -,-___ ,, . , ;: : � _ �- WORKERS'COMPENSATION�DECLARAiION ' � �� APPLICA�IVN� �VR��� v��� ��NV PGR/YiIT ..i he eby aff rin thai 1 hove a ce r f'rcate of consent fo self r �� �76A66 Ab�4T$Y"`" _ �- sure oYa certifimte of Workers Comp`ensot onlnsb"rance,ora: �E������8���- -'�_-- �.��- '� -------�-.��` t��� �;+�y:, �a � ce�t f ed copy thereof(Sec 3806;lab:C 7 �OUNTY OP L6S ANGELF$ DEPT.OF�BLfC oVORKS� �' PolcyNo.989�D� ��Compan�epublic��lnciemnity -- � - � 1.43 B -. �. � Cerhfied�mpy s hereby r m shed � �..� � � �` '-- � � --- - - �--� � .. � Cerhfiied_mpy�is f led'with the mvnty bu Id_ pectio ' . ' dU LD uG. � . - ao�aess 20615 CLfMBER DRTVE _ ILL If��PRI�tiT OR T'/E?� , depariment _ - %•� �UIiAeER FkTURE 6R'TEM �.� FEE . _ eca.T�, WALhT'U7 oa�e $I SIH� Applica�CR B : ' waTeR cioser;ro,�er: 12 00 � � `� � NEARfST��� ..�- CER�i�'iCA'fE dF E3fEW{PTfON"Ff2�Y�n`WORK�RS � y aairi r�s - cRoss sr:-. .:. .,� .:.. - -� . �c��na�Nsi�TioN«vsu'Rai�e'�" ` � sHoweR ew"ER pRESLEY OF"$OUTKE�2N CAL� - y_.,. (T{�rs section ne�d nof be eompiefedif fhe work tnvolded by-� 1�� 6 Q� . - �-- � - -- �-- ' the perm�t is Ior one hundred dollars(;100)or less.) - �� iavaTOev -- � i8 UO . ,aooRess'i7991"MITCHELL SOUTH I c'ert fy ihat n'the per4ormance of fhe;wo k for which rli�s per--- �� � � � " '"---"` mii isissued,I`sholl nor employ any person m anyma'nner so_� � S�N� - � � - � � ` OTV '-` -��-���- �Ei NO� � � IC1V(NE 66U-06b0 as-do 6emme sub�ect to ihe Workers"Comp�nsation Laws �. OISHWRSHER - � � -- '- 6 Q� CONTRACTOR " - Daie �� Applicant �� �� GOTHEStNASHER--�-' � qDDRE55��12]'8'�j �A`jN0(.�li 7ivE' - . �._.F._..._�,.. �OT1�E�T0 QPYLICXiYJT'If,�after making rh s Ce tificate of Ex����� �- � SWiMM!NG POOL_RECE�TOR ,.. -��� �� - `errlpt'on,you.shou(d becom�suh�ect to the Workers'Compen-� - ---- � � - �„_.,_ ���� R�v�Rsroi�� -T���Na��i s000-._:. sa}on provis�ivns of rfie LpF or Code;you musr forrhwinc�omp--� �qwNSaRrNKLER SvsiEM �� � -�.- __.,.... ly.wrth suth prov sions or th�s permit shal'6e deemed rzvok-- . $TATE -�- " - UC. �� �� � ed. .- .. . � WATER.HEATER � LCEn5EN0 � .�5.. - -�. �(commEnn�ENSED CONY,RACT�7R5 D��IARAT�ON� ' . D-5�0. ��- PROC SSED ev I herebK aff m thot I am licensed under prov�s�ons of C�apte�� � � GAS SYSTEM rj OUTLE"5- 6 pp. � - 9 g th Sect on7�`001 ofDlv von 3 of the Business� �. -� OU'LETS OVER '�' " �""' 5 PER-SYSYEhh " -" .�� • � ' . .. 'and Profess�ons CQde,6nd my I cense s n f�ll force and ef- ' - FINAL ���(, � VA�r�AT�ON � > fect " . - . , .. - �- � � � DATE' ti . . - p t<s se Number �36�12� �'iic Class����C.. 36 � T BAR SiNK ! 6 UO FiNni � co�f�o�rd�tCR Plumbin� oare' "R)5/RS ev � °C _.�-- o r _ _;_ � _ V � I am exempf under SeC . . � - W N ' B 8P C,fo this reason � ' Plan ch2tk fBe -_ � ., , � - - � Z _ Date � PLUMBING PERMIT.ISSUING FEE$ �� ,�4 SO . - _ Signature �� '- - � � .�-- - : „ � . . , r�:. � -'` -. �� - TOTA�FEE( SG� OO . ::.,-' ` ' SINGLE'"FHMRY � � . -� Plantcheck a I cdnt._: .. '� .�- �- - : HO7v1E OWNER-BTIILDER 6E�LARATI'ON:�. . .... PP i. ..- . � � . <; _.... - . .- , .:�_ .,. . .,- _ ; r:nn . I hereby affirm that I am ezempt from ihe Contractor's L cense�� Ncame.� . - �� . � - - � - - ` . �`^�" � � - Low for ihe followrng reason (Sectfon 7037 5;Busness and. � - . �� ��� � - . .. -- , Prnfessrons Code) � - ��� -� Address - - � • --{1:'."` � _ . � � I, os owner of the p�rooerty, will dQ the work and ihe��� �''Y � - Tel.'Vo -� - � ;i�, 4 . —.{=-�i� <�-. �. . . strucfure is not intended oroffered for sale;(Sec�rors'7044,�'"� � -- �- �-���- - - - . -: Bus nessand Professions Code). � - � � " , �- --:. . . . -. �- � 'CONSTRUC'I`ION LENDlN��,p.GENCV `.�, . _-' ' ` '<' `' , " ' _ -E __..._.: _..._;.__ .�is� - ,_ .. . . _..' - . � . ..i. :e: � .._ . ._.':. ,_ :::, -.. . �...-:� - - . Iheebyoffrm..ihatYhere�is'aconstrucfioniendingagency�for� -�' --- - - � - � �- -� .ike performance of�ihe work for.which th�s perm�t is issued. �. `-"�- ' " ' � � -- "- '�- � (Sec.3097,�Civ.C.1. . ,.._ _ ... .. , � . .,.._ . _.�:. , .:._ . .:.... ::_ .._„ __._. _..... _ ._ .. Lender'sNam'e. :-. .''.. �2: '.:. .:;�:. ': �;. . _:: :. .: _ . .d� ' . :. . lender's Address �� � � - �� � . �. .v ._ ._ . ,_ . _ � _�. , . ,_ .— . �,.._,.. . � _ , :.., ,_� ..... 1 cerllfy tha{I_-have read this applicdt on and state ihot the�- _ ,, � — - -- -- . - above inforrcrat on s cortect I pgree to,comply w th all Couhty�. ord nonces qnd Stafe laws regulo(ing.Plumbing,and hereby � � � - - � �� � . . . au�tI,�gr¢e epresentotv�s--of this Co"unty to eriie�upon the� - - ' � � � ab,6vk ntioned p opf,.+rty f r fnspedion p r�� � . ; �� / �` �t �j "D�� SEE REVERSE FOR EXPLAN/�T'ORY LANGUAGE � Signaiure o{Perm tlee �'�� . �de, _. .. . . . . . : � . . ' . - . : < _: .' � �,� . -a .``-��`""�"" 9NSPCC�o�2�''V�Y�S'" -. ' � : OWIVER BUILDER DECLARATiON .,_ _ed..,� APPROVALS � DATE , INSPECTOR a S�A��� -. . �. . , .: , :; ,_ .,_ -�_ ,.. .. :.' .... — ..�..._�.�_ _�..�.�""".."._��'��..e,_ UNDERS:navuoRK` `: y{��� - � .. � - ��� � �- Y _�t arn pC�from�'4he Cantrao4ore -- E---- _ _.:� �.__._�,.„.:..�.:.,��;,.,.� . r Licenss s.aw #oP the foliRwing reaeon (Secfion 7031.5, ROl1GH PLUMBING _'_._ _ USI08SS-8R ro essians_,-de)� Any-�-city or couniy .- , �As PiP,N� "' ��.�` which r urres a permiT to`consiruct, alier, improve' _._. . .....__,,_.m_�,..�,-y«..�,�,�..�..,.,.«.u..�r,����...._... �As�ENT .. ' f"�. . � . � . -� . - � - emo�s�i iapair any structuia,prioe fo ifs�issuance, -.--.- also requires the app7rcarri for such permit to fHe a signed HOT4�IRTERHEATEP. . . . ._..... ____'__...—,.,___,.-....�_.....�_.:�:...._�....�-...,__�.,.._.,._,..,,,..-:,._,..,.,.�,�. _ ' sta"teroe"n"T7fiat'fig is]iCensed nUrsuanf,Po the provisrons a�uasewc�izruaEs of the CohtractoPs LicBnse Law(Chapier9(comme»cing w.. �_, ...�._�_..,�,Y.a,.��.. .:.,,.„ Gas rEST -:- . .`. .. ,a'v`;� .�,� �„� �-°. ..`��`f'..".' � � .. --.-_..._ . - - -�'wi�ecfron`��J��ivis�on�of the Busin�ss and Pro-. . - � --�� fessions Cotle)or thaf he i5 exempi theretram and the UTIL4NC0 NO7ffl'ED . . - --.... .-..>,-,,,.,....,,,,,.w,�o--.��v..k.��,...„.„._.,».,> � - -- � ' srs or t e al�e'ged e,x`e�tion,Any violafron of SecUod ,._ . ._..�,w ,�,4��.� .. 7031,5 by any appficant for a permit sebjects tne appli- __ __....,..�..���,�.,..,�,�uM,._..,,�Mr�.�.. F�Na� �nEer o�e 3ront canf�`o a`civil`penaity of noi mora than five hundred _�„ �... .. , __..,>:� _.t��=� - .� dolfars f$5001.. --_.________----- ..,, :,:;.. ,_.....:;. _<o�k».,�,...� �� -. . .._ .. . ❑I,.as owner of ihe-pPoi'16�tY:witl da ifte woria,snQ.the IN�USTRfAL - ,_,_ ;;_,,,, ,. _,; - � - - � -� .,_;_ 3tfUCtUf81SlIM1M811C�OPO�f9P9CIfOP8�18. . WASTE APPROVAL ., _ ,.. � �...:.:. . . __.,... ��...�..,.,,�...�w�.-.:�...xi�:o�-«a.+.:�... � . �.... . ......�.. __�._._ �.-,_,�._,a._;,a_b,�,,,..:.h.m.z�,;.. ----- e`��44,"8usiness�Aio�ions�m�heL�o`ntrac- ��,,��_.,.�_ - _ � - - �, � _, � � tor s LicensE Law do2s not apply to an owner ot property w.•�.,+�=_w,.- - r>_. _ ;. , _ , ""'w"�Yio�u��nmp'�"'"iove`s"�'here`on;arttl wPio abes suc6 work 'n - M ������ Irimseli provided!hat such improvemertPs are not intend- " ' " - �e�'oi'o��erea'�or s2fe:If,however;the building or im- _ - '� :, proveme�t rs,sold wfmfn ope year af comp(etion ihe -� """'"""owqer=twr'Itler i�vi]Thave the burden of proving that ne did .. _ � " noi fwiltl or imprbve ior the purpose ot sa(e 7 - _ _- _. -.. -..._�, � �.,. < -.�.,�,-.�.«mw..,..-+.?,n.,.....�.��.-._-,.�aa�a�.c.wu.�N_«.-.W=;-�.�.,.ti6.,..r..,.� .»�- . . - .-„ -. ..:_ , . .. . . � .. . . _-- ,�:". . . .. _ . ..:. _ ..,,,... ,�...�d.-�..�,.�,...�....-,�..-',�.�ITI��@XBf11P�UP1d�P�8C. ... .�.-. . . , . .. .. . . - .. - . . .�_. ..�:.��.. �.-_.,: .�s.n..,_ .ga�_:-F- .�-�_-;- ,�: . ..>. 8&P� far this re�son� _ _ . �.> ,... _ . ...._.w. . _ _' �.___ ...__,..�,��__._... _ _ _ .����,.=x;: : ._:., a.a__.�.,.�.....�.�,. _ _ _.a.__A�.��.-..,,,� - �e��.,.�.�.r.�:.."_ ...«.,.�.�.. .�,.�.,.T...,.�.4�.,�.,�� D�te :�-,�,_�,---- ;.,, � . � � � � � � . -. . - ,.___...�.a"....,.u.r,.,..�,._�....<..�.a:�_:<.,..-.�.,�C}YYR2► _ . ,_..�.. _ -:_.._�,_�.,_�...._.�.��,..-...,.. .. �.. . . . ....,.::,�__<r..,,..-Y_«�.. � ���.,.�..M--..,..�.-�-�, ' '.- . - ....<.- ;.�.�., � . . -�:�....�.�....�-.-w...�,�_.<:�.. . {NSPECTOFt'S NOTES. .. _,_._�...._�.....T_�;�......,_..:....r.:,. __._�w.,�._.�.u.....�.�. �.,�� � : ��, _�.. _ s.,__���_<�..,.�-�,a.�n>-..�.��-.�«��. ---_ _�;c_.: _., -.. _ .: , ,.�..._., �.�: _ _ _. . ,__��_,..�...d,�..�... _ � � �_ , :%; _.:__' :. ..�... � �,�..�.__� ,, ��„�,. _ _ - - _' _ _. _.. .._. _.._�_.__.r..a.._W.� _ ,�. : _ � _ , ry