HomeMy WebLinkAbout0512A (4) ���� woa�s•���NSAT�oN oFcwRAT�oN APPLICATION F4R PLUMBING PERMIT � ';
I,harqby affirm rhor I hove a cert�fccnfe oi coment�o saif ��p
inwre,or o cD�tifi[atp oi Worlte'a'COmpeMO��on Inauranee, CE 917(REv.IOiBI) .
7��ar certified copy th s�Sec.3800,tnp.G.) COUNTY OF LOS RNGElES BU(LDING AND SAFETY i
�y�3045�00���m�YNati onwi de
QCeaiffed copy ie herobY Fu��ahed. - ,I
roa n.raicnrnr ro Fat w t��Nr oR rvv�� eU1 21660 CO l@ D1". +
Q Cerlified copy is filed with the coumy buifding inapeo ADD`� P - Y
lion depaNmeM. ' NUMEEN fiXTURE OR ITEM ��Q FEE , ��
para ��� Q� ww�a uosEr ��� Di amond Bar j
-�'T*--t�7�Or-�AppttGam�R..�� n7,...�1.a.... � . . ,
�ariFicAre oF Ex�nano�v FRonn wor�xs• �� � �.
i
aonn�Nsnnor�r wsuRar� a�
{This s�cNon nNd nof b�eomphi�d IFfFe wark tnrolr�d 6r � �� �� i
th�p�nnit Is for on�hund�d do0an(SIOOj�or lars.j lqyArORr � A�� '
I rorNfy�hu�in rhe performan�of�he work for whcch this �
- pe.mn is iswed,I ah�fil rm�employ o�ry penon in any mannar ��'+K ��,�,V l(,� � �,� an Di amond Bar �.�. � -
so m ro become s�bjac�ro�he Warkers'Compernatian laws. p�W�� ., _
GONTRACTOR �
L e Plumbirt �
D^'+ epplitanl CIOiHE5w0.5HER '
< �:f TD APPtICAryT: tf, ofter meking thie Cereifieoro of A� �,
Er...mp�ion, yw should Aecome :u6jec� to �ha Workan' SWIMAA1NGPppIRE(�OTqt CiTY T�,�,p. 818 �
Cpmpamo�ipn prov+fiom of�he la6or Code.YOV mus�fwrh- �qyy�,���yER SYSiEM
with comp�y with SUCII F1IpV4ipI15 or this permit shall be �'�� �� C36 I
deCmed r9YukBd. . WAiER MEATER � ���No. 308196 �
umvsEo cavTawcroRs oecwaaxiaN +
I hereby alfirm tlqt I om licensed under provisip'n oFCFqpter 9 cns svshnn our�rs � a�n� o er �
(commeneop with Secrion 7bpp)cf 0lvision 3 of rhe 8�st�s /�
ard P.ofeawons Code,and my I�cenye is in(ull force and effect. S v�ER SVS`�iN FNAI �r� . d �.
lkense rrum6er �ORI Qfi i�c.CYois f_�Fi 3 `� hl L �- � DATE -,h /�V VAUDA710N O '
Cnnhuctor I pP�C PTumhinn pare 7�9�R7 Ca �' �' g�l � :
1— C'!O V �
� W ,
I Cm exempl u�der Sat. d
� ;
8.6P.C.fa Ihis reaaon z �
Plon check fee
Date: ` I
. 57grw�ura PLUMBING VERMIT ISSUtNG FEE b ^� �
iOiAl FEf
Plan check opp{icont � �'C J��2 A
swc,�Fawuv �. . . . ,5
NOME OWNER-BUItDER DECUIRATION Nome �
I. �by affirm fhal I om axemP�from�he Conbocbr'c Littnse I •J J�J�
low for rha followi�g reoson(Seceion 7pSi.5,Business and ��� � �
Profesaiono Cods): CieV Tel.No. • g•`•�U.`.0 u �
❑ I,os vwner o{ihe propeny,will do�he wpk and tha - .. . . . . . �F-rb O 6—S I' �
rnucture is not intdnded or oHercd for snle (SeNion ► '.
70M,Busi�s and Wpfetsions Code). � �
;CONSTRUCTION LET1p11VG AGENCY
I hereby affiirn tFKxt t{iere is a wmhudion lending ogency fw '
rhe periermcnce ot�he work fo.wi�ich th�s permit is issued
(Sec.9097,Civ.C.J. i
leoder's Name -
lender's P.�dreu � � �
I canify rhoi 1 have read rhia app7icaiion and stare�hat rhe ,
above infamation is correct.I agree to comply with oll County .
ord�nonces Sta�e lowc regula�ing V{umbing,and hereby
authoriz reseNaf s of this•CooMy to enter upo��he �
above lioeed p rty for�nspection purposes. .. .
SEE REVFRSE FOR EXPIANATORY LANGt�AGE
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