Loading...
HomeMy WebLinkAbout1660A WORKERS'COMPENSATIONDECLARATION APPLICATION FOR PLUMBtNG PERMIT � 1 hereby,affirm Ihaf 1 Aove a cerrificote of conaent lo sel( T6AE87A �/J� �Z ' insure,a a ceAi}iwb o!Wwkers'Compensa�ion Insuron<e, CE 817(REV.8/B6) - - � - (A ' or o ce���f�ed copy ther�of(Sx.3800,4ab.C.) Pnoi��Ywo, �n�►am ComponyHilsi�7a�dr 7»e_ COUNTY OF LOS ANQE4ES OEPT. OF PUBLIC WORKS LJ Can�(�ed copy is bereby iusnished. � f04 AOVLICANT TO Flll M(PR�NT OQ TYPE I BUILDING Car�fied copy ie iibd wi�h tAe coun+y bufWinp inspec- Nu�R FIXiURE OR ITEM � F� ADO�� 20740 8. Ciest Lane tion department . IOUIRY Diamond Bar Dore._B�II/S7 �puqom OTanqe Paca£ic PI $ �ATENCL�6FT 6.0 4B 00 �,�EST CERAFlCATE OF F1(EM7TION FROM WORKER5' 6 B�iH iue 36 00 ��sr.Pa thfinder Road � CpMPENSAiiON INSURANCE � Z SHOWER 12 00 °N"''EA The william Lyon Company , (ih�s s�dbn nNd not br wmp�tl�d H th�work inrolwd by MAII, , eA�o�rmH Is lor on�pundr�d de0en(5100)er Ma�.) j j �,avqi0ay 78 00 A��u� 19 Corpora te PI32 3 a � I cen�fy�ho�in�he perfwmonce of the work ior which�his SINK aiv N2W z' perm it ia iuued,I shall nor amploy ony penon in any manne. Q 24 00 po t Beach tEl.NO.833-3600 � so os ro becoma au6jxt lo Ihe Wwkers'Compencotion lows. Q p�gµWASHER 24 00 conrraacroa Oran e Pacific Plumbing, Inc. Da�a e�licont� CIOiHES WASNER q D A��� NOTiCE TO APVIICANT: If, after mokinQ this CMiticoie of 1240 N. Vd71 Buren, SUlt2 211 Exempfion, yoo should become aubject �o �he Workeri SwtMM�roGvoIXaECEPTOc Compsnsa�+on p.ovis�ons oF rha Lu6«code,yo�mvat fo•Ih- �AWN SPRINKiER5�5TEM ��TM Anaheim 92807 T�� �'�O 630-4090 winc �ompfy wi14� such provi�ions or Ihis permil aFro�l be SiAiE tK. deemed revoked. ' WAiER HEATER uc-�r+sE no. 439226 cu�ss C-36 � LICENSED CONTRACTORS DECtARA710N � WSRt�CT NO. PROCESSEO 8V I bereby afffrm fhot I om Ifcemed wxler p.ovisiorta oFChcpier9 Q GAS SYSTEM '24 OUTLETS Z4 00 (commencinp wi�h Secrion 7W0]ot Diris�on�of 1he Bwiness 4 put�fi50VER - 1,S 6 00 � �' � ond Froieuio�s Code,and my licenae is i�fvll iarce o�d eNect. 5 PER SYSTEM FINAL � pA� ����7 VAIIDATION U ; license Number d�Q�26 tfc Closs,('.-3b � Orange Pac1"fic F�µA� -- Q � Connactw • Da�e�ll�fj7_ BY , U S ❑ 1 pm eRempl under Sea � 4 � B.BP.C.for this reoson ► � Plon check fee 2 �� �� � PIUMBING PERMIT ISSUING FEE S j 0 SO '� 5'giwturs. �` � TOTAL FEE 310 50 , . Plan chaek oppliwnf ;.� �(;p� . SINGLE FAMItY , HOME OWNER•BUIIDER OECL4RAiION Nome - - . . , . . . �: • •.Fi � I hereby offirm�hot I am exemp�from the Conrramor's License . � tow fw�the foilowiap reoson(Ssctbn NC�1.5,8usineu aod �drea - 1 •�� �.,J� � Crofes�ions Code): Ciy � Tel.No. � _ � ❑ I,as owne�of the 1 will do the wwk ond the �J 1 C'�G�� P�oPa Y, '� snucrore is nor ieronded or oHered for wle(Sacrion ► � D t;� Q—g'J ��, 704d,Busineas and Rofersioro Code). GONSTRUCTipN I.EPfDING AGENCV - . ' I hereby aHi�m rhaf the.e is o consnuc�ion lending ogancy for ' �� ' fhe performonce of fhe worA for whtch�bis permif ia issued � ' f5ec.3097.Civ,C.). � Lendar i Name '� Lendery Addroa I certiiy�hot I Iwve rsod this applicofion ard storo Ihat ihe � � � ► � above informo+ion is corrxt.I apree ro comply wiM all County ` ordinancea and Sb�s bws repu�otinq plumbir�,ond heroby . . � aulhorize represenrofives oi fhis Couny 10 eMar upon�he above-menHon y �y fo.Impec�ion purprnea. �,���.�� SEE REVERSE FOR EXPLANAiOR�LANGUAGE i Siqnalure of Permilfee /Da�e � '. . .. ....... . .. .. . . . _ . � . . . . . . i, . .... . .. . . ' � ' � , . . , . AF7RD`:l,LS �D�TE I�:SFECTO�"SS�GNFTi1RE INSFEClOR�SNOTES � � ��- �� � � � �� '(�','il�:��;-L'J'.IlLl:i'�iCLF.F.C.iI��': � `__ i' ' Ur.DEa LAB N Oati ' ' . �.�. . . . . ' . . f I I J � �O'JGHFLU Ct�.� _...,. .. . � �. ��,�' .:.. '"..'. . . ... . .. . .. . _ . ..._.. .. ._... t�ccn rl � f<'I� fol.� 'r � � I c Tr3l:5•. �={,-�`rI-t� � �� GtSt"P�,.. ,-. �-.. . � ' = ' !� H�isin nclP�nl s(.od A -.r� r�'��hcn . ,.�_ _ _-. __ _�'� '_ " ' _-.'_ _'_ '_._"` .�rn�i Gas vENr .._ _ .. . -�..�•_' .y�.�l,-. -_ .. . ... - ; - , , . � � ; . _,, - ren,�res o F i r,cbn.�rucr o.rn, my,<ie de�ioli:l: HOTV;P.IEFH�ai,P. —�� `.. . �`�� -� ---- -- --�� - ��---__ -- rep'renysf�cure �r�o 1 --s:,.,c. a; re - . -. . . r r r r - r .._ . ..__ _� ._ .... .. -.,. . . . . � . , ntf � �� fn a .. i � �lU.'.:F t.G FI%T.IR�S -� ,�,: ' - : � ., ' -� -; ----.'. ' -�" "- .' -- � . ... �t enl lln 1 I`isll;ci.nsed5�ursuar�t lo'f�c f��ov�i pns o+CIFr —/ ' ' .:'. ._���,_� �lt_ GAS iFST _' _ _. _ i�(Y�.A �L(G„!�i . . . . .......: . . .._.. ._.. . � ���. . Conf 1�,'s t c�•n;c Cv:�/C£ .� r'9(cc.,.. in�v.i!h UTiLrtYCO NOi�F_�Ep � � '�'�T �� � —��'' ' Sccrl n 7C001 oi D�v7sion 3 0l tl c Buvncs,and Profes� -' � " . _ ' ' " ;. -. ..__._... __ .__.__ __ ._ _ "____. . sioisC� c1 rih , •d o r t. Mpr fF�-refr.,. o J ih �bpsis — _ T'_ _L_ �. � ..� . . , lorf°c otleurd . '- /tny eofr.l t �:ho�, H!�al � �,r-,. {, f r o�� .�ror(.-,� . � _ . - � ;.c .. _ . .._..-._... .— •- � 703L5 Ly uny a;.phmn!lor�a�pormu wL�e.isn�,e oppl�� . _ - �..,. .� . -�� - .�.�•.�:.. i_. . __. _ _. ....__ ._. __.__ _.._._.� ��� eonf fo c nvil pcnohy a(rior rnorc th��ivr'nunr.red _.._.. _ .._ ....._ ___ _..- - . _� . . .: ,���.�� . � � , � _' " d., orL�s(SSC9).� � . . . . . .,. ..... .`J�USTF..l. - �..� ..''_"'_ . �-_ '���•�Y.X-� ... .�_. ._' ' - . _. _' _ - __ . 'll I as o n i'. t� ;.II cla tF rt,,ar.d , F � 9 ' _._.. ___� ,f� '::AST:I�FC ...,. .. . . -� . .. ��.� ,.�. . - -. � SIrUCIii�E�i5 it i r �i.I..�� O{Fort-()If,.5 � .�.���..��.. . . _.. r . �lir 1�.r. i• � � �..---•^—r�-.-�,�-�.. �. . _ . ...___._ ..__ .. ._ . . _ ._.._ _.__ ' 1 " ( � ____. .-_____..._..... ._ _'_ __. __. .. ._.__.' � �. . .- .. , . - ' (S�c 704d�Cu;lnc.s ciid Frolcss�vns Codc. •�Tnc Corttrc,- � .-,• ','._r,..• r,�� ,. •,. .. • . � . - - _—.� .....�—� _ . -._ .— . ....' t�r's U.enic Cc�v docv ncf b �f to cn av.r��of � . .� �,.�.. '�' • _�::.':� � ; � . ��- . . PA V Pro�crry ._ _.-._. _---_ _._.._. . - - - . . .. � ,, u - � , . . :�, l .x�ho 6.��:is o ir�pro�cs Iha�co� �o�d�.ho dors'�such : --'� -�`-----'�._------._---------'— -'J.� - - , ' � or6 Flrnsull provided t6c�wcfi Onprovements orc nor ..� ., :., _,. _.. i.�!:._._..... ..._�.._. ._.:r��.. . � �. � .� ' - ,,- ' . �.. � ' .._ __ . �• ._ t inlendeJor.oflcrdtorscle.lf.•hownver.fFe6��ildingor , ... _ , . _. ._ _ ..-- � — ---'-- -- � ,.. • � � �. ., � , .. . .�.; .. , _ mpro n .t I .d ;th. one ycc�al m pl �on.!he -��, ..� �_--- . . ' '_� ._ _ .. _. _' _ __. _- , r .. _ .. ..�. ..'. ..,, cv.ncrE�ild�-•v,lLhavclief.udrnefpronnjl.,.,hed�d . _ ____.. . _. �--�--- ...___.._ .. -_-._...-�.-.-.--•.,- -- — � _ - —._. _�—� . ,. ., .�. i :. . , � •_ ... . .�.. I � • , nof hw:d or I�nprovc fo�.lhe pur�-,oso o(sn�F.� . . , � � " .. , - � __. . . . __ _.. __ _ _'_ '_ .._. ._ .. _ � .„•, ' : ..._�. . .. .. .�._. �. -c_.. .. �, ,o .._._ . . .,'__._..._.__""�_' "..'__ ._ _' ...-- S """'_PCRI'CXCf.l�1 L'1".�C^SC_�_ . „ ...�. ; ,_' __._. , I ' . „"......� . ... �.'�' '__��—._'_-'__' _'___.'"_ .":_____"...-'____ '_'--'_ ��.\'j\<. , _. . � " � :' ' . . � _ � . . , ' �. ..., - . ._. __._. __.. . ...--�-- , G E�F.0 ior F-us rc c�vti.,— . .,_. .._� - . - - - --.. _ . _ . ___. . .... . . , . � . . . ,.. : ",Aa: �.,.- __.._.. --- . "' -_.- ____. ____:_ ._._-�_t , - ' -__—_ -- ' \ - ' " '' . .__. _.._.._ . .. , ._.. . . , . , e ... .. � , , .. _. �� ..:.:.�... ,: ,. .�� . �.��'�._..'_.�_�� '�'���:' ' . . . . . . --'__ -`_.__...� �Jififf-�_�.__ �: , . � . � „�.. , . _ ... ... .. . - INSaECTCF;'S NOTES -.--...._ _._.. ._. . .._--- - -�-_._._ .- --- �•, _ . .., . . �. ", ., , ,, . , `_— .. — ...,. : . , . . . .,. � . . , .�- . .. � .. --------. _... _._ ._ . _ . .� . . -. .; , ?—.__ .._... _._. --_.. ___._ _. �.. . �.� , - . ...�. � � .. � � '� ' .. .� .. .. - �c. �, ... .