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HomeMy WebLinkAbout1751A ��� u*��'. �.w s^.��. #-`t��r,��'�:K�3 r��r$�?:��..�.�"-��.,a.,,��'�,� � ..`�:�," 5.,�. ..,,. ,�: .;,.,,., P .,r.�- N �� F�,��`IORKERS COMpENS�710N DECIARATION � �� � /� p � � - — - ,. .,I he eby aff rm thof I have o cert ficote of consent to self M��"����T��� E.�R �1 f"�5 PY .... 7CA6d7A � L{�M •. . . .. � �u�����i��Com an� a„�e ' LE�8i7lREV IOi81 �... �' . BlNG I�ERMIT � ,., � 800 Lab C) ...-„ . ��.,,.._ „ _;,,, -Sf a ce t f ed�c�'+� th<rsK-s'aFP�3. �.+P .. � . ._.,. ..., . . �<....., , .,,;�.,, ...., ,.,.� ,,. � insure or p cerhfimie of Wo ke s'Com ensaLon Inwr � 7�01 p v�Dllt Tn C�UNT�l Q�LOS APlGELES � � _ sT '. ❑ Certfedco .. �Pmn�-�Y . DIN A . ` . ... . .. .,,� pY�s her,e6y turnished ' ........ .. :s; n....V- :..'r" G Cerl fied copy s f led w th the county bu�L'ding inspe,c- FOR APP(ICANT 70 FI��I�(PRINT OR 7YpE) � � BUILDING,,.y V�� ND S/(FETY � .s;� t an dep rment "}] /. � � � _,. ..,.s'�+-�'.+ .._........ ��Da e� �`�����Ca���'�;" � ./� ���( ���� HUMBER FIXTURE.OR REM .. .. � ' �EE-� ADDRES� 3 r �� A i. ')' . � � PP .�..... ` `,�Jc � . _ ..,... �� � G( 'L�`J� WqTER C O5ET-���" � '?-:R�,'�x��"��kTIFICATE OF EXEMPTIpN FROM WORKERS' . . � . ..�... `..�:". IOCALITY 3 � NEAREST� 1 �Ona B a �-�-� �?�? �'OMKENSATIbNiN5URANCE�� � ���� - BA�H�e ���i CR05SSi 60/Phillip — s Ranch � (T�'t�s sachon need noe be complefed iI the work involved-6y SHOWER' � � � ��� a !he perm f is Ior one hundred doilors($ip0)-or less.) � OWNER , s''Dut�2 C01111tT � ,,.... , .M... _ _ _w.,..�.. Cor � �ce t fy tho�in the � � LAVATORY � MAIL ' �� � ' ._ performqnce'of ihe work for which ihis --� � � � f"''p'errn t s issued;I shofl noi em lo trn� Y ��'-��--�•` " 'aoDRE55�� - - �-� � •" - � p Y y person�m an rrtonner�' � SINK � Sd as Po become sub�ect�o ihe N/orkers Compensation Laws� � � - � � "'�-'"""'^�-� � ' � :....... ..::.;:...:,� —� � CITv .�� . 'w"t = x �'A .'�dn z' w.r+•:a s.^�.;x,z.�s., . GISHWASHER � � TEL:N ..... .. , ... .. v .. a,r.a�. . �::.„'.. �`'`yDate . � ....�. :;:.: - .� . — �APPicani . CONTRACTORR �..R Plu.mbing �:!S$1'fCE 7�AppLICANT:�If, aftoi mokng fihis 6ertificate of � � CLOTHESWASNER �� .,:,,. � Y rp{on� yo� sho�ld become su6�ec1 to fhe Workers' SWIMMiNGPpOL�RECEP�OR ��v � ADDRESS 1278)r Ma hD ,t�,,.. np�nsalion provisions of ihe la6or Code,you�must fonh- • � lla AVe IN ��-w th mmp�y w th such prov s ons o th s � ���� � . . ... C.•.........�. perm t shall be �AWN SPRINKLER SYSTEM ' ,��eemed revoked . ,�,.. .-,N,.} :,..< �,.. .. �,r R, r , ��..���,3",��I�C�`ENS�D CONTRACTOR$DECLARATION �� WAiER NEATER - S7ATE -�- � LICENSE�NO 33642g . « N ' h I�he eby affirm/hai I m.licensed unde pravisions of Chapfer 9 � 1 GAS SYS7EM � OUtLFTS � ` ��� w^"^���--CL RS�S�� .�E1 � �t3r(cammenc g w 1h Sect on 700p)of p� s on 3 oF fhe Bus ness � '� �� �� - _ . D kl � �5 �N� -- . ��ESSED e .,.::, ,.;., „ �a d Profess on��s Code ❑r�nd�my I tense is n{ul I fo ce and effect OUTLEiS OYER� � � : ,�a'ir.Ei;s�'S w��'v n"".v aYa�T�aS�'h.�4'c T�," „>:x . ..::::.;�;, 5 CER SYSTEM . ... aa �L cense Mumber l c Class� Y��`''�"fi���""'�°�— ,. ,: - _ �: �aTe_ii VALIDA ION � -- � �R.� P"� ....�_� � '�� �[7«a«o � bzns �J1g/85 � ��at ...,.� .�....,,..: FINAL � $ �am exempt under Sec gy f�. �' .`�b x,��.�'�,#� �t"' .�3«.�« s.,.a�;_ ,z „ . :� .. . .. ... u�xC.L.. ��". B$P C fo t(�s reason - � ° �� �,':�'^� '�'��i��`�����e���y sE4.r..��� s- �; :.' Plan check fee � �^� k,�, p � � �ate�^ 9e P" ,'��� Sg afure . . ., .• `", � ,'m, .k'�� a PLUNBING PERMIT ISSUINU`FEE�$ �' �Y��� �� � ��.��� ��� ���:`�n;�, i��� , ,.. /� �G' �1 7 5 i A r w:.v'3a � �S �r�.4 � �z�x����d��b �w,� .n.x' ., ._.. T07ALafEE c' v � � •�' ��"�'�� ����' ,.,.","'�`�$.Plan check applimnt x ^ '�' _ 1 (� "�"�''�sv �.""'� i.,��SINGIE�FAfv11LY ...,, iF' . . . . • e • ) ..e'C; #' •5 vw HOME OWNER-BUIIDER DECLARATION w'��� j y a?Q S Q . ._..._. ._. ��'S e6y off'rrri thai I am exempt from the Con/roUo's License NOme • • � . fo the following reqson�(Section 7031.5,�8usiness ano' -Address � ��� :�j�� .Jr�c. �'`� Profess ons Code): � � � � "" _., . . :. .... .�. ... x � . .�_._,.� ._:,: - � °# ❑ I as owner of ih City . Tel.N �.�. . �. v 7,2�+�8 5 $;. .. e property,will do the work and the • � .i slru�tu e�is not mfended o.offered for�sale�(Se�fion � � � � - - � � �� � � � � � � . ��44 B s ness a d Profess ons Code) r �' : '� :ur .°:.,.; ....._„. ,... . , _.. :..,..:.. .. .,.,... .... . . ._.. ....::.:.. ........ . �.� C�NSTRLICTION tFN01NG AGENCY��� � ��� � � � �� � � �hereby affirm thoi there i4 a conslrutlion lendmg ogency for � the performonce�of the work for which this permi�is issued � �� � � (�ec 3097 Gv C 1 � s : � a 4� _ � .: , . . � .._ ,� ..._ ,.� .,.. i � . .�;,s.'�..� .,_�?C..... ..t a'.:. .M.., .,.�.M:':�'.°?,`�,w: s.„:.�r.6M,...w.:. . ....._.S',; �..7_.a ...�:;s,>,,.e..:x.#,n�.'fi�+'w.,"tre�;..a._ a.:,�3 ...Mr<,,,..:iu,.,R..a6��er:'.;',d+�.xd>�.u,,.. .e�,..:�:5� , ,a�... , ,.,.�., ..,,..+ .i. Lende s Nome� � r =Ca"b:ti s.r_,...s.n..,-.� .:::. .0 :_�., a �i=+�4kr.3XT"'.,v a- �« �.,�A�s .: r '. �rx � .P�°Y'�'k:tr :'e^s � � �r^, f �t`"."S..:aSx�"�-'Y�*.�uf�:�.w* . , , ., . Lender s Add ess _� � � � � � . ,....,... . .,✓.,w/SY. P..E.r'::; .. e..:.. e �i aea�i.._..R� .:'w.-. �f;.iYs�,.�, ... . ..:�y.bn . 1...1 . �«a.Sw•. �3E::ti'� t .- ..�.:i �., ..r„a I ce.tfy that I ha e reod IFus aPPLcation end sta�e thm the . . ., m.` _ , l•l�.`.,,.... � � ... 1 L�{ abo�e information's correct.I ogree�to<omply wieh oll Couniy � � � � �` o d nances and State lows regulating plumbinq,and'nereby � "� �" � $�itho z � � . . � e ep eseniotives af th�s Couniy to enter�upon the { � ab e me fio ed pr erty for i pection purposes:-� � � � �� �� ' � �' ��- � � ` �+t S wn r - ': y .m r.:��3 - , . .... . . <.. .,. �.,. . . �„ . ,:.. `�� � �' `' SEE REVERSE FOR EXPLANAFORY LANGUAGE � C R B Q i�� 1�� . Signatu e of Pe m ttee ���Q/�S '�'rx��` ^�,�� t ki �'� �F�r�:1.4T Date . . ... . . '`s F �• i t` .�'t .< � ;.5 ff ?� �a ri;. kr 3�; _. ..; � .« „ ... . .. . ;. .. ,. : . . ,...:� .. . .. .,. ;' , . . . ', au.:.�, _w ..�x:: .,br„aw,y� .;� ,.a'^� a��«..� a'�F,; T r,�...:.- ..,,.�.,.� ,,..y..r� �..,. �:;�.�a�zn��r,: w,�,��,*;..., dn,k'c.s . ,..,x��.��u :a � txi-r.��tr �a�-.�� �r �,� w�� �fi�+,�.- �s: �:. �e � �s . - . ,z, " F .�.�t a V-.�r«`e,`3`� t`�fJ� ;�°�olr��#.r'^�Ma(�$+ . r�'�^ '� . .. * ✓ . ;,'�.'� r«r,; rs:-,.�. . � : ;�. ' � k � �`y � . i�. . 'T1 . . ,. ... . . . .w ..: .= . ,. . .. � �: K . . � _..-- . .. .. .. .� . . .....� .. . .�.�. ..... ' [ .:� . � .,r; , .. . .. :� .. �� .. <'.� .. INSPECTOR'S N07E5 � OWNErZ LL�R DFCL 2 TION ew _�- ,. .. .�... .��A'TE'�".,.."����TOk'S�SIGNA70RE ....., � .:..., . �� �'' ` `t'�-"'� � tierebq arf rm ilSat I r�i eze"�i'ipt om 11-,e n�1� -Ys APPROVF.lS P . �. � ." . ,. ... ( .�y i ��y_, � � . � License La�v. for ihe follow ng reason (Secno 7C3.5, ..� UNDER SIAB WORK � .,... ....,.. . — . ... ... ..... ., . .. . . . c h;cn - -^-� --'�' ��`' '- '� � -�$usine3s cnd Professions Code) Any dty a' c y . . ......:...... m ���� ROUGH PLUMBINC ��7`�4. . _ - � ��� . . requ'rres o permif fo corsiruct olter rrprove,damo�isn, '�.: . . . ,� ��...... . ., .. .:: : ; _ GPSPIPING . - �� FD:°���-' � ' �"' '- �� or'repa�r any�strociure, pnor to rts ssuance, also rc� � . . _._. . ..... . ......... . .. . ..- . . . ... . . . ' ' limnt for sucS pe m t to ;e v s�gnad s a*� �': GAS VENi �. . ...�..1 . . . �..� � ..� . ��:.: ihh f 1 a� licensed punua i to l Prows%ons c4 the _...... , . .. __ �.4mre �� v tie' t _, ,.._. . ...._ .. . ,_ . . � HOT WATER HEATERW�� � '� en+ a . . .. . y • � � -------- (,o,'rracVur�Licer:se laev(ChapYer 9(commercme�vip1� �L1.M61NGFlX?UREc . � �,__.�. �� �`'�� � - - �� ' � Secion 7000)of�D'vision 3 of ihe 6usiness ond Profes- GAS TEST .� 8yl�� � y:y� 1°.�. -�' „ ,. , s ors Cqde)or ihat he is�exempt ifierefrom and 1he 6csis- � � -....: _._._.,_.,...,„..,. �.�....». ...... :...:..<.„, _....«<; ...,-,......�.,..,,,.. .._.._,�:::_»..¢or the al(r.ged�exempfian. Any' Jiolat'on c: Secfion U711ITY CO.I�OTIFIFO���-��� . ...,..,�.. . � _ . ... . .. .. _ . ,..._-------- .i. c037.soby�°ivil PFlicant far»otPmo i4 su�eneCrveh Ln�pli- �r c7 ...- '... ....' . . �� ' ani t� c ponalfy of re 9h f' h�n ed FlNAL - . G f =}�r�'_'f �... . ..,. doflars(5500).: sx¢r ort � . � ` . � -���❑I,os ov✓ner of ihe property wi'�do the w�xk,cnd . . ::: .;t'::: :, -. . . . . . .'_' '._. ..' , . - .. . _, , ,: . : ..;. ihc structure is noP intended or offered tor sol - INDUS7RIAL�. . . , -------- .� ,..:._ .,,.: .; .:; . ...,, ,' . .. WASTE APPROVF. - ' (Sec.76c�4.Businesx and Pro/essions Code 7he. ��-� .. ........; -.-- . -.�-. - . ..,,.- . to('s Ltcense Law does noP apply io un awner of pro;-.rfy � _.,�:j,�. '"':�s'"i,1Sho builds or�fii'�pro'Ves�thereon,.artd wfio does such ,„�,� work h'mself provided thai sucF improvaments�a�e nof �� , 3 ,.. �nfen[red or o'�feied for sale.�i,however,ibe building or : 3.; .�. . , . .. � : , : ..... - . . , „ ;:: � , � �-r� "�� � .;:� ..:�.. ' ' " ' ���� im rovement'Is�sofd�iifih�noneyechefcompfetion,the " `�' ' ' ' ��� ' ''"� ��°- � `P hove!he 6urden qf prov"rng tfich ho,dir' _... . . . . .. - . .... . : . ,... ,; . , .... _,;: ,,�`',._. ..- , .:.. a_ .... , se of sole.l� .,�, oWner 6+.11der wi . . "... . -�� ._ .... -�.�.. . .. " . � �... - 'noi bwid or impirove far t6e pu�po .. . ;. . 'i;.a '.'. . .., .. . .. . .� , . .�.. ., : ' ..._ ..�.. . «,w...,.. ,�. .+,�.... � ,.- - � ` .. ., , ;. ,., ., i arri exempt under Sac " , , s ,. _. ,:, � . : _ . ,. z:` .:" .I. 2'.�or ihis rea'son`_ "" �._.. . . B&P - ., ���Date � .. _ -- . ;,��� `; � . '�' . �„, .., .,.. . :, . . ;_ ....; .. . � ;� � �. � _�a � ;+5,r s e::a a , .�•, - x.: .. :�. Owner • . , . . ,r 4- -<.� s .. . .. � . .... . . . :' . , . • .'� .� .r,. �. . . �'����� � :::t -t ^ . .. :� ';.��. . � n..s a� �..;- . .'. . ' . ><. :' . ..., . .....�„ . , . o . :. . � ,.: , ' . .- �.' INSPECTOR'$NOTES , '.- . _ -. . _.;� ,. . ... 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