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1752A (10)
� ����'.�""�;'�t?�.�i�' ���t�.o-r'al".c '�� 4 � s, � .: :., -" .- 's .,� r^ S� �iw'�^,,;.._�.� en,�� "�+,�?;� ��''.,, ..` : :-b:x' s,,.:,. ��... . .. . ;` t y �. i�V��KERS CaM�PEYVSATION DECLARATION�� �� � `� ■� � .,.. . /�'►���'C/�1��N e�tl�A �%� `� .,��Y PY a ce t f cate of consent to self � 76A667A . •- ��� �L6�lYi P RM T . . . rkers Compensm o.Insu ance �r�� "��•"�•�• � CEBV BEV.�1�li8t) : ... ...... . ..... ., .:. �w.:: ere af# m that I ha e msure o o cerf fimte of Wo i or Ufe t f ed co-� the eof Sec 3800 la6 C J � � �;.r.��,e#� '�.�+ �ex�s t:a:.��+��� :� .: . ,.,.. . , ,,.,:COUNTY OF LOS ICNGELES.;:. . ., .. , � � 4'o�c ompony Fromnnt TnAcmnit�s BUICDINGANDS%� ETY � �pZ� �j�� ❑._.Certif ed mpy s hereby fu n shed. - ._..,._ .. , „ � .,,, � � � ,:�. .,.... .. . '� Cert f ed co FOR APPLtCANY70 Ftt1�IN(PRINT�R`TYp��' � � - � 6UILDING ^ py s filed w fh ihe co my buil5l,ng ins e�= � � � Y y� � � q "'"`�" .. , ..,w .r.k. .. . .,� _.,..,� ,. . '¢y�, 3< <on depo r ent P � /` . '� NUMBER ' FIXTWRE OR ITEM �;j���__R�`ds�'la;v';�",� '�.c,`�li�r��•u/ � ,� .. .... �.,.. ,. ...FEE �Y AODRESS � C�. BB.T t ... f�� �ate ��p�4a r ��� � � �,. WATERCLOSET � � LOCA4ITY Dlam�L� . (�����„"t.�'Ct�RTlfl�'�OF EXEM ON FRbNi WCSRKERS'.:,. . . . � �" �^� � � .. .�,.�..,:�� ,. ... ;� 5'i.,��1'y��"� �`CS�PENSATION`INSUkA13�CE " �- _.. .:.... ' , BATH TUB�' ' NEAREST _,._ , . .�- caosssT 6o/Philli s Ranch q�,�rn (Tl�is sedeoe need not be completed if fhe work inyolvetl Ify � SHp�NER ' �� OWNER Spllth C��ll11tT ;;'� fbe�ermM s for�one hundred dollars($100)ar less,) � � "�� � � .. '�.�� I ce hFq ihot n the pe formonce of ihe wo k for which fhis ' �AVATORY ��J • �.. ✓ ADDRESS r�� �L�`n i s ssued I shall not employ ony person n any�monner l � SINK � � � pr <� sd as to 6ecome sub�ect to the Worke s Compensqhon la s � � � CITY � TEL NO x^—'�Ynt� rn��`,��iy F��-g q ���„r��: ���s .�����".��-�'�rs���r'��R:�t��:t p ,.i���r ,, / oisHwnsHea coNTRncroa R R ' _�' �ate ApP�coni -�P�UA1blI1 �IjQC. . �..., .� L. / ,� CLOTMESWASHER ���- � " ^�,1, NO7�CE`((�APPLfCANT: If, ofter making th s Certificpfe of ' ���� ^�� � �'— qDDRE55 "���wpmpfon �yob"'should bewme subject fo the W.orkers' SWIMMINGPOOLRECEPiOR - �� �].�� q.��Compensafion prov srons of ihe Labor Code you musi forth-. . .. . . . . ��_ �v Ih�comply ilh such pro is ons or ihis perm t sholl 6e�� �AWN SPRINKLER SV<TEM�" �' CITY 2 TEl NO. �• deemed re oked .s�� . � -�- �• � - — ."���� LY _ .�ED�CON1'�AC7��S D�CLAR}�TION "•��� • ..".• wATER HEATER . . . .:. _ ..,�3 � _ . - . ...__ „..., o. �w ere6y aff m�haf I om licensed under p�ovisrons of Chapier 9 CAS SYSTEM;�� OUTLETS DISTRICi�6 �� CESSED BY LICENSE N 42� ��� �,_�(mmmenc g �th Secton 7000)o{Drvision 3 of the Bus�nes5 � ��- �'� (, � CLA55 ,_�, G PRO ��Ygin�ofess ons Co�e and my I cense s m full f ce and e ect . QUTLETS Q�ER ., . ,�i �$z'�.,�u�,',�,a*�.r�`�����r5��:�P'nNk,''s�..J 1�'� ..�fE SPERSVSTE W. / ,.._�l cense Number � L c Class �� � �N � 0 J V IDATI N ,,,,,. „ v ... '�sfir F s .. ..., DA E �te+�I� f�.3' S� . .....4J� �-1�— —e-3'�—' �-"^�,a ����y��.�`:�yt+�UII1�b1T1....�Daie..-. . ✓ .a: �`� Conlract C1 fi�].9�ss �. : ..:-- p: . _�. FINAL ❑ . }- I am exempt u de Sec - � �+� �.�k,.�� '�".�'�"�S3"�a.�#4`�'�7^`c: ._. , . . .. ... � BY � ,� B�o r �s reason . � - . - � �,����'����'��''��`�'^�$������` baie -#'" ✓ �s Plpn theck fee � ,�;5� �d�y 4,�2'�'r :.�.'+r.asn�.� w , . .._. - ..... . s i ?52 A ���,�t�x� ga ture � � 4 , c��+: PLUM6ING PERMIT ISSUIfVG FcE$ ,fi l��s,/�v � L. `�z.�.t '�_��Y ��`r'k�� �-�§ � "� r �� s y -�. i ° . TOiAL FEE . �o a a i o.-rj ft �a 3 0. -.,... ..>_. r} j�"'�"���5�'�'�"'?�u�;�'�1�N�GLE�FAMILV�.� ��:� � s �""� �. �Plan check applicant r ` `✓ � � ..,N.:a,�....,. � .,.,. ,�u,�r.<.,:r. 7� '� i a7650 y�.�. x�.+k<e'� I{�ME OWNER-BUILDER'DFCYA'�2AYI6�(S"' Name � � �. , � ��� eby aff rm thot I om exempt from the Coni octor's{icense �� � ' � � " a for the following�:reason (Section 7037:5, 9usmess�dnd Address � � ` g .„�„ro ess ons Code� .,w ..�.� , 0 7 2 9 8 J � �SSt:S ,. � �� . . Ciry ..� ... .. ... Tel .N..,.. . _ ..., ��.' , .x _ lJ I as owner bf ihe property,will do the wark and fhe k � Struclure s not tended o offered for sale(Sect on � - �� � '� . - - � ,� '7044 Bus ness and P ofessions Code) � � �� 5; y .,3£'� K �..=:4'�' r`Qh. ..a4"k 1:�.��, .,... �:r,.<': ,s,,..� . .. '�`'> �t ..,.. .,r.. ..... ..�':"" -::.�. ..:4a� �' CdNSiRUCTI�N�LEN6WG AGENCY - � .. �rS` I he eby offirm thpt�here is a construct on lending ogency foc� �� � �� � � � � � � � � � � � � 3 s,ihe performonce of fhe work for which this permit is issued � �� ��' QS�ec 3D97 C v C).... . ���:-'i3�s�. � .>s �r` ,.'�. n ,�. ;,�3� r a a,: .., .;'� �'Y�,.::.�'� '�Y,"_>���3 �. "v'"v ti'�4.L :.. ��tt v rv�''� ':a �?a. 'h�'s�+�� *�.y:�°.�}' �yy sv'r1 �+v 7 `� i�"�- ��.;,. Lende s Name � -� � ��� ��� � � rr:�^��' r'�°'�.a [ ,+ � t c,:* "�"'�"�r �h*.�w�"�a+�Yne�u'�x�'+`�N!�'.a'iaN'#�N�Gbt��'✓.nr' � �'S4 �- Qi � aNrw:Car:� )r .M...,-. ��...3..?�"l�.�..x ..Fx �r�.b�.��'. #.�k'C..'"•.hus:. :� .:.,'�. �APse6-:�h..).ru< .:.rA a.r......xu.Y. ,z...a k:�.Y4l.Y x.M1.b�e,. ..+1.U.::h'1a.wAara':k...!.•.....d4�+�r.a.ht;7X .d'✓•cx..cv. .<CtE.=.u: ..... . .zx ..." .. st '. �� �v.� . Le de sAddress . .. . . . -.. .. .- ..- . .� .. •. � ,.: - . . .... . . .. ,..:.,,.. •.x,:-.... ,.ew.�r.�aM�,h:.+,sa...�sc�;a�xwaa.,w.z�_�:z�r.�,.scw«�«vcave!zm..rst � :��,a-.a�a...swm�m.r.„�.�.atw:wa�tuc,w�� �... -.�aoxo.u.:��, . K � I ce t fy ih t I hove read this appl cat on and stote thal ihe � - ���� ���� �� � ��� +"°�' a6 e nfor atio.n is co�ect.I ogree to comply wifh oll Coun�y � � � � �d nan<es q�d,5tote lows�regulaling Plumbing,and hereby +����autho ire�rBp eseNot es bf fhis Counf to enfe � ��e &�o me toned Y r upon the . ���. „� � yp�rry f�,inspeG!ion purposes. � � �� �� � � � � . �� �'� � ,I �I . ,_, w. .F.�, x,,�,:, u y.�.,. ,�...., .' �_;w�.�, �-. � .,r�,�,tri. y SEE REVERSE Fdh�IC�L'AI�711"�s�l`�L"� '"'"'` �^ " x R� R B S �h ���" ANGUdC�i�. � $gnafure of Pe m�e�� Dote � � - . 1 1 2 -. Y . 4 '. l -� �Q' `4 '{' }�RS :4� .,.� '. ..r.r.,,ms—, a _ w� ��� ` _ � 1 s �,? �.,a+.x wv+u. 1F. fi pr.�..- +�,s. auz .t*+ ;w?e Y^ .,��, f.n 'k� �*M^,�j�3 k'*4 ..� ti.� , 7 k M�X"v fu'*`��„�"�.'`�'=.�1%`«�`��a*.�-W'�v'y� u^'�, .. � . , .,_ .., ,F . r.;.�.�.. . • *. .:�,a. - i.' .�x� ��� '.����"w� _ .,._, �q. --.:i' .w:;, x-. :s�� '..p': ,n ,.,:,��,�s- ..r o.e,":.::,.�,,, :r.c Sa4 rk ... p» :'.G.rc. � y'a x a, aS �� �a `�" `� c r � *�""� -. , . ��. .:: ,r 3�, e : €� �.f ..'� � c.s .� �+ , 2 .. T. v.� .; ':� - ..y. ..i ,. >.x - � �- `"I�`9�C1`6RSNOTES ""' `� "" '� `" '� "' "' ' '��O�hrNER BiJI,DER D[CLARATIO^l����, ` � . .; '. , .. ,:� .... _ ... mx�..-., :.. .� '. ..::.., , � , . ...: .,. . Avaaovais o T@""`""`"."ftJS�€c�[?�Y''s�3fGNaTUkE .,. ,. . k u �t� ao##``m hor 'om e f;o ,he�o� c�o's � ._.. ,.. . �.. "� � 4 eay ir t I �� n`ip� i r UN�'cR SIAB WORK. j �l �-���'.-��� �, ..._. . M, .,,_� :��� ��-u ens Law {o �Fe u!�o i c� nson i5ec r �031 5 _ .._._, t _ .. ..--... , s Cod An ROUGH PLUkl91NG�' y�f;+� �"' '�'�.: � .. .. ... . ...d cFe on- � y c ry o 8u inessu r � c u +�w : . .,. .. ` . .... ,. e 4L'GETO�IS}1 � F GAS7IPING - - �3u f') �� � d��~� � � . . .. ...:�...�,:*.�,.. .*cr.�•'. .. �.:.;:: . . :�-,:�:, °; �,,:..requires ape n f to..nnsfruct,nit..r, pro ... .. ........�.... . .��� �- � or repo�r any shuciure, pnor to its ssuonce, a so r¢ GAS VENT �' ����. , ,: ,,...,.,:; R- - .: �v,_;µ� ,*-��-:ey,Guihas i8e applicont for su<h permif fo 4ile a sign�d sEate- : � ............. . . ..-,., . - ... ......: ..,:�. � �� HOT WATER HEATER. . . .... � .,:,�� Y . .. , . ._. . . _ ,,_....., {„ ::. mentThathes rnnslawuChapfer9h(ommonnngfitit� ?LUMBffvGF�XTURES �-;. . ._. _ .... _,..0 -�:..„ . ..:�rz.: r.., , .� , . _. . Gonfrador� cen P... L ( GAS TEST � � .ti h'�� ���- '"'E� �� � ��Sed ott�Odb)of D vision 3 of the 6us ness and P ofes� , � . , __._. . �.�� � . .-•�. � _,,,�„a,���,����,�,�„�.,�,,,�;;x,,p,,,,,�,,;-,;;s7ons�ode)or 9haY he is exempl iherefrom and fh�basrs ......_..,.,-.,�� . , „ ...,> r ' UTILITV CO NOTIFIED ��� �� ����� ' �� - .' � � '� �" violafion o Serna-� . ..... _ .. .. ,. .._.�. . 4or the a11eg=d exemptian. FnY . : . . � . -. : . ..� . .,., ,..._. ,«:..;u:,..x. . �e.�.,»::: "k. _.o�� 31. for rt su6�ecis the a pli- .....� . .... . „ .:,.__..__:_.,,, -. „ �a.?0.. j bY.9nY applicant o perm � P - FiNAI �nfer nn �ron� ' can!to a ci�i(penoffy of not more thon five-hundred ......:. _-....__..._. -,,.� _.�.,.::�_..,-,.�:�.��. . � �,. ,-,.:,;;. ,s _.�_ .,.,::,�dolfars(5$00J.: .,. . .. . _-. . ..:. ...._-. . �'lr . ... � �- � � ❑;,os owner of the proper+y will da the warks,and _:: . '� . _,.... ., . � � INDUSTRfF�L""-� '- � � � � ._ --- ' -�-"` ; ' �• the st ucture is not intended cr 5 f�fesed foer saleQ Co �2� . . .__ .. -:. .:.. . . ..... . - d ih VJASIE APPROVAL � ($ec 7044,6�siness and Profes i n Co . , ., ,,,. . .�...: �. . .'.�... � .... . -�� . . . . . . -� . , ... P Y •:�tor s License CnJ✓ifoes not ap 1 fo on owner of praperty ".��who builds or Impr"oVes fheteon, and who does soch � � � �`work bimself prov�ded That sucb improvoments are nos ��nfenae�r of�erad for snfc If however,the bm d'ng or �`��a �'� � ,.r.� ;, ,,��, rmprov=menf is sold�uvdhin one�ye&r oi complet on�,ihe � . . :� ' .,:� . .. - �. .y .. . , � .-, ..; -,, ,- ' .;.... '"�'' :��` "" ' " ' �� ���ow6er-builder wJ7 hcve 1he burden of proving ihafhe did � ,.;, .': ._;: .,.: , .;-. : ._,, �. ... ,:.; �e� -�..� .. .: , . �-.'� ,, - s.� .. ' ,.a. ...... ......»., ,..,. . . . ._. .. � ., `,. . .., _ � � ��- d or rmprove�o�1he purp�ose of sa . � � ',�a. ,. .�-.,., ...: z '.,- , - . ..., � ;: ,,, �� ,. .:. ,.. :� .., : �. . no u ._ :__ t.;� , " " -� ., .,...., . S�� �Y. . .�:�:. 5 .r:-� � .`�. " ... _ , - .,,r:._. ..�-.r - Sec . � . , l art`ex"empt`6'�der � 6&P C.�for this reason ` � �- -a.era ��.�.,us`��aaa,.�.,,�,us ., .�e:x,.�x.mkv�'���.?��sas,`+��+n' ����.:-�:��-d:;. : �. .. ' :- .: . . x ri- M-..c� ,.y,5";�,:yc3H �.4 �.M .b+n R.'*'.. �`'`� . � . .�� ,.�.,.�..h-x �.,,. .. a,e" , . .. �. ..:. ._. n��, . .«. ,,,,;.. ......-,,.w � � �' ,...-.�_ �., ,:.;�. . .. . ...� ' ' . ., � , "�� b � �`� � � Owner � - � . ,a,._. . ., ,� : g S . ,:. .. . _ . .. _. :. , : � --.. .. . . .::��. � . � r _ ., .� . .-. - . �. ... ' - .��- +,. r: �: � �. ., r: :, . __ ' '. .. ,w.._.._.. �.,�.._,'_ ..Sn.�:.:�� . . .. Sy L�Y��-+- an- � �S. . .b,�. ., INSP�CTOR S NOT�� ,; . . ,,;. ,y ' j a . r; a „ >S. �. s i. w ,d..�v.M.�w+�w�w.�-�u,r...,,.,. ,.aa�++ , ,.�,�:.waa�>,w'p.�„^,u.qy:r;::n'�`.� r ,:y ��w,�+;i»x a .w.�,w.:�W�r�#2�is�.�in-�fi"����ds'r,h ?��.r��-a����C� � , .. . „ �y. � . ,r i- - �� (_�... _ .r� / ;5..`, C�,.'^Fr' ths 'nF J.F.�Y f�.fY, >.,.�,.�,w,u,. ..,.�an.�.e:n 3�' a.�5 K,+s sns"S. �,rx:..3u Sn..x,:u..,s *,i.r ,�5 a- x>��"`' 3"'�wr+�a""^.�,'.r^2�Ei,��z��:�."'+`':*r�.A�ar'.[r�s.3ss+� .,..p�.r�qqwr ,�^'�g�izw*.uhi,��^ �✓ ,:.,,���,t�c���e�a.�Mar�ra a±r.w,_.,ri,iy'�+.�hPd�x+x^�.",.�','x'�ts�r.�,*�%'.,<�.� -, . ., .... .. ,. � . ,.. -, �� „ .._. ,....r e.:� r '�:x'�timF'is`:`%�•y.:.y 1e -4,w'r✓:c•ua'.�kr r.;''i: .+..lwa,�ulc.eFi �rw�.:;��+� `nsre+`t>..4 m W,s, a.rtkv�i�Wwrt.,,rc«,�,f+u+ kadA.w'N wu�.+Y��.n<,t`5r« m,wfl�c'w.M ++swS�ir,. �.. * . � . .�:.. ... �. �.':� .'.a;. :... . .,: . .: :.-� . �.,�.. .:.J , .�..... . .: ,,....r...-,. u. r.i.if .kbskel.tS::w.1.rS..u:.LG'.RC.mw.n`.n�Wis+k+l��`d.F'�<Ai�"�'x2Ci'fis"�n,�ui'�.�k%..A4M1".�'.iY�: W.L1.Fi.,,:'<...:.�. � . .m...j, vy..�E.u. � :,*��t'- +a;rt�sR:.4 r,x+a'�s..�+*� ^§A+m- ;v!.. r rv..'.+.«oPT �';MYrw��u. 'F,n}I�t`m�'m'w�"nxn�y��t� . �. .. . _ �wrc �WaQ�!SR*KF' ... k'" .`Y rr. ,-'�.. :. : , . - )15. la. .,. �� . :-. ' -� . .. . _ ' � �.:' "... . t� ... ,. . ' �F � �.-,,:, .r,.,. .,.:�.�*-ak�evri.�u�vtaA'u� . .� k�3Ea�r�dxql,:�:v.�.rT+YY✓x���u�' a,Y"£r W�rx.�E+��a�; `� � � '�SM,W•� "e7, ,rK.;.x �'2��r�ffi+�[.feYYYiwS ;�a.�:.. ,;a•sx.u,-aa k�ra'dd"�n:,aq ,,:..e.taac.u°'m+ ra •.r.»k.x.M.-r#A"'•t r%�;s c-,S.x�. '&.� ,4v.�k�wa,�'k�H�`mrau. �� ""'��'�'-r .. -,yn �.,x�'%�. t : -. -. .,. ...�.n .,.saar�:-�i^v�, a.�,uvx,-+.uck�rt s�x��u 4,,s�a, � ,.,.;. . .. '� -` :: .� , . ,_ - , ,: , `}{x wi .. � -��d .•t'1,� 'S.� `4�3g�� A. �-�. ,+Y�. .;. ,�.,:. .-�5�:�s,t r "c��",�":s�, .�r:: �t,r{.s�:i>S�r=Ft�y�ce�.�'�c�^�a:?.�`.,�,�^�aL??.Szc'.:;. t n�,..r..,.,y..�. �, ..cx �,s�.. ..,�-- - .w.av u., .i�,