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HomeMy WebLinkAbout1715A . a u� � a -wr,�d.+� �3 °�i. � m�m �:+�n-rrn+�,.�*.m ;?.S�R"F �*�^"�^'� � �� �r�'r � c�^*c . . y �4�i�.::� - KERS COMpENSATION DECLARATION�'�X �+:"'"��..:��'"�'�'°� .� ..., �APPl.r��7(�IN F�R��i'L�IIIU�C��`I�C��I�R�`�TT`� K� .�,� _�, �I h eb�off m ihof I have a cen f c te of consent to self �� �bq��q � � �: su e�"or q cerhf cate of Workers Compensat on Insuronce, CE 817(REV.10i81) � - � � - � �a7 reof"(Sec 3800;`Lab.C.) � � � � � � "� `��� ������ . {� r .T COUNTY OF l,OS AN'GECES BUILDING AND SA�ETY ( �� cy� � Company�HlYi.(�NJ . . ... . . ...... . .... ... . . . .�... .. . LU� �� � ... . .. ,.,w . �. �„ , :.: x�m�c_s�� Cert f�ed copy�s here6y furn shed. ' �:.:. �...c rsr.�'.,- ..,.wa(«+'�:=;;.0�.. n.e:e..... ,:r.,�.:.� �:.,a.. 2..,, FOR AtiP[ICANT TO FILL IN(PRRJT�6R YVPE� ..„_. . BUILD NG - �~..-... ... . .. .. _. ` ��D Ce tified cbpy is filed wi�h ihe county bu Iding inspec- � � -- -�� �� - � -��� AD�RE55 y3 Soc ee�'�/e f on department NUMBER fIXTURE OR ITEM � FEE� ��� .y�` s,'a'�r�'�+v+ ��'`,�irr+.�'� v�'t.�+� 1�'`�lv��"w�"�'�4 �y . -� . . . . .ocnurv ,�. . iL. WATER CLCSET ;,,yk.m!Date � � �� APPI 4an1 � . , fJEAREST �4 �cra C ; �� �` ' CEk�i��1CAT�'E�OF'���r�O�Y'�2'5tvY��t`�S� � aarHrus . caosssr. ;�; G! '���_�!,��� ��`���,,����o�P�sn7��+'A��ro,�,K1Vstv��QA�yE� 'sHoweR �_ owNeR ,�1���. �(T��s sectian nead nof ee comp7ele�if T�e work in:olved by"��. - , ����j Thq permif�s for�one Poundred dollare($lOQ)oe less.) �LAvnTORY� �MA�� F �'L� � . .,>..:,. ,.,..n. .. ,..:_: ..... ._� . ADDR 55 '•E�.. I.. � �:d y�„I ce i fy thai in the pe formqnce of ihe work for wh ch ih.s Z /) � ' ��pArm 1 s ssued I shall not employ ony pe san m anymanner � SINK � .� �- �- CITV� . � /r� ! 7EL.NO.- � -i . �.,��S�o as;fo become sub�ect to 1he Workere Compe sQhion Lows � . � � '^� r D~� D W J' `�S s K �.i."' x 1 ��� ,�* � .aa`.s�' '}'a t a, '+, �'S�? DISHWASHER .: . , � �x r a� ,�.� c� � ,..;�,�E�„�'^�r��' t ,.� corvrRacroa , _ '. Date� Applicont � � �� CLOTHESWASHER �-�� � �. � � . _��°mN0710E`Yd�P��IC�1�Y If a�er aking this CErti�f�icole of� �� � . � ADDRESS,- ��.�C � � �' ` " �-' ' " SWIMhYINGP06l�RECEPiOR�� �-� x�r�p�o you�shobld become subject lo ifie Wo ke s �omj3ett5ation provisions of ihe Labor Code you mus�forih- ' � CITY v + 'f� � � �. 7EL NO ^rz"�y�pvifh.com�]ly wiih such provisions or th s permit shall be � �AWN SPRINKLER SYSTEM �y STATE � �.� LIC. deemed e oked WATF.RHEATER� - - - .ICENSE�NO; �k` CLASS � � "`�{a. r.�,� i� ''�L�C�P�jS�ETJ C����ROf��A`Rt'C�fION � . - DISTRICYlJO." '- PROCESSE� Y � er � .� wt���t�*+.w- �.�rv, .-�.. , ,,•+:� .. .•-�,° GA55WSTEM �.. OI,TLETS- �, I he eby a irm iFo7 I am I censed under pro isions of Ghapte•9 � � (commenung �t6 Sechon�700p)of Divi;ion 3 of the.Bus'ness OUTLETS OVER � � � Q�-ti, j• �`%�rK` and P o4ess�ons Code and my I rc�ense 5 in foll force and effect 5 PER SYSTEM �� � ��--t1. �.,34s �k a4 p��k��y r F�.�U . 1 Y' DATEL VALIDa710N ...._ .._.� '-rtl C ce se r1um�er �� '�lass %' . � '"' .°�" �`�,�� ;�'1 3n(,� A�< �,(y .i /�f; .LI.�:�(/r . . . . FINAL �.. . .� ,���on}racto�., f[1'�'�! ����y�f71'cDafe 'r � tr�9 ..... . .. . BY . .,...� . SJ :,;� � I am exempt nder Sec �� . � �� � - �_ - � " �' � '�� � �� � 7�- �` 'ef k 'fi �T3.y���� F ��.' k l'�... . . . . � ��'�Ys B$P C fo t�i s eason� �� sa � �' ';"��'���,�z*������.�-� �'e ",��'.��_p;�� ��� .,�,�xa�r a� Plan check fee _ a � '�x' +?..u..���'�.wd�e�.a.,=�A . . a+.,�^� Fa .�,�`�:, s�Rs)t > PLUMBING.PERNIT ISSUING FEE$� � � C� � . s� '�. S gnafu e �� � `� '^� ; � 3 y,�i w����=.�'s�ri' az r'"��� '`.s,�"�s ��'Ss TOTAL FEE... 5 �t �' .. ,'� r�� F�k�'g t�..� �>.:`�, � �,�'`'c� ,.„. ",.�h;r, l',x4:,..:; Plo�check appllcont : r �� SINGLE.A�nlC�'' . . . .-- . . ' ° ''� I-�dAh'E OWN�R'1�C1�5�R 6�CT"AfFA�ON �° " ' Name ,,.�., � he eby aff m t�ia�I om exerr�pf from 1he,Con�octor's�L¢ense '- qddress � � � � � ;�� aW for ihe follow ng eason (Section 7037 5 6osiness and .. _ , ,. Pro�ess ons Code): Ci!y - Tel.Na ��� " ; + ; .-s�� .�I os owne of the ro ert � � . . � �. .... . �: ' ':�...... . . .. .. .. � . . - . y.li.. . p p y II do�he work ond the . � ��� ` ,� sl uc"iure is�no� intended or offered fo sale(Section �- _ . .��. �,�� �� � � �m � ;;�7� r 7b44 8us ness and P ofess ons Code) - - � . � rx f-��, `�n» i r z �;4^��,g��r�' . �t�;.��d�m�ufS'F^%�-; u.,._.,n.Sv�a"�;a.s,.� .,.��S ar .,:t�k wt�d�i:a ,r,.". � �.. F"*�,,5.�`�_���ST�L7CTTON��iEP1��7��� . :.. . .�.. _ . .....�. .'. ' _- - ...=.1. . .�...,,. .M.� ,w. � 5 � ��. _ , ,.» _.�. a . . . .. ._, . ._ . _... �....... _.. . ,: - ... _.�. I hereby offirm that there is a eo struction lending ogency for-� � - ' � - � � � � � � � � - r \ _ � ,,,�, � the,peiformance of ihe work fo ,h ch th s permit is issued � � . � •� � � . „�. � � �' �Sec 3097 Cf ("� � - ,:,� ,,��.,,,t� v. .y'� E"s4'�^h c„'� � �`�'� ���r 'L'`� w � 4�?d���` t�.e`"� 97x 2 ':�" zr y .. r . :., .. = f-�� �'�SSx'��.,v r *"Ci L _...., .. r .� �r w� r�K:,+, r�'''�"�' ,�-, r.�c'�. c� �� �t.� pF. ,� �33 '9�S'��- �"^}z.�"�. �+...�sd � .�'' `��s '� �'{y^ r`�e -: ,� *h�� u ;�� Lende s Name �� -: ' - .. -: ]��'�.Ei �s°`� ?"`�r�`�'*.,f_�i.n�»�.:L�r���' �.u�.,-`:v+.�.Y?�:,.,���;�." �a ,.. �aw3'�t W.`�*s.yaw,z�k+'d�'�$"k ..,i�^a ;�. 63 y�'+"�''+ w,7fitt � k Mr.'. �: K�v�'�a4 �.:�s*`"'t�"txR� iv ���.�y"�C.ky4-6-�."�'T "'r;� Lende s Address ,„,.,.. ....,.._....w ,.,., . . . . - . ...... .. . ...._�.: ... �. . ... . ....... ...... .... ,, ...,. ....._.., . �._.......�.. .. , " ��:'�' cerr fy 7Fot I h�ve ead this�applimfion�and stote thot the � � � �SX� abo e, format on s co ecf I pg ee to comply wdh all-County -� � � � '�' o dinonces and,Siote.laws,regulot ng Plumbmg,and here6y � � � -� � � � �y� # .: . . . . . . . � .. .. . � - .. . . .� . � . _ aulhorize,represenfotives�of ihis�County�to eriter upon fhe � .;�o- abo e mentioned property f r' spe<tion purpo�es. � �+�"�S;;,s •, v+°'� /} J��,��L SEEREVERSE FOR EXPlANA70RY'LAhrGUAG� . -.___ _. ... . . , __.... tt, . �r ;c � Signotu e of Pe tte � Dare �� . , „ k :'.. k � t^ Nl�.. 's �, � � "x ..� X.^ _-.......—.-.,.-�,:.�-.a.�a.��.,. - p +th 2�."4, "' �. r' - } }F ��'i � i K�,, :a�,..,�....ts��a.,i'�'..��.+. -�t;,•,�: .. -� m,;: �..;,��. w�� ,�. ,._.n _.... -. . .,rv vi+µ�.6t'm ").. r'Y.^. �� �3 lyL T y� 3 ( . , .��._��_ ';�� ..�.��.�._. _�`l� .,. :��.:��. . �� '�� INSPECTORSNOTES� •, ' a.9i4• � O�IN�e12�'�iI��ET2DE�'I/�RI�i'IOTS �. . . . APPROVALS DATE INSPECTOR'S SIGNATURE . � -- ---- � y . . ..,. . . .... . .... - .� ...., . .,,:.;, ,.�. „� .... . ...�....,. ,..,.,» ..,, :. . � UNCER SLAB WORR� � � - ' � I hereb/u�fi�m ha:�am exem}�i frarn*he Co:i iacfor'; __ . ROUGH PLUMBING � . .... .. . .,.•�.. . . . . .. . � � � � -��� �� �---�-�� ������-'•-• ��-^'^��""�•'�-�"-"�� license Law�for the following recson (Secticn 7031.�5, �� GAS,'IPING, , ..-.. � I � ��� � � � Eusiness an(1?ro�`ess p,s.0 Uo).Any crty or covMy' h�r.l� - _ ... . . .. ....:._._,... ..„., .,.,__«.,,,....:.....,.,�_..:,.,, �requires a pe,mr�fo cons7rud,ahar,improee damo6s», •�. GASVENT . . . ..__....... . .. . .... ..� . �.. . . . . . . " . or repair ony strucfure, prlor to iPs issuance, also re- :. NOT WATER HEATER . . .�... . . . --.-.--.. , _...,_...__. ...,.._._...._ ,...'...quires ifie appficant for such permit to f"r!e a signod slote- _ . .`� PLUM6ING FIXTU�E$,_.. � � � � men(JY,at he is licensedpu�suanf ia iha provr<_�cns cf the � � .-- , � . , --- � -- -'�-' , . �,�.-�•� . Conl�ocfor�i iitense Law;Cha�fer 4(tommencing . . ...�. . ...,.., .. ,... ..:.: wii,i cac r�sr = -�. � ,_.. ... . ,..... .,... . , . ..,..Secflaq 7000J of DJvision.3 of fhe Business_cnd.?ro`es- UTILITY�CO.NOTIrIED �. � - - -��-�-�- -� �� �-���•�� ^��� ���-�- sions Code)or 4haf he is exempf Pherefrom ard ihe bvsis �. .. . . . ..__. . . .... . . . .. . . . . . �...... . ..... . .. . .. . . . . . . . .For tha allaged exempiion. Rny.violetion ot Szdion : , � �.,_ � __. � � . . - .... �...._.._,.,....� :�.....- ..............-. . . . .. .._..-._... �,....- ..q,.___._,._..,:70315 Sy ony appllcant for a permit subjecls the appli- FlNAL. � �� ��,er on �ronl. � . � ccnt Sa o civ!!penalPy of nof more than five hundred . . _. . ,..,........ ......:._. . . . ,. . _ . . . , ......_.. . _...... ._,..,........ . .__aaUors(5500).: - .. �.� . .. .�` ,� . .,,.:..�.,.:,. ..�....... ... . .....:. ,;...: . .�. . . in!o:�srei.ai .. .._ _ . ..: �� � � ��� : � -�� C I,ds owrr�r af 1he properiy wil oo the wo k,cnd . . .. . _"- .._.,.. ...�_..�. ..�...,_......_.. 'NASTE APPROVRL � � �'-' � - ihe+1fVciut'e is not intendad.or effered for;cle. ..- , ' .. ,, � �-,. ,,,: ,.._... • r,: ., -•......., .:.. .8usiness ond Professions Code: ihe Com. �. :,;, `:: .: .. ..... , ,. , Set.7Qd4. . •- � ��. � �-� .� � ��. � , - ���. - ""`�9or's LlcenseLow does not a ply to an owrier of prope�: .;� ': _ ,.�..�.. .. . . ., �.. F ,. ; ': ��� '��: -�� ��' - �' - � ��• „,..�.1 :., (� `-�who 6uifds��os�improves'�thereon, and wfio�does such ; - ,. ... '>" i-�.idrk htmself provided thai such improvements�cra�na� " ��lnfended or offered for sale.ff,�liowever,�be bui Iding or � � �mproverrienf s soldw�th n one year of complef on,i'r,e . .. t: Y o'vwner 6uilder w7f1 have�the b�rden of proving 5ha7 he did ;. �. ,� ,��, " " ,�� ",»ot bulld or improve far i�e purpose of sale.) .. , , �� .., .N . . r�>:, k . . � , . � �' � . �`' �am exempf under Sec ��'�" ��•� �Y4_, ., t ... .. . i ... .� ... o. ...A wwav-.fYY�:t�"" . .. k .. .. � " . ° .:- .. c. ,. ;, l, . '': ' �for this reason �,. . � , , , , v ... ,_ ,' ,, ..w ....,.. + ,, ,. ,. :. ` - - �,. B&P�C� ... ., ., -, . ,� .. .. . , � . � .. . . -,t. - „ ..� '... :.. .�., .. �:.� . , . . � ,. , .�.- . . �. :... .. . ;�., ., .. .. , -, . . : ..'.� , , , >�.. Date � . . ,. . ,'. . � ..-. . :.,. , ;�: . ::. . . _ . . . �,.. � . . , : . ...:. _ _ , �. . _ . , ... ..� ...: .. .-:+� ._4� �.�. '.'. . .' . . ..... �.: � . �... ,.. . '.. r .�'.� g .. .' .., . .. . .. .... . .� . ... _ ...; :: ';., � n:. .... . ..��. . ....:. . . ....:.... . .�'.., . .-..' ...�. . .. ..... .'. . ..... .. '• ;:-� � :.:. .�.'.' ' � .....: .,.:. .._ .., ..... . .... ..- .... .. . :..: . „ .<;," .. , .`.Owner �,. INSpECTOR'S NOTES �,..,.�. w. .,�.,:,.. r,..r :..�, ��_.,�-, a,.<,.�,,'. , x.....�::,r< , . .;:. _ _. w.._„_� <,,_ ��� ..v.�,�„ �»�- ,,<.,..r3va,�..�.z�m,� .. , ... �.... .... ...... „ .,.�:.. ,.ws�,.vs,;:.-.,w.. .�.�w� ..�uro�++4�TM+�°'w«;�«« .,.�?z'::M. .-+.k e�r. '�.a.,sa'-�^�'a.�;. a'�"ri;�u�.'�-;ws 3�-f+�ta . �.+...-ua»;..r�r �n _ N;-.u:wsa�«k.�ane:u!„ytiY�y..h�a+Y,.;i".��5aa `NKrmm:H'�Y h-xs?,..� a�.s�.a .� :.,nR � xi"+�e� R$'b+'+ N,q.� ap,r.m.i u�4x ,. i., " -rn k` �^I� ,�Y,e.sri'SYi"2"`Y 4,.-v,rir.��'. � i ,:.:, ' � �'. . �.. �' ': ,' .. .. 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