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HomeMy WebLinkAbout1666A 3 pJ•z���t�..::�� i.�.�;�5> '�-�5��'*�,..,''��,.�y"""' '°�„"'=_���`csq=�s'.� �,v"��r��.;.. , ,�.'',���_�°'t�"4#'a.` . '"'�::-, ""�.„��" L-C, av "-.�i '�� �WORKERS�C6(v[PENSAT(7N DECLARATION � ,��� � ., �ppL9CATION FOR�PLUMBiNG PERMIT � �` h hereby difirm t6ai��f�have a cer"fif ca�e of�consent to��se�if 76A657A � -insure or�a�certificdfe o4 Wo kers'Compensation Insurance, CE 817(REV 10 SI; ;-``'�oi d'X'cerhfied copy ihereof(Sec 3800,Lab.C.J COLiNTY OF LO$,ANGEIE$ BUILDING AND SAFETY � � P��olpy No.�,�l ����� Company �'�.�.F'1�7f.lj I 110F].lUil: . .� Certified copy is he eby forn�ihed '- ' ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDiNG x Ce�t f ed copy s f led th the county build ng inspec AD�RE55 {,=5 �� �S l'�i�1�1 t�'t:'�. ��-� tion deparimeni NUMBER FIXTURE OR ItEM C FEE �OCAUTY w��r�"w,.t�`r,�"�.�..e�,�'* ��ia.::{ s ;�z�,?�r.»ro�., :rt:�; wn1ER aosEr ll1!ih-iJaJ� Yi Af� Dd�e �,.K. Appl Spnt � - NEAREST y� :����y tERTIFICA�'E OF-E�M�PTYbTI Ff2�11�dR�C@RS ��-� ." bniH iUB CRO55 ST.� �,�.QI'3a D t.A�f ft-�'7✓C(; '� "` �b��ENS�YTd7J INSORANCE owNER � ' �:�z ..-�s s.�,.��., .�. - SNOWER �1'�n 1..�D �.`. (T�iis gecfion neeil.nof"6e eompleted�f�ie wo�dc involved��by�� � MAIL i 9he permit is for one hvndred dollars(5900)or less.) �AvqTORv �' w:�.. ADDRESS (�1t,:� L?'"I''cerfify�t�at in�iFe pecfoirrrance�of�the�work��`or whicli this ;;.�.y�;,-''�"�emYif is issued,I shall not employ any person in any monner SINK CITY TEL.NO. 5o as to became wble<t to the Wo ke s Compenspt on La s � � ,y � ,�6s ��}.. .��.t_ ? � x��g�F� _...�: DISHWASHER CONTRACTOR .?.f� 3 .�: ...;f: ,, .,�.'L12.. iA.�:ti�3:� � c:1', V 'h•L �., f�a�e �Applicani �������� CLOTHES WASHEk qpDRE55 "�NOfi�CE T��tlA��CICANT. If, affer�making this Ge trficare of .°1.0 1�1'} l:� f� OL? :-E empfion,�you-shou�id bemme su6jett lo the Workers' SWIAMAINGPOOIRECEPTOR ;�-Com ensatiori iovisions of ihe labor Code, ou musiforih- CiIY .���`�� TEL.NO.�'�i4�L .. . , P P Y L4WNSPRINKLERSYSTEM '`=""�;"vith mmply with�such provisions or this permit sholl be 5?ATE " LIC. ���s?`��deemed revoked. WAtER HEATER : ..'s LICENSE NO. �>Z Ip (r'� CLASS C'-�4+ �"T' �"�"' � IIC�NS�b CONTRACTORS�DECLARATIdN - ������ ` �oiSlRicr NO. - veoce55ED Br ;?'-` .v3"k'�.�:.:... 3..-es.�a,�a.7.x+ew• y „y ,r x.t�,:�s{ .�. ,. GAS STEM OUTLETS A I hgreby affirm ihat I pm�ce sed� n�e p ows on6 of Chopfer�9'' � t�� (mmmenc ng ih Secnon 700p)of D v s o 3 of the 8 s ness OUTLETS oVER � . , �s3�}-�6nd Professions Code and my�cense is in full force and effeci 5 PER SYS7EM FINAL ! y 0. - �� ,�������-*:^�;� � r:;.,:.� ;w�. .,_... oATe a �� �� VALIDATION � ' C.-3{< - L cense-Num�ier F � �+ _L c Class .�.::.��$�i, I�l.��+-.tL-Sa CF�k-P . . . :.` FINAL � r.-,��co r acto -y- P1.l.[rOIU� oare `�n���'� 8 `� 0 �. .. _ .�. ,..... � x I om e empt nder Sec � .�; 8. s ���,B BP�� fo th-s eason .��� . � .-� .' . � .a����7„�„�u -6, .� � � t ac ,� � Plan check fee , � �'.,���'rs{�.n*^fr r-# .a�+�5 � � 3,x� , `Date - ' . . :f ,,,,,vt�, ,,,` �-�, ,u.,, s , PLUMBING PERMIT ISSUING FEE$ ; ��� ,r r*.���gnatu e . ...-`w� �y, .. � tF '.�,�r` � _ •� � �. r� TOTAL FEE • � �,�%�g t '�R �r �� s . - �.-s�� � Plan check applicant ���Z s�%"° �x` S�rJ�tE FkMiiv ., , �,;,P��.' �,�ti HOM'�OU/NER"BUILDER DECLARATION Name " , J G b F •�'- I here�y o�f�im that I am ezempr from the�anir�'dctor s Lcense �� � G '""�'ti�L'6w for the following reason(Settion 7031.5, 8usiness and Address ' e � 4 S `(-��Profession5 Code):. � City Tel.No. 4� � � '"ir`i. � .: .._... . '�.'�:��-,'� � NI,as owner of the properry,will do the work and ihe � e ° i ��%r+' x .�i`�y�y. st ucture is not�intended or offered for.sale (SeUion ,, , , , ,, ,,,,,, .. .. . ._.. ..,.. . 7Q44$us ness and P ofessrons Code)- �� � ^ ��� - ��f .�s - ��CON�kUC'IIPON LE�JDING�RGENCY :....-, ._;• : .,. .- . -.-_.s .., ._ .` , :..�C C!..'.,y:�� �.�.��., �. . 'h ,:s.. �. ...�... x....... . . M...,.-,....+ . , ..:•-. .... �u. ... :...._<- ...,... ..., . ..:..,"� ,..., ..... . . . . I�he eby affirm that t�iere is a-construct on 4en�ing ogency 4or '" ' - � � - � :�;r;:��-,the performance of the work for which ihis permit is issued �, (Sec 3097'C C) � � ,�:,'�t _ _ ' z��`�4,'�;�� i'�.� a"�'� n.»�u'�E����"� -.�'�n! .,.. a.. 'v .,.: �!,..; '.�."'� ,. -3.-�'k' ea:.;5... , ., ..�i --�,Fr�� ., , . '.z�r, , �`�e de s Name � - � ' - � _-.d Mr�, .��� },k �.:.} ��. �h3..,"�"� �.�.a��`1t 3.�:'_ ,. .. .. � �,�.��"'a'e..r°i�*r"7'w ao-"'t� �:s;' . «�?��� '�_ ia . ..... +s,.�:. 's . ..r .; �' s<:. .. ' � �, - u.;K�a . +- � .. -'�r;. .,:�, � 'Le de s Add ess " ' " ' " ' " ' "' " - " . . . . � . . .. . .:. ,, ., , ., ., , ...,. ._.. . ._ , � . ,j ce t fy t�iot I hove�read this appfcchon 6nd�state ihdt the "�-abo e nfo mot on i�corre�ct.,I agree+o mmply wiih all County .5:3,>-_ ... . .�;',:c brdinances and"Statelaws regulohng Plumbing,and hereby ":uN�i�!"d'u�hori�ze,represe�iotives�'of ihis Coumy to enter upon the � � - � tr �a6ove menfioned properfy for inspecho purposes � pax.^>.a ,x,,;r.e:'rr •:�-. -*�a� . . :,,xw .-,�• ,,,,,,,..>.....SEE REVERSE FOR EXPLAPIATORY LANGUAGE s .� �� �. a � .� -,�i F.s` �-'�-� gnarure of Pe ' ee Date � . . . ..' . . . ... ..; . . .. .. . . - . . L:, ;� ,..._..:..;.,� • ,.�. r ���� �.,�;;. :. .. , . . . ,�,.. _ . _ .;y.., . , . . '4 F F:.�y� a,: � � x �¥� ,�.z,.s� �, ` �, .;ti^��yd. , .. , .. . . � , rf�,4 �-� a�:.;. � ,u s T` :t .� . . � . - - E . . . . . , . . . . ,..r.,. . . . . �F . . . . - . . . . . ..� „., n.. ' . ,i. . �.. . . . . . : :.... . . . ....: '. .... ....._". �� - >�. :ti_,�..�.' �.zuu.:.«.,........._...._.....:............s....� ,.. , .,._.�.��.:._n.,:... . . .. ,., . . .. . APPROVALS DA7E ' -iNSPECTORS5IGNP.TURE �$ T R�SNO�ES�����'������-'���-.�v��'.�.�.+���\.\lNER BUILDER DECLARATiON M.~��.<n . . .,. —'^'— ..., . .. „ ._ . .. ..... . .............. . . .. __... .. .. - UNDER SL>B WORK i I hereby aifirm;na'; am exernot from!h�Coni�r,ctor's ROIIGHPI.UM6ING " . � License Low for rh= fo?Iowing reuson (Section T031.5. � GAS PIPING�� � -� �' � 8usiness and Pralessions Codej:f�ny dty o�coun!y wh�ch GAS VcNT � requires a permii to consiruct,afte�,improve,demoli,h, HOT V✓A7ER HE4TER or rapoir any slrucPure, prior;o I`s ls:vance, afso re- . . qui;ss the appliconT ior 3uch permit to f'rle o slgned s�ate- Pl'JMBING fiX'URES ' meni ihai he is licensed pursuant;o the provislons ni 9ha GAS TEST - Contr6ctor's Lcens¢iq�v�(Clropter 9(cemmencing v�ith UiILITY C0.NOTIFiED Section 700GJ of Division 3 of the Eosiness ard i rofes- � sions Code)or fhat fie is eaempt thereiram end Ihe basis � cy for the ailegod axemp;ion. Arty.violation of Section F�N'4� C nfer oee _trortf 7031.5 by any npplleanf Ior o permit subj2Us tfie appli- mn!fo a clG�it p=nalty nr`not more ifian 6iirn bvndred iNDJSTRIAL ' . _. � - ... . . do�(a�s($500).: ❑I,ns owner o4 ihe property will do th���.�ork,and wasie tiPaaov.4t , . �.��the srructure is not inTended or offered for sale. - ' ' � - � (Sec.794A,6usiness and i'rofess;ons Code: The Contrac- . , „_. ,. _ ' ' ` - �- tor's License Low does nOt oppfy io an cwner ot property ,:. .: . � -.,:.._ ., .. .',:, ._�...... . . ...... . ..... .:.. .... ', � _,i- ,.., .- ;. ��- '��� - -.� � ..-.�,�.' :.;, ". J✓ho builds or improves fhereon, ond who do�s such . ' ..- - .._ ..... .._. . . - ....,<. .:.; �.,,.:.., :, -;:.: ._. .. '::;, ' ... '... , . �'...;:, work himself providad fhaS svch improv9m2nis a�e ro' � � ��-��° ', � - - ��"� � : ��"-' --'��. � . � iniendedoroHered�arsale.lf,however„*beSwJdi,agor -.�. . . ,. �-.., �: . . .:.��,.�. �. � , ... - �_, _ _:. � improvemer4 is soJd wifhin one year cf compfetion.the ._._... , . `. . ., -.�:' .... .,.::.�_ : ::�:. _. : .� . ' . _ ..... t b d d . , � . ,� owher-b�ilder wi7l have ihe 6urder.of prowng tho e i . . -:' ';''�•� � ' .. . . � � ; �,'::-.� _....��.�..:.. .. ..- � . . - nbt build or lmprove fo�'rhe pu�pose o!sole.) . ' ' ��. � � ..:. ' ,� .• . ....,' �:.�- .� �. � . ..:. . . ' .. - . .. . � . � . - -. . . . , .. . _.. ._ . . _ - . ... .,.. -..w�.,.. , ..__ _,_ , _: . .., . .. I am exempt under Sec : , _ ,:_., t.�. ,. - - -,.. .. : , ; _ ,. , _..... 6&P.C.for this reason.N ,, , : , _ „ : ;. _.. _ :, _ , :. , . . �... . �. . . .. _ , Data � F . � , - . , . , .... • .. . . � . . . , . . � . .. : - - � � OWII@T: � . . .. . . . . . . � �...... . ..:.. .. .. .. ,.,..._:..., - ..._ .. .__.,....� _................_,. __._„- �.......,.....__ .....,. � _ .a. .,. _......,... ._..._......_ �___.._... .. .,..,_ .... ...::. ...� .� ... �....'..,, .... �r�sPecro�'S NOTES .�. _ . � ._____.. . . ,Ke.,.,_a;.�.��..,._..W..,.. .�. ...e.___�,.� .,.�....a �. ... . , . ,. .. ,. ,