HomeMy WebLinkAbout1297A (17) ,
� '"°RKE"5"�°"^'E"SAT'°"°E«"R"T'°" APPLICATI4N FOR PLUMBING PERMIT ��aa, �
1 hereby ofFirm iha�I have a ceriificoie of consen�io self 76A667n .
insure,or a cerrifimfe of Workers'Compensalion Insuronce, CE BV(REV.IO�BI) .
or a ceriilieEi mpy thereof(Sec.3B00,Lo 1 /�� � COUNTY OF l05 ANGELES BUILDING AND SAFE7Y � �
Policy No.��Compony !�'�`^� �
� Cerf�iied copy is hereby furnished.
OFORP.PPIiCANTTOFItUN(PRINTORTYPE) BUIIDING S- f D
Cer�ified copy is flled with the coumy bullding inspec- - /+D�RESS
lion deporfinent. NUMBER FI%TURE OR REM p FEE � �
q ���Q� F� �[ LOCALfTY � �
�Do�e_l�.C�Y—GAppliSant v ��L�I _ WATERCLOSET �0 NEAREST .
CERTIFICATE OF E%EMPTIQN FROM WORKERS' ea7H TUB CRO55 Si.
COMPENSATION INSURANCE SHOWER OWNER r L� �
(This�«tion nNd nol b�complM�d if Ih�wodc involv�d b� ���
�h�p�rm8 ts for on�hundr�d dollan(fIDO)or lass.) lAVA70RV nDORESS �� -
I tertily thoi in ihe pa�formonce of rhe work for which ihis �� � lr��
permil is issued,I shpll no�employ ony person in ony mpnner SINK [ITY TEL.N bJ
so os to become subjec�io the Workeri Compensation Laws. , D�SHwaSHER
CONTRACTOR
Dote App�i[ont CIOTHES WASHER A�DRE55 � bG�1
NOTICE TO APPLICANT: If, oHer making �his Cartifimre of
E[emption, yov should betome subject 10 1be Workers' SwIMMING POOI RECEP70R �� q 'n
Compenwtion provis�ons o(the Labor Code,you must forth- QTY TEl NO � �)b6-<s
Wilh Comp�y Wilfl S�[h prOvisions Or �his permil sholt be �WNSPRINKlER5Y5TEM ' STATE ^�/�� IIC.
deen'IEd IeYokGcJ. WATER HEATER LICENSE NO. /(J(7 C1A55
LICENSED CONTRACTORS DECLARA710N otSTeiCi n10. r�tocE55ED BY �
I heveby aHirm thol I am licensed under provisions of Chopfer 9- GAS SYSTEM OUilE75
(commen[ing wifh Seclion 7000)of Division 9 oi 1he 6usiness - OUTLEiSOVER Q
ond Profesi�ons Codae,ond my Itcense is in full(orce and effect. 5 PfR SYSTEM FINAI � �/ IDATION � �
'/OS 7O� DATE //�`� a';
License Numbe.- lic.Class� � .
.�y�� . . FINAL (,).,
Controc�or ��]•�•wl� Do�e q_Z?' BY ��
�
� - o
I om eaempt under Sec.
B.&P.C.for fhis reawn � W
Plan check fee Q�-
Da�e: p�UMBING PERMIT ISSUING FEE S U (� Z-
Signaturo � . .
TOTAL FEE e7,� -.'__� 2 9.�I A �
Plan check opplimnt �!. . . . .5
SINGLE FAMILY
HOME OWNER�BUILDER DECLARATION Name "�� I ° °Z Z Jr O
I hereby affirm ihot I am exempf from Ihe CoNrac�or's license Addrets
low for ihe following reoson fSecrion 7031.5,Businexs and �� . � � • • °�L 5 U�
� Proissionz Code�: ' City � Tel.No,
❑ I;os owner oI Ihe property,will do Ihe work and the � �9�2�$� �
slruct�re is not in�ended or oHered for sale(Section , • .
7044,Business ond Professions Code). �
CONSTRUCT�ON IENDING AGENCY
I hereby nffi�m ihot Ihere is a conshuction lending ogency far � .
�he pe�formonce oi ihe work for which this permit is issued
(Sec.3097.Civ.C.). --
Lender's Name Na [�� , � � �
Lender's Addiess - -
I cerufy tho�I have�eod th�s opplicotion ond sto�e that the , , ' .
above informa�ien is corred.I ag�ee�o comply wiih aIl Coumy �
ord�nances a�d$�a�e laws regulo�ing Plumb�ng,ond hereby ,
auihorize represemo��ves ol ihis Coumy�o enier upon the . . .
abov -menrioned properly f r inspecNon purposes.
9 $ SEE REVERSE FOR EXPIANATORY IANGUAGE
�Sig orure of Perm� e ate
F G
2 � P � Z�
� � v V'' u+ r G� N
p�G ^ � = v_� l�
7 � � �' y .
. � . y?.J ', =c i� ' Yn `•� �i G °� O .
. . �l�' � O !,l � . 7Y� O �: .
R�V T
_��' . . �.?? ' Y�. ' �� T. �l(� .
, t�T: p r ,y-+ .
3 ��
� v ,a �; �
y �� . �•,"
. ' '1� L �� ��'� n _
, �` ' �
, ;� ' � ' n
� p
N • � T i �
t� (�.�1
� Y
0 . J
� ' p
N . . �.
�O . � .
N . .. " i.�' .
, _Z
' A
, . �
Q
� N
�
- Q
m
N
/
J /
3
; , p� � .
• . �-O p � � � .
�
. �n �O n �'� c '� w 6 .
. � � �Q � i ] �0 '�O l� �` � .L
Q'Q W � N � N N r
� �� N O � S • Q 9 Q
f f a � � o in� !�� ^_ o�"� ° � :. ^: O
'_ � 03�O � Mn � ONOff � p� TC1jn4' ��' �
. ' p'�{'O /� r-"3 G K O �O w N�K T' � m . _
. � 7 p.x ff f. ,�p�^•� lNn� t1 pj �� .n =y 3 O ? ti
� � 'O / C � O � T � 7 A '� N O<-G� D O � p � N ?� G
` � 3 � a 3 n.N o _. m _c � 2 " ' .
Q O 'O ��% O.G� O �O�GN� :• ,�� 6'p'pRN '�`.Co? op C
� � C1 " O ° W�°..� ° � =� �'�i�` S a q ° q � 3 �,
3 f co o � � � � an. • = n° v ;o
x
. �^ o 'fl .�y `z. N c� °.vo '" � ° -� �v � � � c ^�O c n.� c�' `.n
� o =� °.a-o `� ? " s o ' X �an� � o =�� �.: ,-
3- < a.� m �.o o � T� w o .. .p .
N o- n °c �° n'v, o,'O�v � ' 3 °° �� 0 -9 � `''
c ' -n _ � p
� '�o m N �- o °'o w �O �. � _.� � �' o �
. . O N�,_� 3'?���'�v m o.p o � T q `•: o v', - n.� �� �' .
' N c� :'s� � ,� �v N �� 3 't � w'.o�o , 3 � �;
.. � n -..m �o �c m -t .�. ° �. � c � :-Nv oin? .
'r � '° � oT?� o?,� y ° .. om,?o� � Qo ,-c� Z
�' �-"'C o [1 4= c o 0 m o,� c n o ,,
. � . -o � w � 3 0 � o �m �� '" 3 �`- � � � � �
� u �a ev � o a.o o ° o n r� a� .
o � � v � � � �
- ;a� p � � �� � Ns �� oa�nN0.a3� Nn .
' � "' � ° �3 0 � 7'�' £ z a v+� �o� o �o ° -. .�,q
7?'
• ' Q�b v�'�" ov n' F � v� °m�,..n� n /
' ,`c '" � o , n..n a ,. N � /
•. "" . v� ao N � � � �_. � �
, �' � S> ; ,� c =^ �
. •� . . � ttt D n
� � � � d T� � T` �
. 0-Q
. t.. . ' , � . ... ..' '„�/
� � �
t
_'�i