Loading...
HomeMy WebLinkAbout1094A -��: t ,S,r... 2�� ,..�,� .�S,w-'�;:.: d z.� �.:i, r .�U i#,,,��';P.Y4^€ ,Ll,� kh.: :• �• �4 :?�, T ,J . ... 3 � WORKERS'�COMPENSATIOt�`!DEGLARHTION �� �,��'�2� � G} � u '� � ' ! ���� s � �—��� ��.� ���`�AR�PL'F�`�lTION�F�7R�f�L�U1V�81R���PfRMIT � � , ��.: �� i �raffirm 1ha�t I have�p certificate�oftconsen�to�.,self 76A667H '" � . ' � ." E`. , ���, ���'`'. �'��' 'r a ceniflcote of Workers'Com ensation Insorqnce,� CE 8V REV 10l81)j • � ' �� -es � i � - y�'. n,,, t�� P ; . . , �o . . - . ' A �h.i. �67 'N� :� �!Fv � n *�o� _ertiyied co thereof(,Se.98 ,La6.C.) '�_ � A � GOUNTY OF105 ANGElES BUILDING AND SAFETY k '? �4 i °� ���'3--S�� " ( � ii;'Pohcy No. Company � �.�5, ..� , . ' '. - � �� � .�'s'�'..��'�'� � i l��'� . ��� CerYfied copy is hereby furnished. . -+'� BUIIDING ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) �ia� � �2� ADDRESS - i M�� � �� ki� �Certlf(ed copy�s filed with ihe county building inspec- t� �✓ �'�� �. t i NUMBER FlXTIJRF OR 17FM L� PEE ,i �' ..lion deparlment. � '� LOCAIITY � .�- ' A�_ ��, tC� . � . . � . � �. WATF_RCLC1SEi � �� d�'T �. i ,Dalg' ' Ap'plitant NEAREST Jyt i „� � caosssr. L-�121�it�i� qJ�� �� � � = CERTIPI C A T E O F EX E M P T I O N F ROM W O R K E RS' ; BATH TUe q� - t,� � '� � COMPENSATION tNSURANCE � owNeR L� �� ��v�., '4 �� �SHOWER �- 1.I i.�i '�.(ihis sactfon naed not be compleTed if the�wurk involved by'+t' `' . � 41he permit is for one hundred dolters(5.160)or tassJ � iAVAiOev +,.�� �"� O DDRF.$$ i`j�� �.t/�ag y�$(,�• �� �� ,� �a""•I certify�hat in the performonce of ihe work for whick rhis��� � � �T r � SMK — � CI?V - �r TEL NO. ,}�``r � �;spermii is issued,I shG��not employ ony person in any mqnner'- ��a� �C1 Gy?}2 (ji tiT C' ' ��..' 5 ,.,so as to become subject to�the Workers'Compensation Lows.�' , [ � pISH W ASHER CONTRACT�R : .1 Z. C.,. -�o i ��a. .��; . 'Date Applimnt �' CLOTHES WASHER AD�RE55 � / ��� �� �NOTICE TO APPUCANT: I[, after moking this CertiLmte o4 � - - �D L�� ���� ���� � � l�Exemption; you should become subiecl.fo the Workers'�;�. SJJIMMING POOL RECEP70R /, � 4� r CompPnsalion provisions of ihe Labor Code,.you mus�4orlh- ��Tv C,i+5_''4S�r3�3 �j/ TE�.NOL/�� � � a� _ LAWN SPRINKLER SYSTEM �f . � �,�with comply w th s�ch p ovis ons o this perm t,shall be � , S7ATE y � / � UC. � . � . deemed.revoked � �� - � � W'ATER HEATER � IICENSE NO J �l,.o C1A55 � _; �, LICENSED CONTRACTORS DECLARATION - � � � O� atSTRiCi NO. Op,[t CE55E0 BY � j s��''�5��;�I here6y offirm tha�1 am:licensed under prov sio s of Chopter 9��. 0 GAS SvSTEM OU7 (��` - . � �1� s`��,tr��commencin � th Secfion 7000 of Division d of the Bus�ness `5`���y���R`�� � � 3 9 wi ) �� GUTlE750VER `j. . . . s �� �?g,'-�� ���F'and Professions Code,and m license is jn foll fo¢e and effecC 5 PER SYSTFM v FiNA� VALIDATION � I �h;��Lice�se Number ��r�t`/�� Lic.Class�:t'"—�� � 1-' ("� DATE � a�,�. . , s; �..�. I��f �,: � � FINAL � � '� � �.`Contracfor �l. �gsr. (a��. Date �r 7 ) �. ��:. BY . .,. � :� ' i � � ��. :� � ,��fj �'��� i am exempt u�der Sec. � � �� � � asg ;� F y� B.&P.0 for thls reoson . � . � •.: rx�: 1��, Pfan check fee t .r' � F�, �Dote. . ; NLUM8ING PERMIT ISSUING FEE$ lQ -�� . .�, < +� ; SignaNre�'�-.,�s''-��„-�...� 4;;, �' L�r� . �I�. }� �':� � � TOTAL fEE ��. e`h�, � � � � . .. Flon check applimnr � � � � SiNGIE FAMILY �i � � � .� HOME OWNER-BUILDER DECLARATION � Name � ' 1 here6y affirm�F�at I am exempt from the ConGacror's�l��ce�nsV �+". Addre.ss � r � : Law for ihe f II.�.. --„'r �`=cyo^?„ • � I ^ Professions Code)� ��,�^�^ y n�'J V �;� City Tel.No.� - . �1 U 9'4� + �, �� i . i,as owner of the ro ert will da 1he work and ihe �a � 1 �� P P Y, �. . �� �;%o.m.• n a rj ; � sirudure�is not intended or offered for sa�e �Section i Y� 7044,8usiness nnd Professiong Code). � � � a m(�d.�Q '� ?(M ! g{..+��'t � WNSTRUCTION LENDING AGENCY . � . �, a ,�/��r�y u .� 7-��I hereby affirm that there�is a construdion lending agency for � ^ .'�rhe erformonce of the vrork for which this ermit is issued , z `E;�Secp3097,Civ.C.). . � . P � f�I.1 r"�8 4 . ,. M1 �i � ;.Londels Name . . � " j ` . � r�" -�.Lender_'s Address . ' 4� �� I cenify?hat I hove read Ihis opplirn.�er and sta'�tfia'the . � . x �i above information is correct.I ayree lo comply with all County � . . �� ��ordinances and Siate iaws regulating Plbmbing,and hereby , � ����authorire representoiives of this County lo enler upon the � '��` i'above-mentioned property for inspeclinn purposes. y v� ���� SEE REVERSE FOR EXPLANATORY LANGUAGE � � rc c � �ignoture Permittee � D e .k T. . c �I� _ � � �: DCi� D ��Ni� 0 � cpil0 0 , ,. . . . m v" < m � $ rr� ��S �I �..� � )y A� () -Ni z -D-i Z Z '� v'�D � � AA� ' r IO T� TI � ,�}�'�I� � � X m 1. W`�'O S . . � � i �� C D: Z m D� � I T � G� � , o �, � G . [ — � ' ' ; � z � � i° rn v I � i �� rn o� � � �, ? I �� � Z I � € �m � � O � � G1 Z . D �� i � ,7;. .... ,.,> � '. . . .... .... . � .. ,.. . . . .'. � �� .�. . �. �. . �� .. ,. .;:.r :.. :... ... :.::..... ��-�; ... . : . - �. ... . . .,.. � :� . � '.�� :�- . , n �� _ . . . , .. .. , . , :. . .:. _ �..:� � . ... ,' ' �... . . . .:...�. '.,i .,:::. ..., . � . ,- € �- , �� . � .,� I I I i � I. i � , �. - I i � i � � ' I ' . � i � i , Z � � i. n I I I I . � , I A; � N ! � � � � i , �' ... . � . i .. .. rT1 .. � . ' I � i �. � i I . ( � � � � � � , I � I � : � � ` � � i ! ia � 1I � , � ; , � i : . ,. . . , S }, ' ;: Q ' � 5"Q � � � F F o.�+ � � �,� o � � c o�,:� �:� , .x ..� I .. � ' � ���? �l� 41� N.. .^ .. N ..� � �D �. 7 � . .:� 3 �-� � � -� ❑� �,s � ❑ - �� � � � L. �'SD � � C O'N N�t)'^A[��i .-in p O'� Q 7 n �^�'� � � � . ;o o y 'a �++ � � � � ° a� �c� '" m tr��c ° a�^- ° �aoo�mv° � � a� � G - -o • m o,-�o ,-� -• o . <:� <a ° ��.-e�� , ro � � � � � Q � � � .. � ro o � � � � 0 3 < �.. c .n � `; �,, g � 3 � -o.D a3- c� —'n _. o Z N 3 � _o � < 3 a� o m m-o r� :. O w "m � c � ro�-� � , . .. (p (D W S 4-�,�� c0 Q � � �^ N 3< N N C � v, �+ - , '0.7 ' ❑ 0 N O � O �D ui ry p � p . t o �y o@ f � am � a`� r � 3 ' � 'o' o a� _'m U o o � �. ? m '' 3zp s.,, o v�ac� o -�,v, �p � 2a `= -• �0 3 0 ; �:. ': ' .. ��.� �o .. o Q� � 7 w^� �-? c o � �u n x m �'� I S� � W fl w - . ; - ��..w a'p ' � N� �D G � O Q � � �..S C L` O .�-. �p 7 � . i"7 1 . c Q� r'i O .G v�,. o m �� D�-• 3.,3 ° j q� � 3 m . .'� : ': a �;�' ':. �^ �� s S= - � y � O µ , � N -..�. ' .� �.., . ,. :` . � . .. _ - � �' _ _ _ . ...,. : :, �. ..:.: -�, �' � C; z. � - � ? �.: .. .: .. �:.��.. . ,. .. , � "'_ _ . . �: .��.. . .. . `.. � � �O _ O o � � � -« O G -, a o � � „ - � °cN° o+ .n o 'o _ .O.,b. �W O Cl O ��Q Q� fl O ' O�p tD'iri ZS �` } � . -Di a k o °_ � � � � �' ° ' �.o � h 3 � c o o ° �� O F� , ,� ro�o � �ro °� s�m <� > > a3 < � r �' O �` n � -. O'� Q�� � �A �O 0.�� O � ' �j � O . � , . ��' ,�, '.: : . �.W. C i^ �� O p ,-� � _ Q Q � .., � : ,.. : .: S . � . , �j j' ro 7 . 3 Q n � Ow `n p O � w 0 ;.. . -:: � ; ,.t� � ..,..�� C � i .. � a�< ... = _ � O ' -. _. '. .,c•. :: _. .. ., - _ i � �' '.� . : .. . . . _ ._ � N T�G � � , s� n . .v . . . ...� . . . � ,. . ; �� . w � Q ,: � . I � � d m� � 7-`G � Q �C N N fd -- n (+i ` 2 ... '� . .. . .: . . .. -..: - . m U � ''�� S ..::;'. .:.:. .. .�;:� �... �..; ...'...:'. �.; . . . .. , . ': ...' �.. :. '�.'; ' '': . '�:. ''�,: .� . '.. '��� ' . . '.. .. .. . . .. ;. . :�. ' . ..' . .: .�' ..�. �.. . � . .� . . .�:��� ,.:„ � . ,.�.:..�;-.