HomeMy WebLinkAbout1338A (11) "'°R�"S'�""�"�"°"°��""°" APPLICATION FOR PLUMBING PERMIT � ;
I hera6y affirm�ha1 I hava a cer�ificate of consen�to aelf �y�yy�q
insore,or a terlificpte of Workera'Compensa�ion Insurance, CE Bn IREV.IOiBI) - � -
or a cenified copy+heroof{Sx.3800,Wb.C.) COUNTY OF LOS A.NGELES BUILDING AND SAFETY �
P❑olicy No. Compaey � . - - � ,
Cenified copy�s hpeby furnished. FpR A�PLICANT TO F�LL iN(PRIM OR 7Yff) EUIIAING
� CertNied capy is filed with th nty 6�i�ding inspec- �� �
tion deportmenf. NUMBER FIXiURE OR ITEM �' ffE � �
IOCAl17V
pote�.�Appli4on� . . watEttaaSEr riep,rs�sr
CERTIFICAiE OF E%Eh1pTION FROM WOR�ERS' BaTti ruB CRO55 Sr.
COMPENSAiION ly$URANCE qWHEp - '
SMOVfER
(This s�ct�on�nNd not b�rnmpl�»d II th�work Invoh�d by .�n
Ih�permTt Is tor on�hundnd dollat�(5140)or Ipf.) ' �qyqTpgy p�..A� � �
I certi}y rhat in�he parformonce oi�he work fa wRich+his �� j
permif i�iuved,1 shall nor employ mry�rsQn in any mannm � S1� � �p aTv � lEl.
so os�o hecome subject ro the Workers Comper�sanon laws. aqyw�St�R - �
_ -QONTRACfOR
Oate epplicqnl CLOTNES WASHER 6 p'� �
n0�RE55 `„
AO
NOTICE 10 APPfJCANT: If, aftm mok�ng thia Cerufim�e af Swin4wtdGVOO�aeCtv7at � �
&tion, yvu ahoutd lsecome subject tb �ha WC�kers' �LITY � 7F1.Np.
Comperoatim+prorisioru of the iabor Gode,you musf forth- �qyy����R SVSiEM - � ,;
with comply with such prorisiom or thia permil sMol! be $7AlF UC. p_ j
deemed revoked. WAIER HEATER �- GCENSE NO. F Glq55 D �
. UCENSED COMRACIDRS DEMRA710N oiS�R�R No. aROc.fSSEo 8r �
I hereby affirm thM I am licensed undar prpviaiampf(�opter 9 �Sv51FN' anfls /Q !
(commende�g wNh Sx�ion 1p001 of Division�of the B�sinass 011REigpyEp � � '
and Rofeuiom Code,and my Iiceme is in fiAt.forcn and affect. s PERSrSifM � �� �
Dah� VA11D TION Q �
� Llcense Number`�—Lic.Class "� . � V �
4 FIIVHt � �
II Controclor��� Date � � ' . �BV � ,
I � .I am ewOmPt under Sec. � . . d i
B.BP.C.fcr this reason Z �
Plan check fee �
._ ��� PLUMBING PERMIT ISSUING FEE S d Sv
Signoturo
. TO�AI FEE O 'yZ�
. ' Man check applicant . . .... .
SINGLE FAMIIY
HOME ONMER-BUItOER OECIARATION � Nrnna , . . „ �
I hxe6y affirm tha�I om exempi from the Connaclor i�lice'ne �d��s . L'� .i j A A
law for the following reason($eclion 7031.5,Busin93�and � ' . ��
Professions Code): Cily Tel.No. �• � • • •rj . �
❑ I,as owner of rhe properiy,wHl do�he work and ihe . . I.• •U Q v O �
:n�crure is not in�ended a offe�ed for wle(Section ►
70d,Bus�ne�s and Rofeasione Code. ,
CONSTRUCTION LENDIIVG AGENCY . . . � ' ` '(���O U
I heroby offirm rhot�here i�o consnucNon lend�ng Qyency for . 0�� 5—8 Jr
the performonce of fhe wo�k for which rhis permii is issued . - � . �
(Sec.3097,Civ.C.). . � ,
�-��y�/y. /�/.-1/n /��/� //�` 1
lender'c Nome • W' '�.G /I.� _ `�� `_�,i
Leeder's Address . . �. _��t� .
I ce.�ily rhat I ha�e read ih�s appl�caflon and sta�e�ho�the _ ►. '
above infamoeion is carect.I oqree to comply with all CouMy ^ •.
wdi,mncea ond SIo1e lows regulating Plumbing,and hereby - l "` i
aut nz represen tives of�his Coumy ro enter upon the � , y I
a �e- ntioned roperty for eclio�purposes. ��
SEE REVERSE FOR EXPLANATORY LANGUAGE � � I
�� �
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