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HomeMy WebLinkAbout1418A � i ,/`.f, ,. � . �� .�^�,+KERS•�°^^PfNSAT�°N°E«ARAT'°" APPLICATION FOR PLUMBING PERMIT � � � 1 he�'�:(irnt thot I have a certifico�e of consenr to seif �y,yy�q inpr r��rtifitate of Workers'Compensalion Insurance, CE 8V�REV.10i81) oi I..p py+f�y�eof(Sec.3&I0,Lob.C.� Cj�/r COUNTY.OF LOS ANGELES �BUIIDING AND SAFETY / P�oli�c�f�lo�.^ r mpany .-. ,�I D . ( Cartified copy is hereby furnished. FOR APP�IC.>NT 70 Flll IN(PRINT OR TYPE) BUILDING r �Certified copy is filed with 1he county building inspeo- ADDRESS �$• � S .D/AHQ1l� a R �l�4 hOn departmenl. � NUMBER FIXTURE OR ITEM @ FEE / � O lOC>LITY �q,�o� ��} oo�� 9—4 8� APPlican� ��i r���:� WA7ER QOSET caoss sr. .Q t+! CERTIFICATE OF EXEMPTIQN FROM WORKERS' oj,y BntH iUe � I� O . � COMPENSATION tNSURANCE SHOWER OWNER ��� �� � (ihis sMioa nNd no1 b�cemplH�d 0 tM work Inrolwd by . n / �h�p�rmit I�for ona hundrod dollan(SI00)or loss.) � iAVnTORv � ApD'RF55 ���� � �7%1��'�'�� V`� ✓4 I cerlify thot in Ihe performonce of fhe work for which this � permit is issved,1 eholl not employ ony person in any mariner SINK � CIN ������-��� TEL NO. G' � .. w os lo become subject lo�he Workeri Compensolion Laws. DISHWASHER 6 CI O CON7RACTOR 7' Da7e A liconl CIOTHES WASHER NOTICE 70 APPLICANTPIf, ofiar making this Certifica�e of G ADDRE55 g''g� �a^y��v� �v i Exempfion, you should become subjatt to �he�Workers' SWIMMING POOL RECEPTOR dTY l.r� TEL NO. Compensotion provisions of fhe Labor Code,you mvst fonh- LAwNSPR!NKLERSYSTEM �~ ` `/�N �� G� wi�h comply with such provisions or this permit shall be . SinTE tiK. daemed revo4ed. . WATER HEATER � LICENSE NO. d (/�[ C7A55 �i �t � IICENSED CONTRACTORS DECLARATION tl � DiSTRiCT r10. PROCESSED BY t hereby aHirm thol I om licensed under provisions of Chapter 9 � GASSYSTEM OUTlETS ,r �� �commenting with Sec�ion 700p)ot Division 3 of the Business OUilET50VER and Professions Co�n,andCmY I�pnu is in full Iwce and effetl. 5 PER 5v5ienn FINAL VALiDATION � �� �:� � �7 V y � � ��/� DATE ��� � Ucense Number'-��"�'?� lit.ClossS,.—.L "� O �IAT��Vl '�� FINAL U.. 1 Comracror Date BY � � I am exempf under$et.� . 2�.'.� �L�.S A O�� 1, B BP.C.for th�s reoson f'• • • . •S w p� Plan check fee , � � re:___�c:�Q'�0/ cJ Pll1MBING PERMIT ISSU�NG FEE S r O �O I •9 2 2 5 0 Z $�an�i„rn —�1 _ _ TOTAL FEE �� m a^y 7�,j C� Plon check opplimnt 0�.��-_�'] SINGIE FAM4Y HOME OWNER-BUILDER DECIARATION Name I hereby offirm ihot I am ezemp�irom ihe Co�tRgt�or's license p���p�s law for the following reason(Settion 7031.5,B�siness ond � Professions Code): . � City Tel.No. ❑ I,as owner of�he p�operty,will do the work and the struc�ure is not intended or offered fo�sale(Section . ► 7044,Business ond Proiessions Code). CONSTRUCTION LENDING AGENCY . _ ._ .. . . I hereby nffirm ihat there is a tonstr�clion lending oqency for the pe�iormance of the work 1or whith this permit is itsued , _ . (Set.3097,Civ.G.). � lender's Name � Lender's Address ' . ' I certify thot I hove read Ihis applico�ion ond s�ate�that the ► ' obove informafion is correU.I agree to mmply with ell Counfy � ordinances ond Siate laws regula�ing Plombing,and hereby outhorize represeMaiives of this Counry to emer upon the � obove-mentioned perfy for inspeclion purposez. � Q c7 SEE REVERSE FOR EXPLANATORY LANGUAGE T' !~ �� Signatore o ermiuee Dare � C � O 2 .�- O �' � G � �+ ➢' G �' j Y �= . � � �` '• i �� "v ,i, ➢� °.. � v% � . . . �.�0 �' '` E; y' �' � � O � - l� a i.; p � �; � _ ,� ... z � n � . �� , �y,N �? C � � '�7 a � � �,r U �� m F� , � , N , V i� . � J` ( .I\ �O i � . �; �Gr�� � �d. , • . o � ��\�,\o.�'�•� . � � ��• � . �, ^ N `4J � � C ' � , � � �\\ N { � 1' N ` � ' �` ➢ � ��� � . . - Z , . 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