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-„`>.'r ra5� � e� y ^,. 4 - r�2,�*^� -i�'� ��' �rw r.t _. , . , :..^�.: -- ���e.'°� `'� ��,�^`�` � 4 s�'���'���$�m ;���t ..�,*+�s �� ���.�/1 :.��sR} � ��'F�`�€ "n'�" -,,..,..��1 '.V:,'��,a,�y�'7?�'t���"�- . .°� ��/ �O.r�PEfYSkTi�t6�C�RA�ON _ 4.. . . � �� y £ �m, �r,. � ..a.�,� ww ��.:�.r�. .,. . ..e _ � I hereb� a�fir�ii at I Fo e a certificate of conse t to se� �yqgy7q � insure o a'-ce t f cate of Workers'Compe sation Insu ance ce 8v(eev �OiB�) or""�t�n f e.d copy lhereof(Sec 3800 lab C; COUNTY OF LOS APIGELES BUILDING AND SAFETY � � ��-SY°��x a�8s..��',�s.5�'"�'.-�� ����s�" "�,a��s�"�-��.�'� ���{�,:,tr���.,.;�uz..r.���?�;��ay`."�.a�,;��3";:L�"r"_�3r�#ez�:€�.�d"�.,:'�:,M:'���"r."�' - -� r Po�icy I�o. �Compony . �'�3'4'�t%'�'a;aab°"n�;?�i,:a�':�.�':.i�,.r m :..,��„F�cB���.: ��.❑ rcs� Certified copy s he eby fumished "" � " BUILDING ry ,t ]� � ✓Jf �,r�5...,�.,,,.,.,,,,,n„„ ,�,�- �x- - � -�,,,, � - -,,,,„ FOR APPUCANT TO FILI!N(PRINi OR TY?E�_ O CerY4ied copy s filed w�th�he county build ng ispec- ADDRESS fl nt �O lJ L }� � , fion deQo ime � NUMBER fi%TUREOR ITEM C� FEE . LOCAIIN � ADafe ����' '�����•Y='k.�»�-'3.�.� WATERCLOSET � . . .. �PP}�a � NEAREST S,1 :�: i� �'4'g1?" �r -_ ...- CROSS ST. �C��CATE�EXE�Iv�P'f�IO�I�FItUMG�C'Y�fCE�F� BATHTUB _ . +r - C��tVEN"SA7f0�`ilvSl�kA`NCE'"� � � �� - �� owNEa '�f{�— �.,� � �x✓,waeaa.t.��,,.+wm} w+ . , SHOWER O �1✓•+ d ,�This setfion nee�nof 6e campleled of T�iesworsk involved Sy�� ,...». .,.,... ,,. [^ .} �xtFe perm f is for one"C�u'ndreFl dollars(S10D)or less.) LqVATORY �DRESSaDy � �- !��/!J`t A� ;;�R; :,:>:.aa:..,..�_........._.,.,.__,..,.., .«.:»,.:.:... . . . .. I ceriif that in t6e er�'ormance of ihe�work�for which ihis "�s`' "°p"�'l�mit fs-issued,I shol)not employ any person in any manner SINK �, (/^)} CITY ' �� TEL.NO.,�, 7,q -"'so ds to bemme subject to the Wor s'Co ensat�laws. o�St+WnSt+eR � sg�,M��� _ , .�,�,��..�„ �ONTRACTOR ' �'� � �-� �p�e Applic CLOTHES'NASHER ADDRESS �r � ��� * �""�1�S��CE Yb APPUCANT: If f}er moki g this Cerfificate of SWIMMINGPOOLRECEP70R `>,W` E'ze.,,,,mpt�on, you sYFiould�oecome subject lo the Workers' ;�... �•�.�.rv��fw�� CITY TEL NO 'L z „-:y Compensafion provisions of ihe Labor COde,you must forth- LAWNSPRINKLERSYSTEM � � � �.��,'�. t�h comPly with such prOvisions or this �ermil shall be. STATE /` UC. -`'`y�eemed revo�+ked. . WATER HEATER LICENSE NO. .S CLA55 �: � L�I,EN�D�CTOFI'�RA�:TO'RS�dECLARFiTiCSN . _ DISTRICT Ntl�.- PROCESSED BY �"'�'�' �� ��+�-?� GA$SYSTEM OUTLETS � ..'� : �Y` e eby�a.irm f}�iat am"�icense�un�e+�p�ovis�ons o�f C�iapier�J'` � -�, �� ��(commenc ng th Seciion 7000)of D vision 3 of Phe Business � OUTLETS OVE2 y��� � . �, 5?ER SYS7EM �`� `and ProfessionPos Code and my L<ense s in toll force a effect _ , „ PINAL . �; � VALIDATION � rt'�,.,��'��y`��, .(� �/_(."�.. .., ,. DATE � SS Lcense�um6er "'�+'�(J L�c Closs � - �4�, ". .s-...,._, .. . , ..,�..... �� ,�t�, � FINAL � �. ..,Co �racto�� 7J� 1 N Date BY , � ' '+✓ _.o: � � I am exempl nde Sec it�j +n a4u,��`k���..i.. t��d 7 ✓-'A�..1^:��,. `y'=.:-��r'� � ���"'��w���f�s''°��x"�'��s�p�«��� � . .g.� Plan check fee � '+��_:`�� r � .i.� ,,,. ��rar��,�,�,�.�y..��.a*;F,c�.��'F�4� PLUMBING PERMIT ISSUING FEE S U �'a ����S gnafu e �.. rts�Y������� .Y-��,�3�' ,-�'.� sv.F�ti�� -'� ����-" TOTALFEE.. . . CCF '� �a.,�„s�a �i �'� � �,- '� �,g�w'� ��,F 'r,;�"vs� ,� .. . �+�r" +�� �� 5 6C�E F�l�M�L�� �� y"^��""� Plan check applicant - . -. . . � o" ��5'. ,-r `S'�9:'�t'� . �'-' ����H0145 t�ER��71lD��O�CLARATION , Name ; �� ,.. . . ... ., .,. . : �. �S �(�ie e y a firm that I am exempl from,fie Contrador's License� Address y��-:�Law.for the following reason(Sed on 7031.5, B�siness and „ ,, � _� (? � >L ��"` Professions�ode)'� Cily � Tel.No. � � � � `� I as o e of ihe property will do ihe work and the � S.�4 �.'�"ra�,;�'�. �slrucfure s �oi ntended or pffered for sple (Sect'on , , ► x�'�r �70dd Business and Profese ons Code}� � � �s�. q �.. �rr #�,� n,a �.r�� 5.a..��m` . A'i '��?#� xi ��`� f:.y.'E.`�t�r,s.'�5'.3.'�4:�2-�ii a.'x�,:� 3e.�ts` .E'� �g r � �.,�C�RUCTIO�LEIJ�ING�GENCY ...... .,� ..,.....u....,., .,.�.a�.:.«.,;�.�.,...,.,..,.ti,...,.._..,E.....,�...w..... -�,_.,....-.v,sw._� >,,,,�,. ,..<,_.�._»a.�.ac..�.,.....n�„.:«J:s.,,�.......-a�._,.,,.....F.,_,.�. ......,.. s `f e eby aflirm�th'af ihere is a consiruchon�end�ing agency foi` � "lhe pe formance of the work for whmh ihis perm 1 s issued . . ��_ ;(Sec 3097,C C) 'y �`�'�'F.�'"r��y�si�0 `Y€Z,�:�,a� F�� ',€ �t,,rf �'� x. t�: R "" &s--,,._,��` i '� � .�5+ `� �� �����C����a-�� : �'' �sk.. '�:�� 3��'x. � �x .+'�9�'� .����r ��'��"� ;�x�w�`����c"'�."+ac�3.-,a+c.Czs���t�'�s�t�x.S���«„'o-�''`` .,ye.^''"; en e s a e g r:���xsa����x�1�+�,�z� �.'-� �e�?V-t,�''�' ..x'.'�_ { � ti `r s ��`' � �kkn;� � �" <��:x 5�?..u`�-�.,'k�'... �'�:'L-.`�..���. ,�.,�-,a;?�"�.���� �5:�.,.. <k i .. C..- ��^t��.11� ��^� ��'L��Y.��4� ,.� R 3"a.�Y�,. .�Lender s Add ess , `�- � .. . . . . . . .. .... .... . . .. �. . .._._.,., �� I ce t�y that I have read th�s appl cat o and�tote that the , ua'' '��'nbo e nformanon s co ect I agree to<omply w ih all County � y��`.o d a ces�a o�State�ad s eg lating Plumbing,and hereby � a iho ze:representaiives-of this County to enter upon 'he ' k�'above._.,ii � d pr perty o inSPection purposes. ;M'� ��` SEE REVERSE FOR EXPL{lNA7ORY C!SldGUAGE i � - �:r.i:r r J . i. ���Sig o4 rmitee Date � - �� - � � � � t .a``� ,4': �,.,.c ��`s�� ,x;- a. ��'', �,T_..p� � �t �\ � .. � '�a J 'h. �``- 3ra'.� � . _.y �n .�,� ' ' . ' , ' . ., ,- ' .. -:,.„�.. ...�,d �' ,�.�C t . .. '-. a...�': , . _ .. - . , ., , . .:, . _ . . .. ;. .. - .,�... . . :. ..�� .,�. :.,;� `.�. .'., � _ _ �.,,. .-,. .�. .. _ ...... . - . ,. - .: _ .. . . .: .... . , � ,.. . .: � .,� .� :.� ..� :..,.... � ., ,� . ... . � ,. ' .� � :.... .- � ..... .. ... . . .. . . _... . . � ..�. � . ...;.�,_,... ...U,..,,�.,: : ... � - � � � �"� � �� ���� ��� �� �I�ISPfQCR�S NOTES OVJNER-S;iILDCR CECLARATION � APPROVALS DATE fNSPECTOR551(`,hA�iURE � V � .__ • _.�_��J �..: . .. ... . ... .. .. . . ._., . .. . . �.. ' . ;.. UN�ERSLAB'NOR.�__ ! I 6ereby affirrc�rhov I nm exemp�from rha Controncr's ROUGH PLUMBING li<ense law for ihe foilov✓ing reason (Seci!on ;03L5. Gl�S PIP�NG �-.' '-: 2��.� ��_.�.:� ,' � 6usMess and Professions Codej:Any city o�county evhich GAS VENT reqoires a permlf to construcl,a.ter,impro�e,damo�ish. ; or repci�any strudu:e, prior to i9s .ss�once, c.,'su re- HOT WATEF HEATER � �"�-� �-'"�� _... _.._.,_ . . . .. , yuires fM�applicortt for such permit Vo fife a signsd stoie� PLUMBING FIXTURES � ment fhot hE is licensedpursuonl to tha provisions o�the ....._.,,....._...._..,�,......._�.,.�,.,.,�..�,. . . GAS TEST � - - Confra<tor's f.rcensg Low(Chapte:S/co.mmen:inp N�isi, - UTILINCO.Ni�TIFIE�� � _ Section 7000j o�Division 3 0l iha 6usiness and Profes� , . sfons Code)or ihat he is exempt IFerefrorv+and fhe bas7s �+ fpr SF,e afleged oz2mpficn. Any violotion of SecNon FINAL � �(�[ar on �ronf � �7037.5 6y any applicqnf fo�o permi7 subjecfs fbe appii- � � ' .cpnP}o�civif penalty of nat more fhan five hundred . _. , .._ .,_..�_......._-.„.,�..,........b . . . dollars($SOP}.: INDU57RIAL ❑i,as�owner cf the prope��y will do the v�ork,and ... ..,_....-_,.W_..,�.._.....,...._...�_,..._....'.._ WASTe'P.PPROVv.: � ihe siructure is not intended or offerod for scle. .... ' .�.. . .. . ��.�: . ,. .. . �" - „ � ' - - ' ' � � �(Sec.7p44,�6usinessand?rofessions Code: TbeCantrac- . . �. .3-.:. `�. �. -....-`..- :. --_�._:,.. '..,' , ;, . ,� - .� :. �--. ,;;.,, ,",',�. ��}or's 1lconse iaw does not apply ho an owner of property , _. .. � - ., .._. ... .,. , . ..._:. �. , .,..� '.. .-� . � . . , � - � . . ',: ,.,�, • .•-... - �. _.-...-.�. ��.. � wbo boilds or irnproves fhereon, and who does such - .'� ... ... . . . .� - ...� ....�:....� , „,�,. . �.:.. :;. ..:. ;t_��. �. ;,�" ... .i..:� .- ' �.... . � . ���� .:...work hfmself provided ihoY such improvemenfs are not . , . ��- � - -� � nfentTedo4offetedforsafeWif,fiowever,}he6uildingor . . � � �w �-� -�Improvement is sold withfn one yea�af comple'ion,Ihe '. :`._.-:� ' ..�.v:,.�. .�-.-.--. . .•..:--�.. ::��.`. �. �._ ��r . �.:-��'- - - - . .-ql�vnerbutlderwillhqvetheburdenofproving�hcthedrd ' . .,�., �� � . ,.:�� .� ,.�- . . �;�. ,.,, .. _<.; . �. ,_"- � ; . .a: �� . . �..__ '� � _�� � " ••��� - ���- - � - - � riot build or improve far fhe purpose of sole.J . ..�.:. ._ ,. . .,. �-, . -_.:-.-..« , .: ��.., ...`�., .�, . . , - . : . � - . .-, � .- . , . : . , . . �� �.. . .,,,_._., "�.:���. .:.-�... , . � . . �... , -:.� . � ; ,. ' . :� I am exempt under Sec . .... . . . . .. ;, � ..' . �_ - �:.... . . ..: .. .... • - .:. : _ � ' � ... .. . ., . . , .�.. . . . .. ,.,: ...� '�.��., � `. � ' �' . . . - . . � . . ` , . . ,. _., . ��... :_ ._... . . .. -"..���.._ ,._�_. '::. :_. 8&P C fcr this eason ry4 ....... .:.. : _ , - . , �£... ..�. ;., �:. . . . . �.r.,,. ;. . , �., . .� . - , -, _ .., . .. . . . ._ .. _ _ . . ... . .... . . ... , .. .'� .. . " i .,. -.., . . . .. . ..� . . � - . . ,..; `.:. . �� . . ,. , �. �- '�� _.�_ .. Ca,e� .._.. . . . . ; ,...:. ._ . ;. _ .._ _ . . � .. . . . . . . , , . . . . ..- :�'.a. ' '. � _ .��,. . _. ; , ..:...... �.: , �....-<� _ _ �"... _�>..._ .,�:_....Owner . . . INSPECI'OR'S NQTES ...� _.. _.....r ._,.�.», .. ,o. . . , , }' ". _. t .- . . . ... ... ,..... . ..,.� �,,. . �..� s.,. � .�.,»y,... . ..,._.�_ ��_�_-.•v. •+,.t.:.a...a..._. ...._.:.-rr.�r_.s:�a�,�-.._ . _ � . . . . .. . . . . ,. � ' . - .o.rr. . . ;.: .; . . .. , . .�•.. _� . ..c �.,... . .. . 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