HomeMy WebLinkAbout0786A (4) -„`>.'r ra5� � e� y ^,. 4 - r�2,�*^� -i�'� ��' �rw r.t _. , . , :..^�.: -- ���e.'°� `'� ��,�^`�` � 4 s�'���'���$�m ;���t ..�,*+�s �� ���.�/1 :.��sR} � ��'F�`�€ "n'�" -,,..,..��1 '.V:,'��,a,�y�'7?�'t���"�- . .°� ��/ �O.r�PEfYSkTi�t6�C�RA�ON _ 4.. . . � �� y £ �m, �r,. � ..a.�,� ww ��.:�.r�. .,. . ..e _ � I hereb� a�fir�ii at I Fo e a certificate of conse t to se� �yqgy7q � insure o a'-ce t f cate of Workers'Compe sation Insu ance ce 8v(eev �OiB�) or""�t�n f e.d copy lhereof(Sec 3800 lab C; COUNTY OF LOS APIGELES BUILDING AND SAFETY � � ��-SY°��x a�8s..��',�s.5�'"�'.-�� ����s�" "�,a��s�"�-��.�'� ���{�,:,tr���.,.;�uz..r.���?�;��ay`."�.a�,;��3";:L�"r"_�3r�#ez�:€�.�d"�.,:'�:,M:'���"r."�' - -� r Po�icy I�o. �Compony . �'�3'4'�t%'�'a;aab°"n�;?�i,:a�':�.�':.i�,.r m :..,��„F�cB���.: ��.❑ rcs� Certified copy s he eby fumished "" � " BUILDING ry ,t ]� � ✓Jf �,r�5...,�.,,,.,.,,,,,n„„ ,�,�- �x- - � -�,,,, � - -,,,,„ FOR APPUCANT TO FILI!N(PRINi OR TY?E�_ O CerY4ied copy s filed w�th�he county build ng ispec- ADDRESS fl nt �O lJ L }� � , fion deQo ime � NUMBER fi%TUREOR ITEM C� FEE . LOCAIIN � ADafe ����' '�����•Y='k.�»�-'3.�.� WATERCLOSET � . . .. �PP}�a � NEAREST S,1 :�: i� �'4'g1?" �r -_ ...- CROSS ST. �C��CATE�EXE�Iv�P'f�IO�I�FItUMG�C'Y�fCE�F� BATHTUB _ . � +r - C��tVEN"SA7f0�`ilvSl�kA`NCE'"� � � - �� owNEa �f{�- �.,� - � �x✓,ww.ta.t.�.ti.+wm} w . e.+.,e .. .,� SHOWER O �1✓•+ r'�� ,�This sechon nee�nof 6a camplalad of T`�ie`worsk mvolved Sy __ _ .._._,___— ...,«,...�-�. [^ .} �xtFe permif-is for one C�undreFl dollars(S10D)or less.) LqVATORY �DRESSaDy � �- !��/!J`t �� „R, .,:>:.aa:..,..�_........._.,.,.__,..,.., .«.:»,.:.:... . . . .. . I ceriif that in t6e er�'ormance of ihe�work�for which ihis "�s`' "°p"�'l�mit fs-issued,I shol)not employ any person in any manner SINK �, (/^)} CITY ' �� TEL.NO.,�, 7,q -"'so ds to bemme subject to the Wor s'Co ensat�laws. o�St+WnSt+eR � sg�,M��� _ , .�,�,��..�„ �ONTRACTOR ' �'� � �y �p�e Applic CLOTHES'NASHER ADDRESS �r � �""�"1�7`��CE Yb APPUCANT: If ffer maki g this Certificate of ��� ;,:$�,� E'xemption, you s�iould�oecome sub`�ect��b �he Workers' SWIMMINGPOOLRECEP70R � �.,;_.•�.�. CITY TEL NO „=F Compensafion provisions of ihe Labor COde,you must forth- LAWNSPRINKLERSYSTEM i � � 'L z �.��,'�. t�h comPly with such prOvisions or this �ermil shall be. STATE /` UC. -`'`y -��"'tleemed 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 � '+��_!-:y, r ,�w.l� ,�,�.�����,�;�.n;..�y..��.�*;F,cr.,;�.?�.p� PLUMBING PERMIT ISSUING FEE S U t�'rj �,k��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 ��"` P fe a_s�de)'� ... . Cily . .. .Tel.No.. . e� .. . . . � � `� I as o e of ihe property,will do ihe work and the � S.�4 ����,'�. �slrucfure s �oi ntended or pffered for sple (Sect'on , , ► x�'��' �70dd Business and Profese ons Code}� � �� � � ' - - :� �s�. Y '.. �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 ��� � �.���RUCTIO�LEIJ�ING�GENCY ...... .,� ..,.....u....,., .,.�.a�.:.«.,;�.�.,...,.,..,.ti,...,.._..,E.....,�...w..... -�,_.,....-.v,sw._� >,,,,�,. ,..<,_.�._»a.�.ac..�.,.....n�„.:«J:s.,,�.......-a�._,.,,.....F.,_,.�. ......,.. ',s� e eby aflirm�th'of ihere is a consfruehon'lending agency for' � �"lhe performance of the work for whmh ihis perm 1 s issued . . ��_ `(Sec 3097,C C) y.#`�a'i'�.�"r�p� s�0 `�y"e�,� � `�� � ,1_,rf �+'�, x. ta�: R � ,��,,_�` i '� � .�+ `� �. �����.���xk -�� . 9 �.. �!3 t 3d�.'x. � �:�' .-Y'�E 9�� .J���s� �'w��� ;�4��`*��i�c"''�.`k^c�3.-,a+c.e'di3��Ts�t"'�x.S�`�tX^«a��� .,yP.^x'"; en e s a e g ���xsa��x�a.,�-,,�` �'� �e��v t,�'� ",� { � `` �'" t "� " �" � r <��x 5�?..u��''-�.+��.. ��:i..���. ,.,�-a;?�"�.sr'��$ ,.. ,s'>,.'. <k i ....xC..- ��^t��.11�:��^� �� �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 egulating Plumbing,and hereby � a iho ze:representaiives-of this County to enter upon 'he ' k�'obave � fi " d pr pe�ty o inspec�ion purposes. SEE REVERSE FOR EXPL{lNATORY C!SldGUAG& ;,��s:�� ���—� - ���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, ' UTILIN CO.N2JTIFIE�' � _ Section 7000%o�Division 3 0l iha 6usiness and Profes� , . sfons Code)or ihat he is exempt PFerefrorv+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?rofessionsCode: TbeCantrac- . � ����� � -�' .-� � - �� - : '.• �, ��' �.� - onse iaw does not apply ho an owner of property . ,', .:.,:. ,.'_ ,;:., - . � _....- .. _ - _ ._�.. ; . , ._:.' - ' '� '� "" '�' � �'..-...-..�. �.. �� ' wbo boilds or irnproves fhereon, and who does such . . . - ,: ' . .. . - - '� ... '-�. � ' � .� ...� ....�....� , „,�,. . :.. ::. ..:. :t_��. �. „�" . : �. .- ' �.... ' -: -. '... ���� ....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.,,. �.. , �., . .� . - , , -, _ � . . .. . . . ._ .. _ _ . . ... . .... . . ... . , :: ` . .. .: . - . , ;. .. "4 .;.. -... ,. , :'�- '�� � _.�_ ....Ca,e�... . ...:. ._ . , _ .._ . � ;� �:.. . ., , , . _ . .. . � . . . . , . . . . ..- : .a. �.: :. _.� , �..�,. . . . . . � .:... _. . , ..:...... , �"... _:..._ .�.-. -���� •"Owner . INSPECI'OR'S NQTES ...� _.. _.....r ._,.�.», .. ,o. . . ,:,. ,. .. -. , �. . . . ,...� ..,.� �,,.,.'� � �...�s.,. ��.�.,»5..:. . ..,._.�_ ��_�_s. ��t.,.v.�.. . .._-��_.a�-,�.-_ t- . _ � . . . . .. . . . . .. � � , . - .o rr . ' ;.: .; . . .. , . .�•.. _� . ..c �.,... . .. . ' '.� :�� ._...Ai.:. . ..' ' -...f: �'.ux �'w3`.. ..,...�.: ..-....'•e....�:-�n Jt -.�-<ai:a.x,.,tb.ase-;:isiWiwyv�.,>/Aee+sM.ue3�`e,wr�+4�•.e.Jtkx�6is ..-,w� ' - � .� � . `"M1N�$�'��AN.�R'.eNcra.-^ . � .. . .� :. ' . �.�..' � ' . : ", ..' ..'_" , . ... .. C..t �.. . 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