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a° '� �-�x'�-�G� � �1 �-' '� : �,. :� t a ,�r�� k' E `.3.i ,x,�, ,a. �`t+'^t. � '� : �n'fi,�.,, � �'' �� ��r. t �' G i ES CK5 d . dr+� a%^J-.�Ya��#jp`j/ M".�-'. j► J h ,...z ; ' „ .. " . ,' ...u.{f,. ,,, :- .__. ,. � Wb�k�ER�COM��J$�471CSN"6EpLAkATION . .. ( , ,� z �P'\4'"�LI��R������„������� .. V������' �.-.,.__ . _:....;� I 6 reby af�rm tha� I fiave a cert ficate of�onsanr lo seif� 78A687q _ . . � � i insure or a�certificote of Workers Com ensation insurance, C6 877 REV.B%86) � � ' _ � � ,sor a ce?fified�cppy ihereof S .39� lab.C.) _�. ... , � � . . -' � �� rot�cy nfo���pany��F��� COUMTY OF L09 �NCELES 8U1LD� QEP�.Q� P�1BLfC VI�OftKS � �....... ,,.., � Cerrified copy s herebyfum�shed . �� � - ��- � .�� . L� z". .- .. •. � � -• �� FOR APPIICANT TQ Fill M(pRiNT OR TYPF) � ' ' x� Cer?�fred copy.�s filed with the-.Rounty bV!Id ng mspec- .. .. . ADDRE55.. ��� _ �Q��� ��C.{,�"�"., � .. � on deparimenf . _ � NUMBER FIXTURE OR ITEM @ FfE ��� ��A�ITY� Dare A piiGont r -, q WATER.CLOSET � '`��'_.��,,. 2__ a �.l.s�i�.�;�3—�..�� � ceossss.' � p A ` �Ek�TIF CAT�Q���I�VI��TY0�5 F12�J�I�WOR�I�ERS� e�, eAiH TUB � , �. ,,,�,This seetion pe not�ie com le9e U���C� � `�- � . . � owNEk . . . + �� � �Gt� �E�YS�'t�dN'"rN . 4 � � �" � , _. . �tbe armit Is;fbc one hun�d dollars S�00 or less SHOw�e - yd P d��tF fXa wor�invofvod by . MA�i - -. ... . a a P i . . � J . ) , �IAVATORY - APDRESS. . . .. f cerf fy that;�n the p�er#ormance�of�tFe work'�for wfiich this � � . � - � �. perm 1 s ssued,I shall no1 employ any person�n'�any manner �� SINK � � � CITY �}��•A�,� � � - � "sq dS"+o become sub�ect(o tha Workers Compensahon Laws. �� -. -_ � � - f,.. . , ;:. � „ - � , DISHWASHER � � f� WNTRACTOR� ^ . �,� �ate � u�� A p�ieanf ,� '�' �� CtOTHES WASHER �.� y �t... .. T7C�E�A���IT--IP after mqkmg lhis Certificafe of� ADDRESS� -�� emprton you shou�d'become sub�ed to"ffie WOrkefs� SWIMM�NGPOpI.RECEPIOH . . ��ompen'safion proaisions of the Lobor Code,you must fortli- .- � . aiv ,��� �� e TEL NO.��_ab � § . LAWN SPRINKLER SVSTEM . ith comply w ih svch provisions or th s permu shall be ; � SiqTE � � ' tiG �� � �- � eemed revoked - � 1�- WATERHEATER � r. �� LICENSE�NO ' �� � CLASS w (` S�" �I�..€t45ED'�CONiRAC�f�SRS�,dEC�Ae��.� ..�."a . . �.- �� .oi57RrCt"No.... ' PrsocE55eo ev�_ }I�he eby a�fvm Yha{�f am�icensed onde�prov�swnsbf C�iapter 9 GAS SVSTE'M ,'- ' OUTI.ETS 1 d; . ✓y��p� ��� � d �ommenc ng w�+h$ecUon 7000)of Diwsion 3 of�ihe Bus�ness - OUTLEt50VfR � . � �� �. ,�� i .�, 'and Professions Code ond my imense_is�n full force and effec(., 5.PER SYStEM FINAL-�� � ; r� �, � �c�' VALIDATION �,y L cense Number ���v����Lic Ciass � ��n . DATE. � : 7��(:� , �.�c�c+.r.. -2. � �. . r Contractor ��'l�'Gh@'��!-'k�D�ae e�?r�V °�.� �� . � . BY A` ��.(/s""'�.�..� . U .. - „� e--xr � � I am ezempt under Sec �� .. . , � . . � - G�.3�7:�7 A. � � .V1' 8 8P C,far tf�s reason � - -� . . � � . � � � Plan checkfee < t 0 � � � 0 5 ' �a�e � ° � �y .: ,F.T. �. _ _ �:.,.dz . PIUMBING PERMIT ISSUING FEE$ � ��. � - � �a m.`]Ey S�J _ ._ SignaPure � . . .. . . - . . `� . ,µ �. y �� '. ��; � TOTAL fEE �Q SL? � » M �a`7 E.�w U c� ._ . F :. 4.' �_ � .. . . - . . . . . '> ' , �. Plon check applitant � . . � � ��.4.,��_� . . � � SINGLE FAIfhILY � - . - � ,e'"'"* HOME�OWNEk$UILD@�DECL�RATION � Name �� ��� . � , - . � u�. __ . . . . re�by&ffirm that I ariiexemp9�om`t�Y"ie Confiaator s liianse � .��dress � � � , '«iaw�or ibe following reason (Sectiqn 7031 5,�8usiness and �� - - � � ���� . �� �.� � � .�profess�ons Code). � :� �� . �Ciry_ � Tel No. �� � � - . , ❑ I as owner of tFe� ro ert wil(do the work ond the� � � �� � P P Y structure is not Mended or offerod for sale(Sectipn, , 704a Bus ness a�r,�n.d.Profes5ion5�Code) � � � � ..�.; �C�QN��u�TP�N�CEf�(IJ:�AGENCY` =c =to": r ': � _ , ,. ... �' . ,.._�. , y,-:,..,..,. .,., .,».�� �� , ,,..:�.,...�, .,.�. � � �, .�.,... 4 y�.,,.. . ,� .u„. .�, , .�� �.,, � . . � . 1 hereby af4�rrri thari`h�ere�s a"constr'uchon feni�;ing agenry�for��` �� � ' .;.the performdnce of tFe.work for�wkic,h iFis permit is issued � � , ._,:,- _::, �'.'., . �; � , - � ..�. (Sec 3097 Civ C) '.. . . �" - . . . , %;: ." „ ..;::q "... . ;: , ; -«..a ,�.� � �_�� -c-': }y�-�t - . 3. �." .; '�`.� � ,�., . . . . lenc{er s Name . . . . . ' . - �._ t a � ,� � s � a .a � 3 ..�i�1.:�,.. s�.� �' "�; . Lender 5 Adt([„ess ��� � :: . �`��: �•' >'. < `�. .xT ,. ,�z§ .�:'Ka 1 .:� �'',a r , . . . . . . . .. . ., . .._ .,<.»:. ,:�� ..,. ,- .,, ,._.. ..,,� �. .. �. ,. .. . . ...._,� _ . .. , _ . ,_.. .. I"ce niy i�haf`�t ha e rea{�ihw appliFat on anctsiate�hat the , ���, � `�� �' �"� .,,above nformn�ton�s correct I agree�fb[omply wiYh aN Counfy - � ,� � � . ,�°ordinances,bna$to�e la��s�egolat{rtg Plum6ing,,and hereby � � , � . � � � �� � : . �- . . � .. . �,. aulhonze represen�toiive3 of tM�s County to enter upon`ihe - � - - � � � � � above ment oned property for nspection p�rposes - - -' '�� .. .. � � . �_ � . .� ��„.�� �w -�� �� �-..�.: �^w ° �-_ ��, �^.���� 5EE REVERSE FOR�EXP[a4NI�TORy LAN6UAGE � ���..�° 3 ' _ _ � � 9 �-� S gnature o Permi�� e Ddte � � K f�a � �a�� �a.q .. � ��a� 3 ''"*� a �� �x�*� � : � -o v � � �. . r� ������.�� .� �������������'������������� � � ' F.i .�..�-�.._.,...,�....:. -: - � ' z�'Bt�"tFaG C�Y�T,'¢'3� C'+v1•5F 1r}f Y� �"� �13f .�'����l�1RA�P .. .t 2?'�t,s . t1 0 Apf'�ROVALS ;;, v . INSP ..C' 41GNATU t _.��F„ ._ , '''�'` � t�t�'���� ���'�a �� , l '`�' ,,,.= . 1�.5pECTGR S NOTES •' ��: .�ROt1GH,PL�M�� +�_ '' ,.a.�� .- .., . . , ha'r:�iy,y- F-'.+� L +R-� t, �' � �]� �� " � -�-,� . t ... fi9 a�fihUF am e_ic.e��s 1 r'4 Tii!h�G ircicro''s . �BI'�C'v ] 7 .. ."`� }� .. . , . .. . n-� /�� x .� � :+ ,+ - .+ .- — �L e .r or,tfi folla}t{}7g r�.gspq-l�ect 7�,31 5.- �:�:�GAS PIG7NG�;... ��„u �f � �� ,,. . ..�::�� ,- ,::� `Sus�ne s a d P ofoss�ons Code� flny c ly or r nP/�c�. / „ -. ....~ ` � ': � .^�-t-- � �`-.- `- , re:7Uir�4"a drh+iar'e�eansirarf.ofrYr`Hm rdvcs:�:dsnStYltsn: ,, 1 '` ':-GAS UEN7 . � �� ' _� � . ' __ _. � r �... _�. � � r � ., _. 1-'�, .,. . -r -- - � �- reprp ary st,y�u�e p o Yo fis rs5tf+ance` Iso rc � HO'f W tEA.la€AT R �: � ..+� . � -- �, ,�- � �"'S�':"" �"�- F v f co�r, fo u 'e R itr-f la�+e+ n _ ,�,_ J .....d 9 4� �^ ., t � �,Y.�..'c�` Pf S�t_(? t� [�XfAle- ..�IWMBHa ,j zi� �,1�t1 ��'�� y � � ��� ��.: .. - .:� ���� e t a7� t h ! e sed pv GonP to fin.p o s o .,or ihQ�. ��� sss///ppp ���-� �� ""�" Cor17t&c�"Pat.�LP crf�f �v��1*o ter 9 camm¢nc n wNh GAS 7EST � � f�� : �- ... .. . .. �Z.� � P -.� 9 u r "'�, �-� Seci on 7DOv)of�D7 is on 3�'OI Ph�60smess ond Profes UT STY�CO.�lOY7f1�D :_. -- . -.. , _. . . .-..,., . -.._.,; .�� 'E -. . �r{'�^ <-•.� -. :�- , "�� ::'GS �'sYi'i`As.:C3"� b�f'�iSi`hercexamn?her@i'Y'on74n5't�ic�'5osis � � 4-- , .. a , ,., �,,. � ,, '- � ,� . �� G',��, ;";^�" �. ' , foi {t4e alfsged'. er�ptlo -.Any olo"forv o'�Sec ion . Flnln�" t� ..�`,'n�q, � � t . � t . '� "TD3�7�5 by arry dpp tcrnrt 4^0'a p$ !1 sJ6��rt rRe i5ppl�.. � _.. � .._._ �_.0 �v� _;.�_tG�%,� � _ ,.}i.t?._:.. . i,._...__,-...,_ .. ._ .,...-_ _.„ ���� atft'�f�a Yieet�''erdafij<oP nfit more t'fi��}�",ya�huifZl'red�. x �. �' t� � � ,t .:.,, '4:�.'� v n,� . '� � i�:��'_ v.�.i�al�re`7�' �O�J .�.�, .� � �,: ,� ,. ..: , .�;.r : , __�...���.� �� ... . � . � . � 1N7U5731aAt�-- ".�.:-.: � -.-.�. .._�>.�- . .-. ." "... � ..-. _....� `. ' -- b .,. I,as owner of tl�e .operty w lY.do Ihe crk,ond�. Vr'ASTE JsPPROVAL �r' _ ' _�`�— . �_„_• ... . . P .„. �+ ,..�.x n' i _ . ,..i� ,�,:s",.,,1 k.� .., .... , _, , �.' ihe structurz�rs'nFt in-zn��c}:o�of-eied;arsnfe - ._ � � _.� .�. � .� . . -- w t �,, �� ,��c�Yb�A � )t'�ssa �r�e son Z de 7`heC � a `�°`c''b�. :1�c,� l 3)�.,.�,� .r'' ,<"�S } _, . ��:� _. �; . ._._ � � ty��s�re s��dqes qp�t'a,PP X fo a�"o�n9�o�"propyrty�- . �,-._ _. 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