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HomeMy WebLinkAbout1137A . "'°RKERS"�°^"�"S"T'°"°E«AR"T'°" APPLICATION FOR PLUMBING PERMIT ��j� �eby,affirm that I hove a cartilimle oi wnsent lo xlf 7gqgg�p ._ _ _ e,or a cerlifimte o1 Workeri Compensafion Insuronce, CE 817(HEV.B/88) , � � ' � - � " ' ��� .,cerii(ied copy�hereof(Sec.3800,,Lah.C.) � � - � ; � � " . Q���605739 ���ands Insurance COUNTY OF LOS ANGELES DEPT. OF.PUBLIC WORKS Certified copy is hereby furnished. UII1tS 429� �3�, 431, 432 � � FORAPPL�UNTTOFILIIN(PRINTORTYPE) BUILDING L921 Estoril� Dr. Ceriified copy is fi�ed wilh 7ht couNy bui�ding inspeo ADDRE55 liondeparlmenl. NUMBER FIXTUREOti1TFM �4 �E LOCALITY � � � � � Date HIZG�H7APPIiSant Amatore plllRlb. 12 WATERCLOSET G. 7Z �0 �AREST • .... . , CERTIFICATE OP-EkEMP�ION FROM WORKERS' $ BntH iU6 (. Q$ QQ caoss s,. Porto�Graade/Montefino � - . COMPENSATION INSURANCE . SMOWER OWNER presley of 50. Cd (This�Mion nNd nat b�compl�tad 6 th�work involv�d b� 4 � 6.� 2 4 00 � � 1 c e out � Ih�p�rmlf is fo�on�hvndr�d dollan(5100)or I�n.) 16 UVATORY � 6. 96 �� qppgE55 , I cernfy that in the performonce of�he work fw which ihis SiNK • arv � � �Irvine � 660-0660 permil is issued,I shall no�employ ony peraon in any monner TF���� . so as lo betome su6ject lo the Workeri Compenwtion laws. D�SHWASHER � 4 6. 24 00 corrta�cr • � �e applkam 4 CLOTHESWASHER 6. 24 00 A�E� 127. W. State St. :^rce rc asruGl�JT: it. o�tcr ����.��,y a�c�t�na�wir �r ' `°-�mpflon, you should become subject lo the Workeri SWIhVA1NGR7IXRKEPTOR � ,pe�sa��o��o��s�o�s ot rh�La6or Code,you must farth- �qWNSPRiNKLERSYSTEM °TY Ontal'10 ��•�� 986-58 8] .�h comply with such provisions or Ihis permif shall be STA1E � 'IIC. deemedrevoked.- ' � - � � WA1fRHEntER �KENs���o. 355068 anss C-36 , LICENSED CONTRACTORS DECLARATION dSTR�CT NO. PROCFSSED BY . I hereby affirm 1{wt I om licensed urder provision5 of Chopte�9 4 GAS SYS7EM OUTLETS (.. Z Q� l D - �011� . (commencing wi�b�5ection 700D�of Div�son 9 of the Bosioess . 4 ounEiSoveR ,§ ( Q� ond Professions Code,ond my Iicanae is in full fwce arxl eHeci. s aea SvS�rn FINAL VALIDATION O License Number 355068 �ia Closs C-36 onre ���� � � FINAL/'�, p �a�ore Plumbing, ��c. 8/26/87 sr ( �Y � on r�ac or e . W � ❑ I am eaempi under Sec. d � B.BP.C.fo.rh�s reowo plon check fee �1 1 �7 A Z - �O1e� - PIUMBING PERMIT ISSUING FFE S 10 �j0� t�• • • • •�J Signu W re TOTAL FEE 376 SO I •J 7�Z Jr� � .. . .. .. . . . . Plan check opplicant . • •3 7�.5 0� � -� SINGLE FAMILY - � HOME OWNER-BUILDER DECL4RATION Name , O�a 2 E�+`S% ' I.hereby aff�rm tha�I om e■empt from the ComraUor's license qddreu - � - � � - - �� � � for.rhe following reuson(Secr�on 7031.5,Business ond .eseions Code); City Tel.No. . ❑ I,as owner of the property,will do the work ond the . structure is nol intended or offered for sale(Section � , � - , 70U,6minass and Professions CodeJ. .� CONSTRUCTION LENDING AGENCY � ' " � � � � � � - � I hereby affirm thot there is a conerruction lending oqency for the pedormonce of Ihs work for whith Ihis permit is iswed � � " � . - . (Sec.3097.Civ.C.). Lender's Nome ' Lender's Address ' I cerlify that I have read this oppiiwtion and slaie Iha�the � � ► - - � � � obave information is cwrecL I agree 10 comply with all Counly , � ordinaaces and S�are lows regulating Plombing,ond hereby . . . . , .. outhoriz r presemotives of this Couniy to eNx upon the . - obov e oned roperty for inspec�ion purposes. � SEE REVERSE FOR EXPIANATORY LANGUAGE Sig t e of Perminee Dar � '� , � >.S p G 'C t. �J 'O .� � -C G 6 L« p �n C J p `� C C�� _ ' . _.. " ' _ ' ' _ ' _ ' f I� _� � 0 3 ���_���. t -� �� � =1. -� ��� -- - , _. �, � �n -, e�o Y'� O'r_�,�. .p C� Cc _��� ck' , i . ; � - • , ��. • � c ,•`F- c,a.� N '�, 'J. _Y �o-� o�' � � „ � • _ � _ _ c o�..c � } =� o .� V::i o_� •- � `� I _ `. _ .�. � , - ., . ;�, ° `.J c c 'U . �.'C,a oT�o c'' 3 aL .., .�� c c^ � - , : '- .. . . - - ' .: ' � � � !C •n ' C,� _ �, .0 .,'1-:��0,U CJ C � C � i i] _ .. . - [' . 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