Loading...
HomeMy WebLinkAbout0871A (4) , .____—___._�_..----_.-----...__._ ....___.. . ..._.. . ..__.. . . ._... _ _ _ _ �_ ._ ._-- . - ; � � WORKERS'COMPENSATION DECLARATION ��w�s�♦ � I hereby affurp «�t � ha�e a'certiCcete o<<a��t to:e�f �«.,,,=..o, APPLICATfON FOR PLUMBING PERMIT � � insure,or a�ce�tificate of Worken'Compenaation Insurance,or _. . . � . . � � � - ; a cert�ijt.ced Fopyt/J��creof c.3soo,Layb�.C.y7� �� COUNTY OF LOS ANQELES BUILDING AND SAFETY 4 Po77c7�N8."�/ � �PaQy S/�/� � . . . -. . .. , . . � I � Q/1� `1 I_1 � Certi4led copy is hereby furnished. -�FOFl APPIICANTTO FILL IN(PRINT OR TVPE) ADDRESS 4�.��J' A�G�/v �lp�w �. � CMifiod Copy is flled with the County building inepeCtiOn NUM9ER FI%TURE OR ITEM � FEE � � �� de artmmt � - � IOCALITY Q�� � . P WATER CIOSET Date Appikant NEA EST � BATH TUB CROSS ST. ' CERTIFICATE OF EXEMPTION FROM WOKKERS' � ,COMPENSATION INSURANCE � SHOWER � OWNEH 6 h CvQ�'V (Thi3 SeCUOn IICed not be COrtIpI!t!d iT the WOTk im'Olved LAVATORV �- � � qODRE33 PQ��l �w � C}. I by the permit u trn one hundxed dollats (SI00)or lel6J �. SINK � . . CITY �� � p�� L.N�. U �'�,, 1 ceHify that in the pertormance of the work for which this DISHWASHER CONTRACTOR � �►'�S L�/� � � permit b Issued,1 ahail not employ any yeraon in any mannec ��� so as to become 5ubject to the Worken'Compenation Laws. CLOTHES WASHER ADORESS �O � � U Date Applicent - � SWIMMING POOL-RECEiTOR a I NOT[CE TO APPLICANT:If,after making this Certiflcate of GTY �L.N — � O y � Exemptian, you should become subject to the,Workers' LAWNSPPINKLERSVS7EM STATE � UC. Z i Compensation proviaions o9 the Lebor Code,you muat forth• IICENSE N (� CLASS��� �. with compty wiM such prmiaions or this permk shatl be WATER HEATER �� -deemed revoked. � �ISTRICT NO. PROCESSEO BV , ' GAS SYSTEM OUTLETS QQ}- {(y\ I ' LICENSED CONTRACTORS DECLARATION OUTLETS OVER � �O \�LO�On'� '� I hereby affiem that 1 am licemed undm provisions of Chep�er 6 PER SYSTEM . _ . 9 (commencing with Section 7000)of Division 3 ot the Busi• � � FINAL (( r� �� VALIDATION � II. ness and Rofessiom Code,and my licenae Is in tull force and OATE �( � , efPect -� II License Num �� Lic.Claesv—v� FINAL � . BY � ' 7 ' COntractor � Q� Date - " � Plan check fee I m exempt e licensing requirements as I am a I licensed architect�a [e;iatercd profeasional en�ineer - pLUMBINO PERMIT ISSUING FEE S �� �. . acting'in my proPeaaional cepacity (SeCtion 7051, 6us- , i iness and Profeaeiona Code). TOTAL FEE � - ' Lic,or Reg.No. Date Plan ch�ck applicant � � � HOME OWNER-BUILDER DECLARATION Nam� �. � � � I hereby aff'vm that I am exempt from the Contractor's /+ddress�: � � ��$��� A . ,' License Law for the(ollowin¢reason(Section 7031.5,Busi• Gty �� TN.No. . • �•'' • • •J� . ness and Professions Code): . . � � � 1,es owner of the property,am exclusiveiy contncting �- - � � . �, ' ' � • � �O •'S 4'5� ' with licenud coMrectors to construct the project .•< •�4.5 C�T � (Section 7044,Bwiness and Protraeions Code). . . . , � � " �� CONSTRUCTION LEND[NC AGENCY . , , O�S.��J"S�I ' 1 hereby�afCrm Ihat there is a construction lending agency _ � � for the performance of the work for which this permit is . _ . � issued(Sec.3097,Civ.C.). ' ' �� � . - LendePs Name � ' � LmdePs Address ' I certify that I have read this applicallon and stece that the � , . � ' ebove intormation is correct.I aerae to comply with HI County �SEE REVERSE FOR EXPLANATORY LANGUAGE ' - ordinances and Slate laws reaulating Flumbing, and hereby � . - ' uut rize reprnentativec ot thls County to enter upon the " . � �' e-mentioned DroP�Y for inspec' n �p 1[poses. . . . . .. � , � - j A� �d�C}� Signa of Permittee Date , � � � wsPEcron•s NorEs•� � O�YNER-BUILDGk DECLARi�TSON . APPROVALS DATE INSi'ECTORSSIGNATUFlE � . ...... _. _ .,. � UNDER SLAB WORK � ..-. . .., : . . r , ....... . __� ,. �, . • . - � �;� . � ' � � - ^ - '�' � � '� �.� +, ' „'.I�,hereb affuo`Tfiai�!am e.�Cemptirortt jl�c Conqactor's ROUGH PLUMQING � " S- ;— . ��" -ticense-La�s fai Zhe�following rcason(Seuion 7031.5. cns Piairvc � . -. �. . . . . �..-... �....--... . .�.-�- . -... .. .- ... . .:. Businers nnd Projessionr.Code/: Atty city or cou�r�ry � GA9 VEtJT.. �. �CS'... .� �-.}; :.-�-'. , . � . ... . . .. � . . _ . wlticll fPquires a pernli7 to comst/'uct, elter, intfJioVe, HOT WATER HEAT€R'`` � . � dP1110fish,O/reppif O�ty SI111Ctum,pria�f0 1f.� iSiuQrlCe, ' :`�`� - , � , . , . ` also requi�es �7re applrcant for ruch pennit to fife�a ��uMeuvc Fix4Ga s-'� - _ - • � - - � � - � . .siR�red_sta[emenr rlrar !ie-�ic licertsed pursuattr,ro�tke � cns TeST �� � , �, � - � p�orisions of the Contracror's License Law(Cheprer 9 uriurv co.nloridiF4�.: .�'� :�:;i=�_ '-. "-.-„�'+��'. - ..� .... . .. . ... .. . .- -- ._ ... (conimeircrng witlr�Sec7ion�1000J oj Dirirrun 3 of ri�e �� � ��. �---- � - - _ _ �___. ..:___. . _ - . . _ Beai�ress and Professions Codej or il�a7 he is exernpt .a ' t • �,. -� ---'t�.,-.���' . �," � ' � � . therefrom amd tfie basis for,tGc nlfeged exemptia�.Anv FINqt""�- ti�� �'j�E}, �!-G���,'�' : �. . `� ' ;-.-�. ....�.... �,- - -.- . . -- � � biolation oj Section 7037.5 bl'any aPPlicartt fura pennir .. .. � ,„. , i. ,�[ ' � ' �� stib%ettt tlte applicaret lo a�ci��i!penalty o('not more thmi wiv". �.@` �t_, . - �. �� . �Jirelrundreddollars(SSOOJ.:, � � - � WAST�T'AFPROj/AL- - '' �- � ' � - �-� : ❑I,as owncr of thc property«�ll Jo thc wock,and - .. .�� � - . � ��-the structure is not iMended or offered for sale.� � . . . . �... . , - � � .. � .= '� i.-i . �' ; `•:., . '�..i'ti:`..�..�-`, � �.-. .'-- �.... . ... ... ..' .. . (Set. 704J. Busines.c mid Projersions Code: The Co�r• . .�.' .... �.ir. . � �4�._ .-.:��' _.,_. �.._. . ._ . �. . � . . , - � lrcc{or'r Lirensc La�a docs not�appfy to�nrt��oivner of � ::.:. � � - . ..':r . .. . . . -'-'.. .. .::� , �. . . . � .. _ a.."��=' -. ,r:•t �. �•\� a.,. . `. �,�. ... _ -�._ . ..... . ... - _. . . - �����ue�eti orkr��eimrclj proviAcd�tlwriesieh Q'rrProreneors � �� � � , �-� �� � - - � � - � � � � .are.no1 imended or ojJered jor�sole, Ij, leowever, Nte . ._ . ' . . . .. . . . ..-., .... ', � building or improrcment is so7d withir:��orte year of �, , - . . , � cantplefian, the owner-buifder. wi!! hare..tLe burJen ' � - __ . . _. . � _. _� � ... , � - � - - � - -� - � . of.pro��rny fhnt he did not build or improve jm tlee . . ._...._.. . .. . . ___ _. .�..�,.: , . , . - � _ purposc of safe./ . . ' . � ,; . , . ! I am exempt under Sec. ' ' I _. _.. .... �- __ ' .. . .. �._ .. . . _.. �. . _. .�� 4�� ,� .,. �._`� `� .. . � ' �E S:IP.GFar this reasonL - _... ...: �,. � .. _. . .. . - ..... � . . . . . � � . '. ._. .t (-������1ti`i . =� i''��:(;�f' . --- ;r _ _ Date _. , � _- _ aµner i, � INSPECTOR'SNOTES � � � - . . - -� � . � , - � i . . _ ._ . . �� . � , �. � .. .. , . . _. . � . ��.�(���. ` ` \ �, ��. _d 1 ,l\ .��`t!t.'.,'