Loading...
HomeMy WebLinkAbout0793A (4) �'rr'-----^-^ WORKER3'GOMPENSAiIONDECLARAi)OPt....--.__._.�-.._,n.___..... ._. . .,. ..�:.,,..._..... .__......__._._""' , APPL��ATI 1� �+D�PLUMBIN�% - F I he�etiq afflrm fhpt I haro o ce�7lfkctt of eqrq,ent M teM 76,qd67q � - _ � imu.e,or o cenffirAte of Worke 'Compdowtfon tnsu�ance, �fe dl7�REv.l0iet J � � - ` o.a�ernsiea��at(S°`'�j��� tOUNTY OF L05 ANGELES . BUILDING AND 6 a �o�cy Nfl� �<,brn�+�Y. I�; . ,.,CAU`D , , v..� Ce�tiAed capy ia�+ere.Uy fnmist+ed qp� r� ❑ FORAPR�CANf TOi1Ll IN(PRINTCR-fYPE) .�ADOR�S5G�:�.�V�. '�FTiC.L�O4��E / ` � Cerrtfied�mpy is ftled wirh�he ve1 b itdittQ inspec• � rian deP�+nmem. . : aPNteER FlxNRE OR i1Gn �7 EtF " ou�e��.n�atr�onr • I . � f wnrEaa�Q !�D iovuirsr �/f1i1�fJ111� �' � C�RTIFfGATFQFF.XEMPT NfR0f4` �5f{KERS' .3 .� �sR�nrac: �Qo �"'�.5� � � a S CONlPEN5��l9SM1E]5�1itA[7� � SMOWER P� �R _ . -L-/ � . (Tht�welton eNd ne16r e0inpf�iW If'fh�'�4tlClmeb�d 6y �q ,t A E thrp�rmNi�fotoer�undrnd�do116n{t1DOf'erl���.} �� uvwtoRr . �70 qppRaS � �. ` („�/V Q �. I certtfy rhpr ieM the pl�d�CMtYnci}9f�fi��wprk iM wf+icb rl�is �+ Y� �M A - ? parmN is isave$.I shHChnotq�PlayqnY�qOmin 47tY monner � ��' �a ,�R - �•Ib 6 0 jl �''. �.� �$'S�, ao as b become wWecr�a�he Wtltkexa C�npentptio»laws. , ai5�wn�R �p �� � � a Date ..�PP.�ktln1 -- _- . CtAR�S WASHER • �� . _ _ . _ NOTIC�TO I1PPCICAIUT: tE �iCRt a�kinQ.tiUi�ftMiB oi � � E�csmptian, qou shOuld b6�rtlp tub(6LF �O• 6 Wprkeri 'SW���'P���� . ��/�y� _ I fart+Penea�ionFro�tliCm�of��ket146Dc[�de.YQY4lulifOrlh• IRWNfiGRWfQERb'151FM . GIV �.��Y,lY.� � TEL - �. , wtth compty wif6 ��ch ptrnixions qr 161L p9tMit�helf be STp7E uC. � .3S15o,� �-36 I deemnd rerok�,d. � wnrER HEafER � uC�r�SE nio. anss �' UCENSED GORITRAC7Z)R$`A�ATtON DISTRICf� 8Y IhereaYaflUm��hCtFCmUC� W(dQtP�Dv1415Ng+ofC�Pler9 � �GASSY57FM �' OUTlErS �0 .. 6 ' (cornmp�ny.re�+h Sawan )�Atrt��po�3 9f rhe @us�ness ountrso+�a 5 � FlN/u . AUDATION � i a�d vrafexi�oin Codo-.�d+mrheeeqs�a�lffllRfQ�C0�40t�,Eflecl. S PER SYSiEN4 Licensa Number"'�/v-��%j.- .iiC.S'�pas��"' DAiE ���'" � , � �i13��r DRIJJK oc� v+ Q� o �o��.�o, � n,o��, ., :. 5 F�+n�R- A AINS . D �' Y � � ' � � I om exemp��nder Sac. - Z , � e.av.c.to,�rw,.eosa� Plan chqCk fee — � Doro: _ . - ,. PLUM6UIG PERMIT ISSUtNG FEE i �' � Siqrrohre .. TOTAL FEE Q� � Plon check applievm . SiNGL�FAM11,r HOME OYYNER$If1t�Ea'�ECIARATl4N Noms ' 1 he.eby offlrm fhar I otn exemp�frCm thq C.onhqt�or'e Lieense � �, law far rhe tallowfng.eC�on(Semea fd3t.5;6osinefs end Addrsf� ' .„^c.,'h �. � Vrofessio�n Code). � � Ciry . tel.No. �,�• • ° •� �� " ❑ I,a�owner oi the pro�pery,wdl do rhe wqrk and rMe - . ► . � o �c`l (.�:�,i I snunu�e is nor inrandpd�r offmced fa.wta(Secnon �� 704�,Bueine�.t ond Vmteuivru Cede� ' � , � . , .. ,-i:-;': CpNSiRt,fCTION.LEN4ING AGENCY � � , � i. I hereby affirm rhoo rhere ia o carmhuctian lending�apeney for � b L G.''.-?;`� , rhe performorne of�he work for whicA rhrtpermn ia issued �, (Sec.3097,Civ.C.) . . ' . Lendera Nome � Lender's O�d�ess j I cenHy thot I Iwve+oad this aPP��tlqn qe�P�npte thp�the ► , ��, a6ove infarma7ian is conect.1 tt8rC0�tocqmp ly.w[thdll f30unty , �� o.dinances ond Srote Iqwa�e�Klp�tng Olymbing�a�d 1�reby , � � cuthonze roprlsantpBVBs qb iNq Cpunt�U7 adtpf upon�he i o me rane�t-ropA to.�n�p6cnoRvuraa�ua. 6EE.R�!'�RS�.�FGA'EXPIA�IATORY IA.NGy9�€. FS! � /�'J�" O O�- . IF $i���f Permifiee . Date � � ' Y ; � _.. . — _. _ . _ _ _ _ �� _. _ , - -�APPROVAlS' pATE . WSPECfOR'SSIGNATURE INSPEC�OR'SNOTES , .. 'ObVNER-6UILDER�ECLARATION . �. � UNDER SLAB WORK f—�7 // I hereby affirm�lha�I om exempt�from~he Controc}or's . ROUGH PLUMBING� -- 'r . Licenso Low {or the followinc� reason (Section 70'31.5, GAS PIFING . •�•� -�.1'. . ._. . Buslness and Pro/esslons Code):Any Nly or counfy,which ' GAS VENT _ _ � requlrni a permlt to consfroc},alfer,7mprove,demolish, �'� HOT WATER HEATER . ' ,or repol�ony s}rucfure,prlor fo Its,7ssucnce,�elso re� � - 'qufres IMe opplimnl lor such permU lo file a slgned stafo� h PLUMBING F6%iURES � � � �• � � � ' �,�„ menl}6af he Iz Iitensedpursuanl fo Ihe provfslons a!tLc GASTEST Con}racfor's Gcense Law(Chepler 9(mmmencinr�w;fh UTIIITY CO.NOTIFIED " Setflon 7000)of Dlvislon 3 0l fhe Buslness cnd Pro(es- . „ � , � s(ens Coda)or IhaY he Is oxempt Iherefrom and t6a hasis � ' !or Ihe aIleged exempllon. Any v7�fofion of Secf�on FINAI �` " c7 . . , , 70]I.5 by ony opplican�for o permif subjeUs�he appfi- ; �--•'C l �<n(er on yroaf.,,\ .':�,i �' 1 . . . . ' . � � � - conf to o clvll penolty of no�moro fhan live hundred �" aarra�5�ssoo�.: � INDUSTRIAI � - ❑I,as owner of ihe property will do Iho work,and WASTE AFPROVAI � _ ' ��� iha Slructure is nof intended cr aifered for salc. � (Sec.70M,Business andProlesstons Code: The Con�rac ..���� •.,��+�,��.� .�� �' '-�",' �-`' for's Lte�nse Law does nof opply lo an owner oI praperry . �.`._ . _,� �++`-y-', , who builds ar impraves thereon, and who does such , h; � � ' . � work hlmsalf provided that auch Improvemenls are not � lnfended or offered for sofe.B,howevcr,1ho bvqding or �� , , . . -� fmprovamen}Is so�d wllA(n one ycor o1 complelion,fhe � � - � awnar-b�llderwilfhavelheburdenolprovingrhathedd , ' not bufld ot improve(or fhe purposc o/salc.J � , . , l: . �,.,'�, , -, i'. „��.i -Y. I am exempt under Sec. , � �.��� , ,. � ,,,,.� �, ,._ . B 8 P.C.for lhis reoson i . , . ., .. .� � .. � .. . . Date i • Owner � f WSPECTOR'S NOTES • � � t I � f � 4 � � ,� i . � -' � , �