HomeMy WebLinkAbout1787A (19) �RKERS•�o^^�N�,i�°N°K�^R^T�°N APPLICATION FOR PI.UMBING PERMIT � �i
I hereby affirm thot I ha�a a certifica�e of consent�o self 76qyy�q +7_ i
inso�e,or a cer�ificote of Workm'Compe�wtion Insuronce, CE 817(kfiV.IOiBI) - OCJ
or o cert�fiad copy therooi(5ec.3800,lab.C.) COUNTY OF LOS ANGELES BUILDING RND SAF �
Q����°'"f+o�Y FrPmnnt, Tnriomrtity � . ,.a.A I
Cxlified copy ia hereby furnished. BUfLDING
� . FON APiLICAM TO RLL M(GRINt OR TYPE) �� � ��,
Certified copy is filed wilh the county 6ui 'ng insppc-
fiondEpartmanf. NUMBER FIXTUREpRITENI � � ,pc,�ar Diamond Bar �
Dare G��Appli�pn� wniER[LOSET • — �� . .
c��iFicnh oF ex�u+pnon�FaoM woaicEas• enn+rua r ..� a�osssr. 60/Philli s Ranch
COMPENSATION INSIfRANCE �R � South Countr . Cor .
(ThM s�efton naad iwf bs eempt�f�d tf ihr werk InvoM�d by ii
th�p�enit Is Ior on�hundred detlen(f100)or Ian.) � IAVAiOav � qp17RE55
I tertily thof in the performpnce ofi the wwk for which this I - �
pprmit q issved,I shatl nof employ any penon in.arry manner �K C�r . , hi'
ao ns�o become subject�01f�e Wakers'Compensot�on Laws. � ' �
� OISHWASHER -- ��TORR.C.R. Pl�mmbin INc.
Dnle nppliceM C10TNE5 WASHER �� . '.
� ' �CE TO APPLiL`NM: If, afte�making this Cerri#Imre of 5�������� 1 �8 O�.� — �,
4. ��p�ion, ryw shoald beeome su6jeee m the NYorken' �ry �,Np.
Cctmpensqlion potiaiony o4�he Labor Code,you mua�forlM � �
IAWN SPRINKtER SYSTFM ,
with mmp�y wi�h s�{xoviaio�P or �his permit shatl ba ��,,�. 336428 � C-36 !
deemed rBrOked. WAIERHEAIER �
iJCD95ED cOHrRA4�OR5 O�GIARAriON wsta�tr tao. amc�sSED BY j
IhereMaHlrmthat�aml�eemed+mdnprwisi4m^PfLhoP�9 c,a,ssvsr�nn oun�s — � } +
(cQmmencirg with$ectfon 7p0p)Df Oirisie��of the Businesa OIlilE150YER . - . d
arnlRofasiornCode,ond�plicpmpipinfylYforceerdeffec�. S�PErtSVSfFM "� FINAL / VA DATION � '
DAIE j� �'f ��j
License Nvmber��-ua CIos3�.�,_ . � '�
f�NAI � i
c��.��« �CR Plimibin��„6l19/85 �` �+ �
� I om exemp�under Sec. N �
� i
B.BP.C.for thn mmon p�an check fee� �
Dcte: p�UMB WG PERMIT ISSUING fEE E Q � . �1 7 8 7 A �
Sigrrohne �
TOTALfEE �Jp�� �r • • .•J� �
�
Pfan check applicanr
sir�ct�fmm�r I • +7 G 5 0
�} HOME OWNER•BUILDER OECLARATION n��e R.C�:R. PLtJMBING, INC.. •
� ,_ hrcby affmm thar I am exempt from�he Connadw's Licease agno 1$ Ve.' � �7�5�" '
Jl6w for�ha follow�ng reeaon(Secrioa 7031.5.Business and Addrass - i
Profenions Code): Ciiy Tel.N ��.2 G �5
D ;
I,as owner of rhe propeny,will do tho wrnk orn1 the ►
ahucNre is�rot inMnded or offered for SCIB (Sarlion .
7p14.Business a�d P.afeuions Coda).
CANSTRUC710N LENDING AGENCY �
I here6y offirm rhoe rhme is o conshuctfon Imdi�g agencY for
�be performance of the wode for which rhis permit is isaued -
(Set.3W7.Civ.C.).
Lender's Nama �
lender'a Address �
I cert�fy�hnt I Mve revd this opplicolion ond atole thol�he , ,
abova informotion is mrrect.I ogrea lo tomply wilh all Coualy ,
ordinances and Slo�e laws regulufing Pl�mbing,ond he�eby ,
authorize represeMatives of�his Counly fo enler upo�the
obove-menfioned p pe��y for in fion purposes.
nI �n SEE REVERSE FOR EXPLANATORY LANGUAGE
R-�=R= B�1l.�Js�'.6/19J85
Signoiu�e of PermiHee Do�e � �
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