HomeMy WebLinkAbout1778A woR�Rs•coM�NSATioN oEcwRAiioN APPLICATION FOR PLUMBING PERMIT +
I here6y afRrm tha�I hove o ceNificafa of coment to self �yqyy�p �� /L
insure,or o cerrifica�e of Workers'Comparoa�ion Inwrance, CE an(RFv.IOiBI� � .
or o cerrf�ed copy�he.eof(Sx.380�,�ob.c.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
ac�$53213$9ComPoov FrPmnnt 7ndPmnity . '.
Certified copy is hereby furniahed. �i
� FOR APPLICAM TO FLLL IN(YRINT OR TYPE) ����'l A
.Certified copy is filai with rhe rnunly bu' ing ina ec IJoFU
� 1io�departmenl. ' NUMBER F17CfURE OR I7FM O F� �p�q�ITY Diamond. Bar
Duie �+���AppliSanf -�f WA�R�� � ' NEAREST ' ,
CERTIflCATE OF El(EMPTION FROM WORKERS' n,� ��+T�e � — �ss sT. 60/Philli s Ranch ,
C�OMPE7VSATION INSURANCE �. 5�,� °w"ER Soutl� Countr Co
(Thl�a�N�en nNd not b�wmplet�d if th�work(nrolrsd by ���
the permlT i�fer on�hundrad dolien(SI06)or loss.) IqVATORY qpp� j
I cer�ify Ihof in the perfwrtwnoe of the work}br which this . �
permit is inued,I shall nor emp�by any person in rnry monner SINK [ITV TEI.
SO m M bemme subjecl fo tfie Workeri Compenwlion Lawe. ' p15HWASHER � �
eowmner«eR.C.R. Plumbi.n INc. �
Da1e eppiiCaM QOTHES WASHER _ A�� . !
N^`ICE TO APPLICANT: 14,oRer maki�g�his Cerrificata of �.2 $ M OZ a Ave. j
1 jption, you ahould becoma subjecf b fhe Wdke�i SWIMMRJGPOOLRECEP�OR �TM . �� _
�l ,l,..npenmtion povisiom of 7he lolra Code,you musf foAh- LAWN$PRINKiER SYSTEM
with tomply wiih such prorisiom m thia permit shall be STAIE LIC.
deemedrevpked. WniEaHEnYER �No. 33fi428 � C-36 1
ll(ENSm CONTRACTORS OECLARATIQN D�SiR�CE NO. PROCISSED BY . j
1 hereby aff irm that I am licemed urder prOrisiotn of Chapter 9 GAS SVSTEM OUtlETS ` � ;
(commencing wifh Sx�ian 7000)of Oivision 3 of Me Busineas pURE15OVER . y �
and Ro(essirno Code,and my Iicelne is in f�ll force and affeN. 3 PEN SrSIfM FINAI � VAU ATtON � :
� - DATE I��N��y v :
liceme Number._.�_lit.Class�.�,�.f� � �
FINAL O
r�no��o� RCR Pltlmbinl; �re6/19/85 Br c�i
� " �177.8A W
I am eKempf unde1 Se[. N ;
B.BP.C.fa this repson , #• i • � �,rj � i
Plan check fee
�re� PLUMBING PERMIT ISSUING PEE f � b I � •7 6 5 0 �
Signotwe = .
TOTAL FEE �G.�'O • • .�]Q 5 0�
Plon checic appiicam - ' Q 7,2 9-8 5 �
57NGlE fAMIIY �
HOMEOYVNER-BUIIDERDEUARA710N Name R.C. . I G, .INC.. �
� � �nby offirm tho�I om ezemp�kom fie ConkocMr'alicerae p�rcss �
f �._�/for the following reason(Secnon 7031.5,Busmess and � - �
- , Profe:sions Coda): City Tel.N �
� ❑ I,as awner of the property,will do the wo�k ond fhe . . . - �
struclure ia not inteioded m offered for soie (Section ► I
704A,Buainess und Rofessions Code).
CONSTRUCTION LENDING AGENCY .
I hereby offirm thot there is o conahuclio�lending ageney for �
the pe�formente of Ihe work for which Ihis permit is iasued
(Sec.3097,Civ.C.). � '
i
lende�9 Noma '
Lendx i Addreu �
�.
1 cerlify tiw�I hove read tFis opplicotion ond sfaie tlwt the � -
a6ove infamat�on is correct.I agree to comply with all County
ordinances and Sture laws raguloting Vlumbing,and hereby
oulhorize represenmtives o(tbis Counry�o enter upon the , �
above-men�ioned pro ny for'nsp tio�purposes. ;
SEE REVERSE fOR EXPLANAiORY LANGUAGE
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