HomeMy WebLinkAbout1773A (17) `"°R�Rs•`°'"�"�,T'°"°E`�""°" APPIICATION FOR PLUMBING PERMIT � ;
I hereby aHirm thm I hove a certifiwte of consent to self �ypby�q �Q ���
inaure,or p certifiCata of Wo�kers'Compansofion InsVmnce, CE gl7(REV.10/Hl) �•��r
or a cenified copy+hereof IS«.3800,tab.c.) COUNTY OF LOS ANGELES BUILDING AND AFETI( �� �r �
�Y��5�3,Z13s�,� Y .Esemoat ity . �
Potic n TnAPmn'
CMiNed copy is hereby furnished. BU�� i
FOP APPLICANT TO FILL IN(PRINT OR iYPE) 7
�Cer�ified copy�s 4iled wirh�he counry buildin inspec- Nunna�a Fixruxe op rc�+n g � ADORES$�7 ,
tion department.
wnhRttoSEr �°�'uirr Diamond. Bar
Date G./�Appli4aM � � RIEARFST G ' � �
CERTIflCAiEOFEXEMpfIQNfRC7MWORKERS' BATHTUB .--� CROSSST. UO�PIll�-�-1 s Ranch
cvnn�wsnnau u.isur�n� SHp� ��R South Countr Cor . +
(Thb seetlon need nof M eompiet�d 11 tRs work Imrol�ad by
th�p�rmlf 1�for one hundrod dotlan{5100)ee bss.) � wvnroRr � � iNP',qpp�� 1
I cer�ify rha�in fAe performoe�te of the work 4or which this i
permN h issued.I shall norempVoy mry ppryon in ony mvnner �� .— ��iv� � ig.
so cs�o become aubjM ta�he Wa'icen'Compenmtion laws. DISMWASHER — �
[ONiRACfIXt
Dafe ��licanf QOiNES WA,SHEp A�� �
. �T�CE TO APRICANT: It, aher making rhia CeRifimta of . .
l� mption, yo� should becoma aubjacr to �ha Woricxs' �'��''��� .
/ *�ompenaction proviefons o1�ha Labor Coda,you�nust forth- S�TM � •�•�
with eomplr with tuch povisiom a �his�permit shali be ����NlclfR Sv57FM _
san uc.
dlemed revOkld. WAiER HEATER LIQNSF P10. QA55
U(#NSED CAMRACiORS pE[IARAiION p�y� p +
I herebyaff'vm Ihot I am litt�lxd uPderqo•nionso4C�ter9 GPS SvSiFM pUitETS — A . i
(cPmmencing w�fh Secnon 7000)of Divuion 3 of ihe Businea pUrlEi50VER u Y :
ona v�oteu�ons coda,ond my li4gnsq ip in 1yU fRrcp pr�eHpN. 5 PEa SrSTFM V LIDATION O .
�a
- -FiNAi
license Nvmber�ia Clms,—.�.�_ pq� �a y �� � I
co�,ro�ro� RCR Pltmibin�;,, 6/19/$5 av"`u a i
❑ I cm exempl under Set. � N i
B.BP.C.fw�ha reamn " - G 2 .
P(nn check fee � ��•3 A �
Do�e:
PLUMBING PERMIT I$$UING FEE S Q � �,• • • • •5 i
Siqrqf�ro !
TOT,�F� 'T 6 5b , : •�6 s o
SINGLE FAMILV Plan chgck applicant • •'�%Q Jr O x ;
U ;
HOME OWNER-BUtIUER DECLARATION Name •C•R• � �i •- 0 7,2 9�8 5
` }'�mebY oNirm that I am exmnp�From the Con+ruuor's Licanse ��s , , . .
-..J--Saw fo.rhe following reason(Sec�ion�0:l1.5.Business and
Vrofessimn Code): �;y � el.No. �
❑ I,as owner oi tha D�openy,will do the work and the . � ,
s�ructure is no�imended o�oNered for sale (Section �
704A,Business and Rotessioro Goda). . �
CONSTRUCTION IENDING AGENCY
I hereby afRrm rFwr�here is a comn�crion lending ogency for �
ihe performance of�he work 4or which this parmit is issved �
(Sec.3097,Civ.C.). '
lender's Nome
lendx's Addrass
I certify that I hove reod this applica�ion and s�o�e tho��he ►
above informotion i:corcect.I agrae ro comply wi�h all CouNy •
ordinances ond Stata lowa repuloting Plum6ing,ond h2rEby
a�thorize represenlalives of this Counly ro anler upon 1hB
above-menfioned prope fa inspec on purpases. ?
SEE REVERSE FOR EXPLANATORY IANGUAGE �
R.c.x. By�nh ,�r ��,q��s ,
Signa�ure of Permittee Oate -
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