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HomeMy WebLinkAbout0771A .,,�.._. ._...... _..___ _ .._ . __..._..T.. � '"°RKE"s•�°'"°E"5"T'°"°E��R"T'°" APPLICATION FOR PLUMBING PERMIT � ' I hereby affirm�hat 1 M�e o certifimte of consent to aelf �ypyyaq inauro,or o ceni4lcute of Workers Compensarion Imurance, CE B17(REV.10/H1) � � �� . i pr a cen''a¢tvpy thereof(Sec.3806,1a6.C.) COUNTY OF L05 ANGELES BIIILDING AND SAFET1f Poli w �''� CompanY��+�+-�-�r" . . . .i � Certl#ied copy is herebY f�rnished. N01,ohQ"2.�, � . gU11D{NC � � �I � Certified mpy ia filed with the uiYding'rn3pet• �p p�G'M ro FILL M�PRINT OR T`IPE) A�R� Hon deportmeM. NUMBER Po7[7URE OR 1YFM � FEE ����T,�,, , Dote�-/�� qpplif,o � '� � WAlER Cl05ET � NEARE$T � CERTIFIUTE QF EXfMP�O ROM� ORKERS' BAiH 7UB � tR055 St. . � qDMPEN5AT10 SVRAIVSE S� pWNER � (Thls s�ellon nNd not 6�eo � fahd�if-th��work imehad bp � , . . _ ���� � � 3h�p�rmft Is ior ene�hundnd dolloy(=100)er Iq�.) tqvaT02v 1 cemfy rhat in ihe performance of�he�work for which this , . . ��S , , � �,permit is�uued.i sAalf not emp�oy arry�ptlYson 7n arty manner � . . Giv 1��.� i �p as ro becama subjac��o fhe�Wa ,rhpenXafltl�laws. p���� � � � �� i I�*' � CQMRACR7R ; ;�t���.�i.�a+.'. aPpli ` � CWTMESWASHER � . . .. . . � 1 TIOTIf�TO APPlIC;4NT: IF, e�� idng 'b��Gertifimte of � .. . . �� /' � i �EkempTion. YW sh0utd bem aabject M thq NVwkerd SWuIANUNGP00lREGEPiOR OITv . ..fEL:NO. � I �ymPeawtion pcpvisians of f �Roka.Ci�e�R�msN iernA- � V.W�SFkiratER stSiFiH EL wi�h �amply wllh auth p isirn+s ar (hia pe[m�sbal}ba SrAiE IIC. �deemed reroke,d. WpYEk HEqTER � ��g� N65 � 410ENSEDGONntAGrORS;DEC�nnkaTlON c,assrs�n p�,� , oisraicrNO. �rao�ssr�er Q hero6y affirm�hut I,am Rcemed uadx provisioinsqft�o pter 9 '. . ��ommenting wNh Seaion fW01 of Qiv,lsi4n 3 t�1ha:6us�n�ss qit�75 pyE�t y � bnd ProfC�ienSCbde,a�d:my(icen59 is�in fUll fpre pfld effeB. 3JER.6YSiEN1 FINA1 6 � �A� VALIDATION � l,iceme Number-���'�4/. .tic.Cless�.�-.._ , U ' . . . .. . . � I Flh1A O �Connactor�t?n;lrrr�/a�..��.t��f,,, �i4!l5aRC � � � W ❑ I am exempt vndm Sec. , 4 � � B.&P.C.for this romon � . � '- Plan check fes � � �0� PLUMBING PERM11 ISSUING FEE S Signafurp 1� � �i TOtAI� i . .. . ._ . ... ._. . �. . . ��Plan check opPlicont . . sir�c�F�wuir MOME OVWNER•BUtLOER OECWRAt10N Name � . . �hmebv alfirm tlw�I am exampt from the Contrac�or'slicnme . � � ' i �Law for rhe following reoson(Sec�ion 7D31.5,Bvsinea+ond .Addreu . . . :-f;i�1 a � ; Rofessions Code1: � d �Tel.No. � �r Y 1 I,os owner af the propeny,will do the work ard fhe • • + �5 I q shucyvre is not intended a offered for scila(Saction • � � • �G C.Jr O 7044.Business and Rofemipns Coda). � . CONSTRUCTION LENOING AGENCY .� . . � � . . . "1' "��,J O u. I heraby affirm thot�hero is o construc�ion lending agancy fw � . � f �he performance of ihe work for which this permit is issued.. . . � . . 0 g,� �`5 6 ' (Set.3097.Civ.C.). � . � � . 1 LendeYs Name . �� Lender's Address � � 1 1 ce�tify that I have read�his opplicatioo and s�ate that rhe . � � � above inSwmalion is cwrecl.I egree ro comply with all Cpunly � • ordi'ronces and Sta�e bws regulating Plumbing,ond here6y � . ; eullqri ropreientofivea of this Counly to enler�pon tbe � � � � � � � � " . �j ab tioned prpperfy for inspection purposes. 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