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HomeMy WebLinkAbout1098A (5) ,-___.._.____------�---�----- -------------------- -- " WORKERs•�oM�N�T�oN oK�ARAT� APPLICATION FOR PLUMBING PERMIT � I hereby,o(firm tMr I hove o cerlificote of consent to self 7BA687A - ' .� insure,or o certifico�e of Workers'Compensalion Insuronte, CE 817(flEV.9/BB) � �- , ��� � - � --- . '- or o ce�r�}irf��ed copy�hereoi(Sec.J Lab.C.) . . . . . ` .. . I P❑olicy0ld���ompcn N COUNTY OF LOS ANGELES D�EPT:.OF P BLIC WDR S ` Certified topy it hereby fumiahed, � � � � � . � fOR APPIICAM TO FllL IN(PitINT OR TVPE) gA��� �� _ � (�2�J Cerrified copy is filed with fl�e coonty buildiog l�fpeo- ; tJ,o�dapahment. NUMBfR FIXiURE OR ITEM gi. FEE �«��T� f „ .��N� yl�l }�( ']���� �F�SC P � - - WA7ERCLOSET � � /`}�< r''��~ . . Dofe��Ll..L-_AppliGonl NfAREST �,�)� . � , . . CER71fICATE OF E7(EMGTION FROM WORKERS'� eniN 7uB . CROBS St /� _ . . a eA . COMPENSATION INSURANCE� S��R � OWNER � � �. -- - - - � � . (Thl�s�Nion n��d nof b�compl�t�d if fh�work Imob�d hy - _ . . � th�p�rmM it lor on�bvndr�d dollan(SI00)o.b.s.l LAVATORV � � Ap�Eg � � , I cer�ify thot in ihe performance of Ihe wo�k for which this � �1] , , : . parmit is iuued,I shall nol employ any pernon in any mo�ner S�NK CITY'p ��� so os to become subjecl to tha Wrnkeri Compenwtion Laws. - p�y�W��R �� - S�=�TK�— b - � OO CONTRACTOR � � Date �APPiicant CIOTHESWASHER . . - d� A�E� ��U Y� NOTICE TO APPLICANT: If, af�er making Ihis Cerlificate of SW�MMiNGPOOIRECEPTOR ' �mp�+on, yoo shoold become subjecr to �he Workars' ��T ` �, lpensation prwisions of the labor.Code,you mus�torfh- �AWNSPRINKLERSY5IEM C . i ` .�5 comply w 1h sucfi provisions�or this pe�mif sholl be � STAiE � LIC. �+- , ���deemedrevoked. � � � WATERHEATER p� ��N� CIASS � - LICENSED CONTRACTORS DECIARATION � � WSTRICi NO. YROCESSED BY � I hereby alfirm thol l om litensed under provisions of ChOpb�9 GAS SYSTEM OUTlETS . OZ� , O n � �(commencing wi+h Saclion 7000)of Division 3 of Ihe Bus�ness WFtETSOVER . _._. . . , . a ,� oroi Profeuions C�,ond my licenu is in full forc�nd eff�. � 5 PER SY51FM FINAL �Z�_gv VAU�ATION , v �. 2 DATE d license Numbe� � Lic.Closs V . - � �y FINAL q, � � Controct� '}� Dofe r�� � . BY :�^ . O W y � I om exemp�under Sec. , . �. � � e:sa.c.to�rh�s reosoo plan check fee r Dole: ti %UMBING PERMIT ISSUING FEE S p.`� �1 0 9.8 A Signarure . �': . . - iOTAI FEE � SD . . �'.o • • • `� P. -. � . Plan check applicant ��� � • ^��rJ� }; 51NGiE FAMItY _. , �� HOME OWNER$UILDER DECIARATION Name � �. - - ���B B,Ei�� 4�� I hereby offirm tha�I am eaempt fram the Com�udor's Liceroe � .. , . . , � . � . � '"`�or.�he followinp reason(SeUion 7031.3,Bwiness and � Addross� � � � � O�(i.2 7"H�I E � ��ons Code): City Tel.No. ! i � 1,ca owoer oF the piope�y,will do the work ond the ��� arructure is not imended or eHered foi wle(Sacfioa - � � �- � ' � ► - - , - �ON.Bu�iness and Professiom Gode). � � i � CONSiRUCiION IENDING AGENCY. -- � �-" � " � � � - , � - � , �. - '� : � �� C I bereby affirm Ihot fhere Is a con�hvclion lending op�ncy for � � � �j Ihe pe�}ormonce of the worlc for which thia permil Is isaued . . . . . . - �, . . . . . ... .. . . . . ... (Sea 3097,Civ.C.). a �f lender's Nome � � � � � 1 Lender's Addrass ' . . .�, . 1 . . . . . I certify rMf I hove read this oppHcotion and sroro Ihat�he . . . . . , . ;� � o6ove in mation ia corcxt.I agree b comply wi�h all Counly . .. . ..... .. . . . . . ... . . ordirto e ond Swfe lowa repulatinp Plumbin ,ond hereby _ outh im ropresenlativ oi this County to Ix u n the abo - �ia tor n ct�o pu mas. SEE REVERSE FOR EXPIANATORY tANGUAGE � �� �� � SiQnaturo of Perminee Do . � � � . . �. . . . �. i , � � . ... . , .... . ..... .. ..... . . _ r_ - . r . . . . ... ..' � . � � . . ,,, .".. ...,... _ . . . . . . . , .. .. .. � � .. . .. _. � � � I'JSFFCTOR'SNOTES "�� �°-�� ���'� � (� N�FLUIi �E�'CL L< .�i17 ����' AFpROL'ALS O�TE I�.SF'�'TOR�SIGVATUkE - . � .� • � UNDER SLAB IYORK 1.^ Q'y - i i..-, � : �.;', .. .�.::'.i(..:.�r � ._' . � .. °Y� � � ; � � —. _ � �• `�L' � . I h reb� �f.. �� t I an �m ( n ih C n �c�ar's � ROUGH tlU: JG _.1. . 7.�`.( - .... . .�. . ._._. ......��.._._„_.„_._ L c se f,,,� lo .q r a o r;5 t- 7i131 5 _(�Y .. ... .. ..._......__ . .' � GASCiP:pr, .� ' � l•. �Y � r i = `� � , :. ; � ..' .�:."_ , , 8 sne slc dP.n(� nsCodc� A yc�lyo ec ty,.viFi�:h _ ., V��— ''re c errnit lo mnsrrilcl.cllor,Im ovc.domo�%sh . �—.� . GaSVEN� �. ' . . � • , ,', ' 1^ I ` :.; .: I -:�..�. ; � - y `.�es p pr ' HOT WAtE.;H�ASER _ �.�. . _��� ,.�'—� �. . ..�� ���� �.:�. I � \�. q�Ire�Ahn Lpp��cnnf'/or s��h pc Tlt�fo 11e�s�gn dsloie� FlU1�e��:,Gix7aFE<,. \ . .— . ��„ ° •,� _..4^ . I j._ -.'_ .— . -�T -..� - � -ni tf r F...s�li:cnsed pursuc i 7o iF.c pr � - �-of fhe GASiEST .c�- —��� '� . .. ..j1 `-� �._ — SoetFon'700�`!0l hivlsio���rChopr„r�9(mmmencing wirh , - . .__!._ _____. . _"... . .'.. ' � � ' ' n 3 0l/he�Gusiness and Pro�es� � U ILIiYCO.fJOI C�``�u(4r.nn � � f:>. ,'. � ��.. ,'^ ��j �,j, �,1 I i� . � J031r5 bj�nyc�Vl cc I SuramFlciYcif sub o�s�lyc5abf ` __c___. .,.�.___�__-.._..... �.r..- .-i- , -..,:.__ '_ '-'r�__ � _._.. — _... ._.1 mnY�fo o ci�af penalry�o!riofPindre Ihon fivo hundsis� _ � FI'"AL �� ' ' • �an , � � .: . ,..;.'— :.-.-�,� l. ;. ,.. . .. —;-,'-Z----_ ! Pa��' � < . ' � ._ .. '.._ � --� . .. r/o �s iS5G0J.- , . � . .�,. . ... _ .� lic .. .. ,. red � '� USTf.A__ _ .____ ._ ... . . ...._ _. � __. _.. ' f ASTElP.,O�i,.— � __ � ❑ s o e of th� ap I d o � - �-; .___ ,__ ._,_ ,_.,_ __ _ ive SL•octo e�s nci�nren c,3 b cir d fc�sh7h k nd ._.-:. _ . _. ._... . -_— _.._ ' ' . i � '� � �. ��(Src�704J;�Cusfnrss-onr.Pro/ess n C de. eConlroc- i � - r�� - � - : ibr's Licensc tcw does�nof n ! lo 0 ov-ne o( � �� r . t`' :. � ;' � . ; -_ - , PP 1 Pf^C Y � � --- � ��"- ���, � �"���-' ' ; � '�who buildsbr Imp'roves lhnrvo ard-wh .dps, ch + ` `� �' � �� - ��.� � �. : ,.-i ,,� � -�work hlmsel/provldod fhal such Improvc c ts crc,-no� '�; ��... • ._� .�...Y'�'���•�. .�.... •. _�. . � -_ .� infeqdedor.olleredlorfefe.11,hawever�,fhr,buJdingor . �. � � � ,.. . . .._. . _._ . „: � :l���" �, ' • •. . �_ �� I � ______ __ .._�.._ _ � ,..,improvcr�ent is sold wi�hir one ycor ol cnmpfc(ion.Ibe . ' � _._i—_. ' `_ . ....� --'.. •-- - ' -;.. . ,. .,�oriner-6uilder wlfl have ffre�6urden of proving Ihcl.f�n did : _._� _ . .- . ..._ _ ' ._ ' � , . .. . .^ i. + ; .. ; _."__... ____�__ ...___.. � . . ,_'._� .qol.buifdoClmprovclo�.fhepurposeolsale.l .. _ . .._- - -. v _ '1 .�� � ' ' `1 - -- _ .�.:-_— ._._ , _ � _ i I . ` � —�:i � - t am excmpt und r`5 � � __._ � _'_ _ ' I i _ '" _ � , _ __ - ,- , � , __:. " "- ' � � ' �Fi&F',C.for Ihis reason _ . ._�. �_L'_---•- —�`.._ ...._�. —---- -........ . .... � * -- ---.-- - , ,,. . , .' . . . . ----�---�--- ---- ._ :�'-' .� ' � i ... . ., ., . . ...-- .-'--.. �1 � � ��- �-- - � . _ __._ . � ,� . . : . y 1 .1�.�. .... _"_. _._�_ .�. _.__..__ _._ .___. .. .__J`._. .____ . ._ `_ _ . ....�; __ _ �1 �` __ � . • . 1' �/ .,'!.=.I ,. . . '' _' - ' . . .. . _..- .—.... ., � '� �VJftEI . ' .-;. � . � . �.� ...i ._r �. �:_�..__....._ ..__—__".__"'_'__"_" � . _ _."__._" ."___ _ -._.{ , � . ', .. _i, . 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