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HomeMy WebLinkAbout1100A ' w°RKERs'�°^^°E"5"'�°"°E��^R"T'°" APPlICATIQN FOR PLUMBING PERMIT � 1 hereby,affirm �ho�I hove o ceNifico�e of consenr to xlf �gqg87A . � , . . � , insuro,o�o cerlifim�e of Workers'Compe�sallon Insuronce, CE B1�(HEV.B/88) �� � ���� � � � � ��� � ' or a cmnHed copy theroof�.38�00(�tab.]C�.�) �'+� '� - � - - � COUNTY OF 40S'ANGELES � e,, �D.{E�ay�T QF._PUBLIC�W."O KS � P�o1�ty No��CompanyJ��'T� F� � � ... . �� � I�^l 'f`�'Y ` 1 .�+' . .. . . Cen�fied copy is fiereby�fumi�hed. � . - . FOR APPIIUNi TO flll IN(PRINT ORTYPE) BULL�iNG . Cartified copy is filed wi�h the cou�ry building inspec- � �� �� . tion deporfinenl. . NUMBER� FIMURE OR ITEM � FEE ���,T� WAiER CLOSET - � �� - Dote � APP�itaN � 0� t�,aRESi - . �- . .. .. -�CERTIFICATE Of EXEMPTION FROM WORKERS' . BATH�UB � � .. I��p CRO55 ST. � ,COMPENSATION INSU(tANCE pwnreR�. .. . �. (Thls�Mlon n••d nof b•compt•t�d N�h•work Inwlwd 6y ,� sMOwEa � `a,O�, , - 1h�p�nnU h for en�Aundnd dollars({I00)or I�a�.) � lnVnTOav ��t ' � � �I cenily�ho�in t6e performance of tbe work(o�which this , �� AD�� - .. �, permit is iswed,I sholl not employ ony per�on in any monner SINK . � CITY '���� � � .,.Q(p'7 S � � so as to bxome so6jec��o Ihe Workers'Compenmtino lows. - mSHwqS+iEa � - �� / . . � OO CONTRACTOR j SC��I� - Dafe Applitanf � CIOTHES WASHER �. � � .. NOTICE TO APRIGAMT: li, ofbr moking fhis Certi{icore of ApOREu. .. .. . ' ��emption, you should becoma subjecf to Ihe Wukars' SWIMMING POOL RECFPTOR �� �'ry � ` npenwlion powsions of tbe Lobor Code,yoo mus�forrh• IqWN SPRfNKLER SYSTEM � �- rn Gl�o ve -/0 3G-�j', , n comply wirh such proviaions w this permit shall bc STATE � p[. ' deemad rovoked. - � ' '' � W�TER F{EATER ������ 3 3 O� �au C 3 . � UCENSEO CONTRACTORS DECLARATION� DIST��wo. � vROCE55ED BV � �I hereby afftrm Ifwt 1 om licemed vnder provisio�s oi Chapbr 9 GA5 SrSTfM OUTtEiS . ' , �commen<ing wi�h Sechon 7000J of Division 9 04 Ihe Business ouiLErs ovER . . . � > a�d Prolassions Gode,and my licenaa is{a fuU fwce and effxt. 5 aFrt SvSrEM DATEL �'��ZJ^ VALIpATION . � ' License Number 3 l3 Oa3_�;�.c�ou 3W � � ., :Sc.tir 8-a�- � BY� V Controctor pole j ❑ I am exempl under Sec. p H .B.BP.C.for fhfs reason ► �� � 2 Plan check tee �, . . . ���� . PIUMBING PERMIT ISSUING FEE 5 l . � Siqnofure � . . TOTAL FEE � ', 'r� � O.O� .. . . . . . . Plan check applicant . ' �• . , SINGLE FAMILY � ' I • � � FS�O - HOME OWNER-BUILDER DECIARATION Name � ' �-� • - � �� �' � I bereby offirm thai I om erempt from�he[onNaUor i Ltcense . _ _ .. � . . .. .- � . . • a.� � E,rj p� /'^./or ihe foilowinq rea�on(Sedion 7031.3,Business and �dreu , �� r�7�ssions Code): Ciry Tel.No. . , , . � . .Q�G 7�8 7 � . �U I,as owner of the proparty,will do ths work and the . �� srruc�ure i�not inrended or offered fw wle(Secrion � � -� S � • � � - � )0r4,Busirross ond Profenione Code). � , ' I � GONSiRUCTION IENDING AGENCY �- ' - � � �" � � � � � . . . ' ` � � " � I hereby afflrm thar there it o corotroUion lendieg apency for ' . � � the perfo.mante of�he wo.k fo.which�hi�pe�mi�is i�aued � � �� - - - � � . �"' � � � � � � � �� (Sec,3097.Civ.C.). � , � . �, lender's Nome . . ... . . � .. �. . Lender a Addreu . . . . . . ' . . I certiiy tho�I have ieod�his applicorion ond swro that the � � - �� � . - � �, �► , - � - � o6ove inforrrwtien ia corrocf.I agree�o tomply wi�h all County i � . ' ordinances ond Stote lawa regula�inp Plumbinq,and hereby .. ... _ . . . ' . . . . . ... . : ; ou�hwias rep�esenM�ives of�hi�County to en�er upon the � �, � � ob vs-menfionsd properly fo�inspection purpme�. � ', � `, SEE REVERSE FOR EXP/ANATORY U4NGUAGE 8-a��-� oTure oi ierminee Da�e � - ��� _ _ .. . ; � .t" �. �: .._ , .i>,'.. ,_..� .'�.' ,_ . , ... � , . .. . � , t�.. . :. :. ... , � .. , �: , ;.. : . � �_ .. , • _i � ;�. : � �,, :�� �...<.. ,. :�.. � � .,.��,.��.. `.,.� :.� , �: ,� � , , , , � ,:... .. .; ,..,.. ... ,,,�i .. II�1 P[CTO 'S NOTE� . .,. , � � �� J�cR UI��_R�t E ll�k l�� �� � ( '.1 APr'�QVAt$ D�TE/ �`:SF . 2 5":N,IT( .E � . ' �-. ' UYOER SCAB NlORK Q /.-/8 ��� 1 �� . . _ . . . . _ I h �by t ft '!�� I 4 n i i � I C otlor's .: ROUGHFLU .CI.�.._. �/.�' ' _ . . _ ...-..,....._ _...... ... _ .__,� . _. ..._.__.. _ L nsr la.v fcr t� F II r.p S .�Se r T0.1�S. j '-�.G45FIP.�!„ .., c�.� .-:-,�t � �.� . :y~ � :. ,�,-�-� . . � .�-� -..�.�.�.`-". ..' BusinesscndProlc s�o sCodel Anjc�lyorcaunr�Wfi,ch ' . '. ' ---'-'+--•- - . """""""""'""' ; _'_'"_""'_"`_.- . m r lo n�rrUcr. I�u � � �d mcltsh � GAS VE�.Y_____..__. ._,._ ..,- `._ � - .._. -.:: j . ; .;�� :.. � ; eGui oa�r j�ro . � .___ _____ _ ____ _ o n o e . HOTVJATEHcAiE.Q__ -_ir. • � •�_,' '.i..��'' � . � '�� y ; '-.'. .- .. .- G os�thc a p nl' o Ph pc � f 1 I�o, �. d� tc _ .. _ p I� r 1 �� I . � r ! � FluM,B'.NCP�� u+FS: :• . .'_ '.----- .----^ - �- ,� ' -� ;i�ff fl � !�C - dp rsuo ft ���epro � � sotrhe . . '1�--:—'�_' . �_L_'_� 1 .�� � � ' '�`�- � --��---' '— . .- ho�Inr.S..(Comrrcn<ing will� '_,. . _. -.r . . ansTesr -- - - _ -. . .._.. _._ _ eo�+�o �s u«n: �,rc r ct •I ( � .�i ' � Sechon 7000J o(0 fon 3�of t6e 9usiness and Profes� UnIITYCO_NOTIFJEO-- -__._.__' •°. . �� ._'__'._�_.. ._.__._.___. .. _. '. � ____. _.. . �_,',_�_ ._. ' � rons Cadr er 1ha " --- �'--�--�---- --- -• 1'� s Ihcis.c•zem Hherefromandihe�besis �`� i , i � � c7 � fo��in ol��g2d-�axmnplion Any v 6lofiod��o!�S�c�,on � FlNnt �`. �..r ..'��Irr�u yrnn( �. _ ' , � �+��.. . �� I . ' 7031.5 6/ ny appl'co or a�p � f s-6feds�lh �eppli- , .. . • . .. • ..� -..:J'._ ' _...�''.___ '____'._ :....__._.. . ._.!_ _� ��'toriYfo a eibil pencfiytof no1 m ihon i c hu�ndred . �._...__..__._ .:.-.,. . __._.._ __4._.;' _._ " ' . . . . ��.. .. . .. . , , ,. dou��: sseo�:: . . � wOUSTgl.>....,__'__" 3�.T .' _'f'_ '___... ... �_�.� ). �'.__ _. _____..__..._�'_'_. . .�__ ._ .._ _.__i ❑I,az ovmer of ihe propeny w-II do he wo.k,and 1 »�nSTE�v?aovni � ,.: .'� . -� -, r. . ._ ,, � ,— - "' - '--..t6e siruuu�c is„m��!.'nded crbFFerrd for:oic,- . , . . . -�� .�.. �. . � � .._.�__ __.-__ __._. - '._. . __.. , . y_.______.-: _.-�.___.�..t.---- +_.-..'_._ �__.._._..... � . �.. ,... ., �.. � :��; �; ''.�-(Sec.704J.�dslnes3'onJProleysionsCodo:'TheConfrcc- ; � . \ � � .,� ., . i.___ '..".__ _ __ __ . - _ foi's�ilc ns Lo+,u otcppfyt a 'awn (�.r--'ty �- - �_�__^T__ . . 'i w6o bvifd��or Imp o es Iher�o ord wfi d �., .;h ; ): �) � � ,') 3 :� .�. . ti � I , . �work��h�msell p�ov�ded Ifiai such Impro cr� n�s.arc.00i r. �........ ...... �._. _ _....._� _._ _. .. ,.�__ r. I . _-�_� . � , � � �� i � . . • �"-' , .. �' improv��I{(s�ofd. if'�in one ye� f mh�pfcti�an�,fhe ' . ' _ ;• , �-�I i-.�- •.•- ._....'- .�._.---" ` - -- -ovmerb dde�vnllhcvefbe6urd_notpro��ngtbothndid ... _._ .._ .'�_ _.___ _._.. � . . . -��i .) �.^ '. , ' . _ _. _ . .�,nol.buifd or.lmpro e.lur fha pu�post�0!sole.) ,, i�.: .' . . . .. .... . . . �. .. . �. . �. ._.1_. ..._. . �. . .._.._.. �__. 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',.- .. , , INSPECTOR'S hOTES �----------_ ..--------- ------ - i• ,.....,:,,,-i ,,.,. - .�, . •--_.__�_._._ . ___ __-- . ___ _.. . � - -----_ ._ . _ �------ -----. . - -- __ _�� , ----- --- L,, . . �� -. _ . r r .. , , ; ,. .�r:�•,':.,;x,.:�. ' � . ' _ ._. . .. . .r:��l . ... .. ��..f: ,...�t, .��,.�..I , . . ._ . . . . . ,... �..��-.. � � . . .. � . ..... �_, ....._. . ,. . �.. . .... . . .,�,. , ....., _�l_.::�_c�..... ... , �� .. . . . . �--�- - � - _ C' . . � .. . . .. . .. . . . � ' _..�.�'^'�.. '