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HomeMy WebLinkAbout1106A (5) "`°RKERS•�°^"�"�"°"°E«"R"T'°" APPLICATION FQR PLUMBING PERMIT � I hereby,affirm ihvt I�have o certifico�e of consent�o seli 78A867A � � , insure,or o certifim�e of Workers'Compenyotion Inaurance, CE B17 IREV.8/86) � � � � �� . . -- � � .- � � or a certified copy�hareo/�S,qc.����`. ��� . . . ,,�. . ! �� . acyNoO���pa�y COUN7Y OF LOS ANGEIES DEpT. OF.,PUBI�IC',WORKS Cer�ffed mpy is hereby furn�shed. , j� � ��� - . . FOR APPlKAN7 TO Fltl IN(PRINT OR TYPE) : . A��N � / -i��y . LO v . �I � . Cerhfied topy is filed wilh the touny boilding inspet- < < - �7 .aiion depwfin�en7t. t . NUMBER F17RURE OR ITEM ,� FEE L«.xRy . �^�m0 A ,Dote�v���O�/ qpPliSonl ' RC�• IRc WAiFRClOSET � � fl� NEARIST . a� �. � CERTIFICATE Of EXEMPiION FROM WORKERS' � BAiH iUe � pa caoss n. �►4 r!�lo�h� f{{.Z ,__ COMPENSATION INSURANCE OWNER �h ��� .. ����'�" � - - � (This s�ction nMd nof b�tompiN�d�f th�work Inrolr�d 6y SNOWER � � th�p�.mif ts For an�handnd dolbn(=/00)or I�aa.} iqvnratv � ��� � . I cenify that in fhe perfo�mance of the wwk ior whith this - DO AOU(�u . . permil is issued,I shall nof employ ony person in a�y manner SINK �� CI7Y , n . q�, - 5 . .. �w-as io become subjact b fhe Workers'Compensa�ion laws. 1 DiSHWASHER � � � ejp ���pRp� _ � � � :sC t Q Da�e OM+limnf � CLOTNE$WASHfR � b (� � NOTICE TO APPIICANT: If, ofter maki�y this CmYrfica�e o/ , AWRES',. ' , O S �� - -. _. E+emption, you should 6ecome subjeci to ihe Workers' SW�M�M�NG POOL RECEPTOR , I� � ipansolion provisions of fhe Labor Code,you must forlh- �qWNSPRIMKtERSVSTEM � CITY �� ��v^ .�6 comply with such provisions'or ihis permit zholl be STATE r� p lK. � deemed revoked. � ' � � � ' WATER HEATER ����� I J�U C�u �� � � �� � � LICENSED CONTRACTORS DECLARATION � � c� . DISrt2KT N0. PROCFSSED BY I hereby affirm IF�at I pm licensed under provisioos of CF+opbr 9 GAS SYSTEM WTlETS �D � (commencfng wi+h Section 700p)of Division 3 of tM Business . _ pUTlFTSpvER � � �Q tl Y oad Profeaions Code,and my liceme is in full force ond effect. s vER r5t'FiK FINAI / �/ VALIDATION O 31 3 ��l DAiE Y ��"Y7 V Licenae Number D Lia Closs�3 S�n � (� FINAL !,� i � � Conrroctor ISC 1' 1Mte � a� 87 BY ��/ ,.s � �r' � V ❑ . a I am exempt under$ec. B.BP.C.(oI this reason , � �� � Q b A y Plan check fae � � Oara: t:• • • • •5 � - _ . . . PIUMBING PERMIT ISSUING FEE S �: �Q 5Z� . . Signorure �, . � TOTALFEE '� �, I •-� O G J�� wan check oppltcanr a 3 � �)ft 5 0� � SINGLE fAMIIY HOME OWNER-BUILDER DECLARATION Nome � � � � �� � G II.2 7"8 7 �I ,0reby offirm thol I am ezampt from fhe Conhactor's license - � ,qddreu f �i for Jhe followinq reanon(Senion 7031.5, Business ond � � . �essior»Code}: . � Ci�y__ Tal.No. ' - � ❑ I,oa owner of fhe property,will do the wark ond the . � ' � s�rocture Is no�inronded or offerod for wle�SeOioe . � � � � � - � �► � � � � 70d4,B��inesa ond Profesfiom CodeJ. � ' CONSTRUCTION LENDING AGENCY - �- -� - �- � � � � - � ��- �. � � . - �� - ' I hereby oHi.m rhm tha.e li a conatruc�ion bndiop opancy for . , � � . � the psrformonce of the work for whith lhis psrmi�is iasued �- . - - �� �. � , - �- �, ISec.3097.Civ.C.). - � ��, �. ' ' lender's Nome � � � �, � ' lender i Addreu �� . � ��� . . . . . I ce.tify that I hove roed�hia app�icotion and s�a�a thol the .. . -. .. . . , ► -�� - -� � ' obove iniormction ia co�rod.I ap�ae�o comply wirh all County . . i . . ordinance�and Sfab bw�repobtinq Wumbinp.and iurebY . .. _ � . � . ... � , . . . . au�hodze rep�esen�otWes o!this Coun�y to enMr upon rhs . - '. � ' abore•meMioned property for inspacfion purposes. . � " SEE REVERSE FOR EXPIANATORY IANGUA�iE ��7',l/��� f3 a7-�� � SiqnoNra of permiNse Dale - � � i � _. . . . . . i� �'.�' � �' . • �•:^�r; , i..�� . _ r ._ ...�'�.�� _ .. . . . , ._ . , �, ;. . , ,, . :y �; , ., ,. ... � . .,.� ... . �.. . , . .. . . . , ,� . . _ i:_ -.,t: ..:, i , �� .. .. � ACGFO`JALS }TEI �, 1.JSFE S JATUFE �'`15FcCTOR'S hOTES � ' " ' ' '- -' �. ] ��e F Ull�i��( '�, rc� I"� - ' UNOER StAB w0�2K t. .����//��__; ��� .. 1 . . • ... . L t e � ` 1 o I c.�p (Q'1(f� Con c�. `ROUGHFLW:�NG ___.3 l5��,�T__��� .- . . . . .... _.. .. ..- '__ L tc s�L`U fo d� fol oE� �!� . (c 2 93f 5. � GASPIP,NG�.��. 1- . '� f �-- ..,, __. . ._.,... s. .. � . , . - s . o iv i .s�a c i...� Y�,� �o r�,..b��� —°�'� _--�-`-1^--- ' r�quires d permif Id c �ifrUcf.'aito �p7ove dem��lsh. Gr�SVEIJT _. . ... .._. . '_ � .f ._ . .; � � -��� ' ' � � -- �-- -.-� -�--- -. --.'. -.--- � - - or rc oir an stru^fure -o�ro fs ssucnce olso rc HOT Vv'Altf HEATER -'-�_�._'�--. • -�. ':.._, '. •• "'- �..�'- ... .. I � ufre�f. o yl c n7fo ��h� erm���f�lo�o si Aed slo�e. , -- ... i l� . . 1 • . . � b" P� P 9 ctUMB hG FnTI RLS '.. -T � ;. � ..,-, . . � .-- ..-. ._ ___ . __ . -. � ' rnenl fhol h s I c�nsed p �anl f Ih p ovi .. ..i�thc _.:_._ - i _ ' .._. _� .� �_ ^ i ~,�.-� � GASTEST � . 2} p. .. . -- -! -- -'-.- .-. -. Cortfrocfo�s L�mn ,,La (Ch pl, 9(co�menc�ng wuh UTiL�TYtA.tJO:1.lED-._..__ o � � '� "' � ' � "-. S cfion 70CDJ o'D� s 3 0l lii F Q�z s o d Pro�es� .� --� - �-�� � � �-^ '"� slo�sCoc� In } o!h- c c��pfti elcmcndihctas�s . .. _ __..__ _ . __..___. .___ _'_...._. _ ! c7 . ; ; •. � �1 : !0 1hc'o( q I Rc pt n. Any I I on �!�S U on FINAL .j-..; ('.. (�ijr�.au }ronl:.. .-., ' •� ,.�. \ ' ..� , l\ j i" 7031�5 by any upp�ico t for a�pc�m1 s�b� cl�1Fe oppL- . _ _--_�-r " "'_ _... ....__j_ .. :..____._. _.___ _ _ - -- _ � canf-fo 6 unt pena!y o!'nol mo e �hon�fiv I ndred . ._._' . . . . , , . . �,i � - . 1 ....,.. .� .... . ., _... dollars(SSCOJ: ... . . . ,.. ��.,, .,..: !n��J57FLql.� .... .: ._.i_ �.. _'__� _.._'. _., ._-.. ,_ '_.�_.____...___... _._ _ . ____ ❑I,as o�vner of tF P, P."Y w II do tFc o k.ond :YAS7E S�PFROvaI- _ .. : - 1 , r` _ � ' _ "._��.."._'i'_ _._. - _ .____ _ .`� _._1_ " �.ihc siro<tu �nct�r+ ni1- Cr offe d�f �ol. .• __ �• � L ' _ __ . _ � _. .._�. ._"""__. .._.'_'_- — (Sec 7Q4J B ).sJc$�oro1 . �� . ' �5` � .. � yt � .-- .-- . .__ ___— • i . , sY ciheConl•ac ,, !r sior s Cedc I .'�."___� . -i__._" .'_._"'._ ._ ._ ..,__.' � workChlmscllerovided�hm s I f F�, �,�y ( - ° PF � -' E "" �--- --- t i_ � �+ho 6uilds or Irptavcs tncrcpn and� ho do , .ch 1 ....,_ _._.( ____ _ � '� � p uch Imp oyc enls a c nor , �� . , . _-i.-- _._�_ . infendcd m olferod to^sole-�f;-ho�rre{.lfic 6u�Iding or �:.� � ! �.,, �� . , . . ; I , � ',; i.; � i __'r . . �—. -� q,. ;lrr frovemrn',is so!d,wilhin,one,Yeo of ccmplc!ion./h� ,�.' • „ .�.. . �---f- , '---"-�'- � �.--�.. . ..-.��'..- ;-,_ .osvner-bulJerviilihaqthebu:de.vo/P ng7ho�hadid ' __.__._. . - �. _'_-__. ,..-___ .'__'_._ .l. ' � �.x7� •`1 �� � �� - - --'- �. .--.`- ----- �r, � ' c�� rtot.6oildor�Improvefo fhopurposcclsa�cl.- , . . . `.. ___ .__ I . . I � . , :_ ��` - __- � . ' =T--1--T1 . ._ '_'."_'___-____ "r_'_. ..._.,_'_ .,_.__'� __ .___ _ ,. __r . �-� ` Y . �� J � j � - f nm ez��pt undar ec I - ,_ ' _ ' ':�� . . .�� ' . . - ---- --------- I j I � _'. ..___ _ ____..____�_____. i 6 E P L.{or fnis�rcoson . . ._ --,� _'_____..____. _.. __..__.__.._. . ^__- I , _ ..-.: . . �., �_ , ' � '___'._'_.._._ . �'_'____ .: . 1 , � , .� '____-.._ . ...�._._.-_._.'___ ._.._...._ ____'... . _ .. . � — _ .'_�:_... � __ . �� "-�__ . . _.. . "_ . "- .. � ..._t ' ,.. . . , . _ I� _ � ._._- b�e_..__. . .....-.." _"_—.__'."" _ �.._ �_.__ � . .. . . ' _'_ ' ___- '__ ..'____ . . __.-___'.__'_: , , . , ' 1 . �,' I . . __ �..,��.:� . I ,. • __.....__.._..'_'._...' __........" '_ � � 5�.-rl\-=1.�-'-_ .-.-_ -._.,�---_._._ OwnEr .. , . . .�_� _.______ . .. .._..._. . _._._ __... INSPECTOR'S NOTES , ,� „ -- ,___�_. _ ---- - — __ -- .. . , c if � . , . � � .. . . . . .. � � . . ._.�___�.'"` '_�"____� ...__.__._. _" .... .� :- , ,�.... 1 ,...� . ... i ...._ _' _'�_ � " .. .: , ' ` .. .... _.. . .r : . ,. . . . .. . .. .. - . . .... ._...__ ' _._"_.______'_'--'_"._ . _ __"'_' r'� r i . �t, i , L_� �.. . -. I . . . . . _. . . .. .. . . . . . .. � .:��r,•� -._.: _ ., .: � . . . . � •'��'�:")' �: .'�?I;....I...��.._ � . . . . � .� ., � . . .,�,,.. � :�.:, � �:�.�.� >c,�'�.,,...: � II�..;!:_..�',...!� . — . ... ,�..�......, :� .. i.., e.� .....,. . . . ... , . �.�� .�_. 1 . - _ '-...-' . --�--� '1` . . � �, i ..'..1 . i � . � . .. . . ��—.-"-�.t.---.—_---�— - . . . �� 1-'l"�; C.,'.. . � �. !�� ..i. � . �... . . . , . ' .......... . . .. . . . . ..