HomeMy WebLinkAbout0699A (4) woRKER3'�°^^°ENS^T�°N°E«"R^T'°" APPUCATION FOR PLUMBING PERMIT � I he�eby,aFfirm thot I hove a caAificofe of consent to selt 78A887A � insure,ora certificaie of Workers'Compensation Insuronte, CE 817(REV.B/88) . � � � � �� �- - � �� or a cerrified copy��hereoS(Sec.3800,lab.C.) . . .._ . . ' _ ' � � d783�4.8� S'FR-�e FO�►c� COUNTY OF LOS ANGELES DEP7. OF PUBLIC WO � P�olity No. omponY . . . � � . -Ceriified copy is he�eby fomished. J � � � � FOR APPIICAM TO FILL IN(PRINT OA TYPF� BUIIDING /'► ,Ceriified copy is filed wi�h�he covnty building inspao- A��� � '�ob P"' �� tionde rtmenL , , NUMBER FI%Tl1REORIiEM Q FEE �«�`�TY � PO '�i m ' DaieR ia Rl APPIiSant�:Sc�eR �\�MB�n� WATERCLOSET - NEqRESi . . . � CERT�FICATf OF EXEMPTION FROM WORKERS' B�iH TU8 . . .. . . CR065 ST. �� � . � COMPENSATION�INSURANCE� S�10WER OWNER . - -� -- (This��Nbn nNd not b�mmpl�Nd H th�work�imolv�d by � ��� . . - - . , th�OnmH li for orh h�ndr�d dollon(SI00)or I�t�.) tAVA7pRY qppRE55 � I cerr�fy tha�in the performance oi the wo�k fo�which this � I � . pe�mif is issued,I sholl noi emplOy O�y person in any manner �NK O CITY � � � �C.�. � � (+ � � so as to become su6jatl�o tha Workers'Compensmion taws. DiSHWASMER - � ���,�� � Pi . �`� � �PPlicant � CLOTHESWASHER AODRE55 , O s �_ . .. � i.,1TICE TO APPLICAN7: If, af�er mnking 4his Carlifimte of Syy����p��RKEPTpR , Exemption, you should become subjec� to�the Workers' CITY " Compenwtion provisions of the Labor Coda,y0u musl for�h• IAWN SPRINKIER SYSTEM ���_� iih comply with such pfovisiona or Ihis permit shall be . 9��� O C� ���/ . � deemed revoked.� � �� � WATER HEAiER �P � IICENSED CONiRACTORS DECLARATION � D�STRiCi NO. D BY ' I hereby offirm ftrot I am licenud under proJisions of Chapter 9 � G�5 Svsieh� OUT�ETS � �a �(1�� ��_ ' �(commencing wi�h Section 7000)of Division 3 of the Business . _ pUTLE750VER . .. . .`� , \ � ; and Rofeasions Code,ond my licenae is in full force and effec�. 5 SvSiEM DA EL �/3� /�� VALIDATION U � License Number 313 083 tia Ciass_�ait(1._ � � . .. � FINAL ��� ' � I Contractw { _Dote ��a' � BY ��` U ❑ W I om exempt under Set. � e.&a.C.for rh�s reoso� Plan check fee , Z � D°1°' . PLUMBING PERMIT ISSUING FEE f � � Signoture TOTAL FEE � � =O 6 9,9 A �� � Plan check npplicaa� � �t• • • • • �J � � SINGIE FAMIIY . . � � � �� HOME OWNER•BUIIDER DEGLARATION Name� � � � � � � . �- "I • �O b.S O� � I hereby offirm rha�1 am eKempt from the ConNattor'e Uceeae � � .. . . .- ' . � . . Low for�the fol�owinq reason(Setlion 7031.5, Business and � Addrass � � � � + � 1�0 b 5 G� Profeaaiont Code): - City Tel.No. . � • ❑ I,as owoer of fhe p�operty,.will do�he work ond the . - - . - O�� 4�8 7 � strod�ro i�no�intended o�oftered for ml� (Sectlon - - � � , � -� � � � - 7044,Busineu ond Wofeasion�Code). � CONSTRUCf10N LENDING AGENCY �� �� - � � � ��- � � - �- � � � � � � , 1 hmeby affirm�hat there Is a conatructlon leediny ogenty(or - � � � tha performanca of the wo�k for which Ihia permit is issued � - - - ' ' � , � ', - - � ' � (Sea 3097.Civ.C.). � L�ndei s Noms � � lender's Addreas � � � I certify that I hove reod this applica�ion and s1o�e that the . .. , . .. . � , - ► � �� - '�. obova informo�im is corroct.I oqroe ro comply wirh oll Coon�y � � ordina ces and Siate lows rogulotiny Plum6i�q,and hara6y _ _ _ . � ___ . . . . . .. oo�hor repre enlolives,04 this Counly ta antar upon Ihe �, a6ove m �io w ���for impedion purpwe�. � : . . - , � � �7�`.y.� SEE REVERSE fOR EXPIANATORY IANGUAGE J � � rw�uro of Permittee Oate . _ ., ., ._ „ ,. . , . . a.. r .. . � i. .... .. » ie .. '. i , ..i.... ._.°�. ... i . . ���.���.'7: : _ . .. . . . . . . - .. . . .. _. .�.�:i�,l . . .. .,� .. ��1 AFPRO'JA�5-�-, _ .--�-n}TE� .,.IhSF�CIOP'SSIG;'�ATUF�E INSPECTOR'SNOTES. ' ' �., _. . � ' � .,��0 N�F,'-E1U GcR�D�,'�[�I+� �I�,J� ,. . UnDERS�APl4C¢t �' {�'-(([jJ}r�,'�'''� �/� - . � .�. � (/ I 7 r .> �� ` S ('V ' ROUGHFLUht'uf'�/G 1 .,.�.(l�� �V�/�/'y - _ '...._ ...'_' ...,, -._ _' ..' .__'_..._....._.__ ._..t��}' eLyi ( l�Fa�t . .>ISIf f.�i 'CJn �c o�'s �J Lc n ln f> i� f�ll g � o !(Sectu 70315 �GAS CIFING.•..:1 ���.�i ,1 ��!. � `-_ .�� ," ., � i".' . - 8osfness c 1 f rolussio Coc'N-A �n�y or ro nt� :hrch , GFS VENi � f .� ; -�� requi-es o perr 1 1� onsrrucf.olrer I `o dc i f sh. HOZ V/ATEF�ICqiER � C- . „ ���'�7 n7-f��f .�-„�-_,-()�' ' ' -- -�-- ��---- ��.�- , ' ( r po a y f u<1 rc prio� lo i� s nc �c�so re� . � I " _ . ..- l 3 �� ._ � �'r��l,• a�"�.sfhcarl �.tu�to suchperml+o� eF�.i9�'Casr t ttU,�18iNG Flxr.._Uce� �/ i)��_�/ � �r !rl i �� ,: !.t � _ ' __ .. —�1_(,1 nn!��har I !'-.ns d p n�ro�he p.ov� �!rl c GAS TEST .ST�.� � i. .1'_ _. ___._ . ..._. . __ Confroc�o s Cicens�to �"nipl� 9(con inc c' q �,l�i uTiiITYCO..t:OTtv�ED—� I.l.=_.��.%rt �• 1 ' I � 7.�- � � Secfioq 700�ol�D�v� 3 bt�ri p ness ond F� les� .'.__'__. _. �-:��. . .y _""'. '1_-' . _"_ .__ . . ._ a:_ _ ' ..- ... . i - �� � so Codc�orf�+ath. c cmhtth rsi cnafhc6 s: �i )�.��i � ' .�� ,,��4 fo ihc��1 � �1�. e pl o Any la!nn e 5.N-on Fl:vnl �•} �r ' .�. ��r���l , ' .� , i � 7UJI.��byci�tp�h;antio c�per Isu!,ccn�h cppG� 1 _! -t ,3.R(�� - .=r�: ' -� �-.) � ' .. _�_.__ . .. _ . _ _r..�� . . .__ �. __'. . __ _ -_� canf ro a c !A al y nol mo e I�cn (i d r� ,-�,_-_�1-TT_ , � J-� a\ i-- - - - - � ' doiia�'('ssno�: _+ +- i.l. j��_'__ ��� _ I�— I _��_ t�, h ndre . .ASTE AFF.OVaL t .,, /_f , (_ , � -_- , -_.. .-f- .- � -�rSec.7J-SQGEus resintelndcd cF or.y will do+he .d .NJUSTFitI J}f ,/._ .�+7 ..�i'�.�lo._ �- ,----- —�=- �---- ,,; � .., . . '.- .:.:.. . . ._.._.. ____c ___�._. , �.wF�a.bvi! n s and Pro e ffc ed f s^.I . . s - (essio s Cod . -The Confrcc� )) �. �,)/ � .' 7 � y � � ) � tors Uce�ri e Co:v does po�ppyily�fo n ner o�p c�+eNy r ` .., 7 � � � „ d or im roves lheroon nd ho does such •�� � '��--- C. '��Jc�` jy_ - , � ' � „ , . �work hrmseff prowd�d that such Imprcvemon,s ore nol .,. __.. ._�. �._._. __. .. � ,,, .. t �, > � C.. -:., � ..�� � . -F.. -- - - ' in�enicd or o/leend/a sola.:�f,buv cver�:fhe b Iding oi . i ,� '.� � `;' _-- 1 .�� � . _.; � .���� � - 1—'�- i,,.� I .pravemcnf ls so:d,v i7'�n o�c y,c:o+.compl-t�o�.,�hP � .+�-� � � . - � -.. --...-�-- -�... .. _"•-�- ,--. �otivner-butldoni,illhovolF.ebordanofproving�fhn�hed�d _ ._.__. _ __•'_._- ___. . _ . � � �. � � . �r. � I ... . �. __ I �__ � . __'___'-, . ____ . .`.�:n�f bvi!d ar'mprovc! t5 p�rnafc of�ala.� ��. , _ . .._.._._ • _ y I � , ` �n �--� I �L . , . � ------- -""� .. ,=-:: L�...:_-�' ti1 . , � . �it'' �__- '.- -�- ---- - - �—..� f L .�.� � : .i i ! I. ` � _ _ cri exempi under S c .. .- � . . , , . _ ... . ' ` ' � , , � , ,— j � r l-; , , ,`'l`� ;+•. �, ;'� __ . _ - � •._...._------ _- . . � _ _---_--f 6�,P C. or ihis rec�son _ . . . 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