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HomeMy WebLinkAbout1109A W°RKERS•�°""�"SAT'°"°��"R"T'°" APPLICATI4N POR PLUMBfNG PERMIT �I hereby,ofiirm tha�I have a cer�ifica�e of consea�to self 78A8B7A � � � . i�nuro,or a certiiicate of Workers'Compenso�ion Insomecs, �CE Bt7(REV.8/6B� '. '. ,' �� � .. - . . .. . .. . or o ce�ified copy ther�oqf ec.3800, a .C.) l . � - P❑ol+cy NoQ.�,�.�Co�pany � UAd COUNTY OF LOS ANGELES . � DEPTy-OF'PUBLIC WO.flK� Certiffed copy is he�eby fumiahed. ������ � � � . � . � FOR APRIGANT 70 Fll IN(PRINT OR TYPE) AppRES3 ���, � �, Cenified copy it fliad wllh the touoty buildinp inspea ' n department NUMBER . FIXTURE OR ITEM � FEE ����ry 3 WATER CL06ET � ' � �. Dote � APPliqont� NEARESi .� - . . . � CERTIFICATE OF EXEMFTION FROM WORKERS'� a BATH 7Ue p� �ST� -i � COMPENSATION INSURANCE. - � . SMOWER ��R nU'l� ' '..t.`-�- . .. . . �. (This uetlee n��d nof b�eempl�»d M�b�woAe invelv�d by �it . . . ._ . .. . �h�p�nnl�U!er en�hvndnd dellan(f100)or ba.1 LAVATORV . � AODRE55 I certify Ihat in ihe performance of Ihe wo�k for which thls - � perm�t is iu�ed,I ehu11 not emp{oy eny person In any manner 51NK CITY- F . . � � _ ', so as io become subjec�ro the Wo�ken'Compensaiion Lawa. t D�SHW�SHER ��� �- �- � - � CONIRACTOR �`S . . ' Date � ' erpliconi � � CLOThIESWASHER � , � NOTICE t0 APPIICANT: If, afler mokinq Ihis Cxrifimfe of ��� 0 - � - � �mprion, you al+oold batome subjed to Ihe Workeri SWIMMING PDOt RECEPiOR � i �pemation ovisions of ihe lobor Code,you musf foNh- �tTY r �,�o�e ��O � P� L4WN SPRINKIFR SVSTEM .ih comply wi�h so<h�provi�iom.or this permil-shall be Stu A��� e�` �� IICC� , delmed revoked � � � � � � WAtFR MEATER � � ��� . � IiCENSED CONTRACfORS DECIARATfON�� � D�STRiCT NO.�. y'��PROCFSSED BY ' GASSVSTEM WTlETS 'Q . 1 '�Q`O �� t I hareby affirm Iha�I am litemed under provislom of Chap�er 9 (O � ��(commencirp wi�h Saceon 700D)of�ivision 7 0(�he Bu�iness OURET50VER �p and Professions Code,ond m �iceme is in 4u11 face and eHect. � 5 7ER SVSTEM QY (`1 '��� DA EL �/� ;'-� VALIDATION v I License Number���QG� lic.Cloas�L _ � C ' FINAL ,,��f .}�` � 0 � Conlroclor Da�e ���—�7 BY �'�Yf?' � U � ❑ W Y, I-om exempl under Sec. y k , :_ _ B.BP.C.for thi:reoson ► �, ? • Plon check fee ;� � Q 9 F� Da�e: S � � PIUMBiNG PERMIi ISSUING FEE S - Sig�arure �+'• •' • •5 � ' TOTAL FEE Q _ IolOQ50 plan check epplicom . � SINGIE FAMILY , . - � ^ � t G 5.5 0� - HOME OWNER-BU0.0ER OECLARATION Nome �- � � � j ereby offirm ihat I om exemp�from rhe Contractoi s License . Address - - O-�2 7+a 7 � ��,for the followinq reaeoe(SecHon?(131.5,Buainea and - � � � . � - � - ��� �� ' � � �� reuions Code): CNy Tel.No. � i ❑ I,as ownar of the proper�y,will do ths wo�k ond the , sirocWrs is no� latended or o{fsrod for wle(Section _ . . . . .. . . . ' 7041,BuNness ond Profeuton�Code�. - , � I CONSTRUCTION LENDING AGENCY � � -� � � - - � � - � � • - . � �' � F I haroby affirm tha�there la a canstruction lendinq agsncy for � � � the performance af the work for which ihis permit Is issued � � - � - � �- � - � - � � (Sec 3097.Civ.C.). � � . . . lender's Name � � - � � Lender't Addreas � � I ce�tify thut I hove read�his opplicarion ond slafe tho�the . . . . . . . ► . . . . . . . above in{o.marion is cm.xt.I oqree�o tomply wi�h oll Coonty � � ' ord�nances ond Srofe lowt rep�la�i�q Plumbiny,and heroby . � . . _ , . . � _� . _ , authorizs reprosantotives of this Coun�y�o eNar upon Ihe � � � . i a6o/ve�-mamio�ed prope.�y for i�specrion pu�poses. 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