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HomeMy WebLinkAbout0697A (4) '"°RKERS•�°^"�"�,T'°"�«"""T'°" APPLICATION �OR PLUMBING PERMIT � I he�eby,oifirm fho�1 have a terllficol�of consant fo self 7BA897A �� � ' -insu.e,or o ce�nficoie of Workers'Compenw�ion Insuranca, CE 817�REV.8/88) � . , - - � . . _ .. . . ... . or a teri�fed copy�her�o( Sec,3800,Lab.C.) -_ _ . . � . ��p�ppr�. � COUNTY OF LOS ANOEIES . DEPT. OF PUBL�C WORK PDoi�icy No.Y�.yL��ompony�t �1�� � . . . . . � - � .. . CerGfied topy is hereby fvmished. ' ��� �� . � --.- FOR ADPLICANT TO FILL IN(PRINT OR TYPE� BULLWNG i'` � Certifiad copy Is liled with iha muNy building inspea �R� • �� � . lion depoNmenl. NUMBER FIXiURE OR I7EM � ��FEE a: Fisc�e(L A►�rnet� ioc.�ur pnre -� � APPIi5on1 Y WATERCLOSET . .. . . ({ NEAREST . � . CER7IFICATE OF EXEMPTION FROM WORKERS' `� BATH TUB . CROSS ST. � � � COMPENSAT�ON INSURANCE - � pyypEq � (thii atcfion nNd nof b�eomplN�d 11 fA�vroik fnvelr�d by �WER � �' �� - ��- 1h�O�rmM Is for on�hundr�d dollon(f100)er b��.) UvniORv . ��l . .. - . . AOOItE55 ' I cenify Ihot in fhe perFormonca of fhe.work fw which Ihis � � permit is iuued,I sholl nor amploy any person in ony monner SINK . CItY � CO U, ' . 6?� 5�_ . � so as ro become subjecf io the Workers Compensation laws. DiSiiwAS�iER� � � � corm�ncroa :sc�. P �1 6cn �_ arplimnt � CIOTHESWASNER A�E� � �NJTICE TO APPLICANT:,If, ofter making lhis Certificate of SWIMM7NGPOOLRECEPTpR O�� " O - . Exemplion, you�should become subjed to the Workers' CITY�s ^'_ f� � Compenwtion provisians of the la6or Codr,you must forih- �DARL�GY7 �p V � LAWN$VRINKtER SYSTEM wi�h comply with wch provisions or this permit shall be STAIE /� � LIC. , �deemed revoked. � ' � � WATER HEATER �KE��� O O CLASS � � � � � IICENSED CONTRACTORS DKLARATION ' . , dSTR�C7 w0.�� ��D BY �. � I hereby affi�m thot I om licensed under provicioni of Chople�9 GAS SYSiE/� �OUT�ETS� � (commencirp wi�h Sec�ioo 7000)of Division 3 of 1he Businau ,. pUilET50VER . _ . � I O �� �! �. and Profes+ions Code,ond my Ikense is in full fwce and effxt. 5 nER SvSiFM FDIA�L �//�� VAUDATION U � Licease Number �.)��+��.-] Lic.Class y v� - ` . . fINAL n ff Comracror ! pore �a la $l BY �L�?' . � � ❑ I am exempt under Sec. - . �� � �, p i' B.BP.C.fa this reoson � � Plan check fee - ? Dote: ptUMBING PERMIT ISSUING FEE S 5�, � , �'' � S�gnafuro � . . 4 � � � � TOTAIfEE � � . . . . � Plon check applicaot , � '��6 9�7 A , I ��i � SINGLE FAMILY - . #�. • •5 . - HOME OWNER-BUILDER DECL4RATION � Noms � ' � - � , . 1 hereby offirm Mat 1 pm exempt irom�he Controdoi s Lfcenae � Addrets � � � -� - � - - � -. �- . .. �. .��•.�-� �..J�� . Law for.the foilowing reoson(SeUion 7031.5, Businesa and Prafeaslons Code): City � Tel.No. ' � ' " � � �.rJ�c=i ' ❑ I,as owner of tf�e properly,will do fhe work ond ihe � , Q�� (��$7 � structuro is not intended or offerad for wle(Section � .. . . ' . . , - � �� -- � � . 70d�,Bvtinese and Profesaiont Code). � � . � CONSTRUCTION IENDING AGENCY � - �� �'-- �-� �- � �� � - � -� ' � -- - � I here6y affirm tha�rhe�s Is a conshuc�ion leedinfl aqency for ��. . - . the performonca of tbe work for which Ihlp psrmil is iuusd � � � � �� -- � - � - �, . - " . � � , (Sec.3097.Civ.C.�. - . ' , . . � Lender's Name � . .. . . . . � ' � lender's Addreu . . .. . � .. . .. . . . I certify rhar I have reod thia applimtion n�d s�aro thot the _ .. . � . - . , �. . � .. . . . _. .. .. .. obove infama�ion is correc�.1 ogroe ro comply wi�h oll Couoy . � � ordinonces ond Sbte low��equlatinp P�umbioq,and hereby . , � . . _ . . , - , � '�. ... .. ' aut 'e re resenloti ol Ihis County to enlar upon fhs . - �, obc�e� �ent' rry for apaction purposes. . . I� - EEE REVERSE FOR EXPLANATORY LANGUAGE 4 ipnoWre of Perminea pote � � � . . � � i ' . r r���. .[ P� . t, � r r �, . L., �,. .. .., r . .. -.1��: f:� � , . � , � �7 , l� . i ._.. . . . , . .. . _ . . . , _ j. � i _ � - i INSFcCTOR S NOTE ' �` � " ' - � r r � � avFaov:,5. ._,,,.�aTc . ,.�.SpeCloa�55!cNnT�ae �� J fvcR-GJ�� �C-�lF RA I i'„ .. uraoea ine�voer '] �. �� r '� ���/� ��� - � --- � n6i !i u177 i4u I y •rr.�;�17Lr��..2.Co� cor�s � ROUCiFW 37:G1�+ p��._., ���_ _'._'__ ._.. . . — l �• la f n' f�i ng r a,o�.�5ecfo 70J�.5. � �.,1 1 ' �, ..-'� . .�_ . _."�—., .A incss a I f nl�...i s Cnde. A y Uty a cc i� .h rh .... ._._ ._ � GAS FIP'y' ._. � ,,, �... . .:,. 1 -r-1� `t.�- _S�_1f��G _._ i - • ): . �res'c err�t 1�i5�corrsfr�cf:a7l �-I,�r c.di.rtia��:h. GAS VEP 1� - �� : q � ( + HOTWAIEF{{:A7EF- .-.!I !l �. ._ , 1_1�_`�_�.f_� � ' -" ' :' ....__. . .. '-'- _��^ ��� � cr p ir y sfruclure. pricr la II s u-�^e also�r FLUhBtIGFIx Pa 1 C—" �. .�_ ' ___' . ..._ �- •- - _.r.�� rOttFelt��tPn`lnre�chperr�ltpl�.}_sci�d rn�r ��� ':f�`J y���,n" t i(� '.� �_�.�a � I �. �. enr Iho�! � I censedpursuanf to Ihe p �.lo ol thc GAS TF.i � . �� �_ ___'__ __...._ ����'�`—r• -" Conlroct� @ Cic sc�! •�'(CFapt 9(commc c ng with U'1tITV(:O.-tJ:J7:F:LD---. __.._.."_. .. ._ _l.r�_.�!t .�__"_' ...��:�_,,,.�f ...: (•�_ Secflon IO^JJ c(-b'vis on 3 O!ih Suslness ond Pro(os .. _.. _____. Y f C,., h F . . .,.. -- � �7'_ �' � ' lo��1 �ol���� .. � rcm��h ofa nrld�tF�bas�s ri»ni ' � ' f' � r� c7 r � �osi s o ' ' p �Ii� � '..J :In. ,yrn.i( �t r:��..' . 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