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HomeMy WebLinkAbout0929A (5) � � � WORKFRS'COMPENSATIONDECIARATION - OR PLUMBING PERMIT ///��� �� I heraby,a����m Ihot I hove a cenificote of conseol to self 78A887A � ! insure,or a certifica�e of Workers'Compenwrion Insurance. � CE 817(REV.8/88) :� . ..-.. . . � - . -. . .: . .... . --. . . .-.. . � . .or a certified copy thereof(Sec.3800,Lab.C.) . . . . . . . ' . .. . . � . � � . 7�-�Q��.87 ���u� COUNTY OF L05 ANGELES QFpT. pF PUBLIC 1NDRK C P�oIkyN6�Jl1�.L�L_Company . . � . . . . �, - �_ . . Cer��fied copy is hereby�fvmished. � �._ � � . . .� . . , FpR APVIICANT TO FILL IN(PRINT Olt TVPE) BUIIDING^ . Certified copy is filed with ths coonry buiiding iaapec- A�OREu o�3 �. fion deportmenf. , NUMBER FIXTURE OR ITEM . g '.fEE `�L1n, Q� -����� Q� - WATER CIOSET - �`�w�� ' . DareSJ-2��L.t1—Applf4anr ` � � ��T -.. � CERTIFICATE OF EXEMMiON FROM WORKERS' eaTH iUe - - CRO55 Si. � COMPENSATION INSURANCE � ') SNOWER OO OWNER ��{-` . � '. .. . . {Thi�a�dlan n��d not b�compl�tN3 N eh�woh inmlr�d by � �i� . . . . . �. . , 1h�p�rmlt y fo�on�hundnd dollan(f100)or I�o.) uv�iORV . � �pp�u I cert'rfy that in the perfo�monce of�Ae wwk for which this � �, permit is iuued,I sholl noi employ any penon in any moonar $INK . � CITY ���u�n . " � - , � so as io become subjac��o the Worker�'Compensa�ioo Laws. � D�SHWASHec � b Corrta�croa �' Lr . f epplicanl ROTHES WASHER� � A�F� /� O/ �� I � . NOTICE TO APPIIGANT: If, of�er moking Ihis Certifimb of SWIMMING POOL RECEP70R � Exemption, you zhould�become subject fo Ihe�Workeri C�TY ln /�,.'�/,, Compenso�ion provisions of the lobor Code,you must fwlh- ' �qµrN SPRINKLER SYSifM v � � �"'"`" � wifh camply with such provisions or fhis parmit sholl be SiqiE �K, �� deemed revoked. " -� ' � - wntER HEntER �� �KENSF NO. � 3 CVi55 ' - � LICENSED CONTRACTORS DKLARATION D�STRiCT NO. PROCESSED BY � I hereby affirm tha�I dm licen�ed under provisiom of Chapler 9 GAS SYSTEM OUTlETS D � -(commencinfl wi�h Section 7000)of Division 3 of N�e Business . . . WTLEiSOVER . . O �Q y and Aofessions Code,nrd my licenae ia i�fuil force and effect. 5 nER 5v5TEM d Q Fit�A� VALIDATION O licanseNumber ����0�� Lic.CIaxG3�O ' Q(� DATE 5-3- � � � � FINAI . � Contracror � 6a�e �'a0'�7 BY � U � 6 I am eKempt�nder Sec. e.av.c.fo.rh�a reosoo Plon check fee , z Q 9 2.9 R z Date: pLUMBING PERMIT ISSUING FEE S slqnaw.e �;• • • • •5 TOTAI FEE Q SO � - I • 1DQSb �, � Plon check opplicont • 1 O�y O U y ' SMGIE FAMItY • F = �t � HOME OWNER-BUILDER DECLARATION Name � ' -�� � . - �I heroby offirm�hat I am exempt from iha ConMac�or'a Licente ' � � -� � � �O E,Z� �8 7 , Low for the followiny roason(Secfion 7031.3,8ufines�o� � Add�ess �� � � - -- � � � � � � � � � Profm�ions Code): � Ciry Tel.No. � ❑ 1,as owner of the propery,.�will do�he work and the , � ► � - . ' strucWre Is nm leianded or oHerod for eole(Sea�ion . � � �. ��-- , - . � � - �� � - � . 7041,Businass ond Profesaions Code). _ ' � CONSiRUC710N LENDING AGENCY � � �. � -���� � - �� - - � ��� � � �- I hereby aHirm�hoi there is o conthuction lendieq apency fo� ' ' � � Ihe performonce of tbe work fpr which Ihis permit ia iuued � . �� ���� � - - � � � - - � . (Sec.3097,Civ.C.)• � lender's Name � . . � . . . . . . .. . � . .. . . . .. . . . lender's Addrou . . . . .. .... . � . .. . . . .. . . I cerrily rhot I hove reod fhis appHrnfion ond fiab thnf the ... --.. . . . . . . _ .. '�. . ► �. . . . .... . . abov informa��on b corract.I oproe m comply with oll Counfy . � ordi o es o S�ots low repula inq Plvmbina,and hereby . . � , . �, , , _ oui ri ro sa ol thi County ro enfsr upon Ihe - � o e ni' d pection purpoaee.� . . -. . .. . . �� SEE REVERSE FOR EXPLANATORY UNGUAGE Sipnntore of Permittee Do�e . .. . . .... . . . . . . . . . . . � _ . ,.E'_,... . ._ .''.,, .. r: _ i _ .!`.., ..s . _ . „ . , .., _ ,. .. .. �„ ;:. , i qFFROVA;S _ _ DATE ,_INSPECTOR'SSIGNATURE �NSPECTOR'$NOTES " '-- ' ���� ' '�'�� (�v'J J�4-IlUI � F [�[,_�FRFiI'�,I _ �� ... . . , . ..�. .. UNDCR SLAB WGRK ,T ���. .� . �-. � 1 4 '�. 5 � . ,. _ . ROUGH PIUM1luIqG _:.� �_ ���`v .,,_,,, , ...._. ' _ ._ .. _�...._. __..�.....�_ '��'. h sc v nf 1c t�.� fnll q'r of,, (Secl�un 1707I 55 � � GAS PIP��NG . •. . . t_ � � � �'_ . .::' .�V"'� ''.:;. . -:;•,: ,.��. :, . 8usiness`c 1 frofeszlonz(.odcl Any uty o�counl�;��.Fs ch .-_ "_'_' .-::� ---•-'_._ :,' , . i . .. _ i � i ''"� re uires n orm6 fo cbmtruri.�olr prove. der�olish. GFS VE��i . . .:. �'�-� I ! ,..4.. . ' 9 F . . ; ... . . � -+--%-=� -- - � -�-� -�--------- ---- - -- ��� o .repair a y struclure, prior to is �rssuanre� Iso r ViOT V70.7EFHEATER......: ...._'" "!' 'j_ ___'...__._ .__'_ �, -.t i i ., -. .-� . ;,us�s II+eaFPf coiy for,such� rml,loff!eb srgrterJstale. FlUM6RIG p!KTU4 -. .�. . .� :>>`_ ...� a", , ; : � ._ i �� - ''' -��- �_ -,��1.{g r i Ihot h �-f ceneed p s onr r t .�,- v�s�ons o!�hc GAS 7E57 ~� -�.�-�-�� ''��--�- ... ��.._.�.. -1� ... -._._... .�� .. �'__ Co'reclars L censc.Lo �Chapl� 9(co �mencin with ( 9 UTIJTYCA_fdOI..1E� ' �-T� ' ^ '�` � ' ��.':".� �: �. , Sedion 7�001 0l�'v�s on 9�01 Ihe Busmess and Profes . __. . __.___ ._ ._ ...'_' .__._ .. i .,._- . ._.:_.. . _ ___ _ .._ .... _. .'( _. _.__._.. - . ��-y�onsCai�e) ifhafhrl. � empft�.c16 'c�ndth�6osis _ ct _ —' � ! � � ' },� Y �Ihe`ol q.d� .xemprfon.'�An boloi�on�o( ScU;on ; .,_.c7`�. . � -- ' . , fINAI •jM�n(h y�e _Y _ t ' _-1-� __` ��-=,. �..._..._,__I____� _...__..____..._.� �.� �703I S�b�c���pplicon!for a�pe m sublecis the appL- l�'��_ .S _ �' r�_ . __ � . . ._,... ;, . , . .. �T"- ..,.i Jol1o^s(s�cD�.'�F .�� ,.. . . .. d iv�usrs.ti�__ `:__, .`_i ____ .--' --{ ------. ..- --' -- - - j --� �� i NrASTE��/.P'rF0'JA, 'I, � •. l -•.�. —=-�— �— - ' '— ,.° no(ly f o� 'm fhon`liv hund-e �`- u I,os own r of th opert II oo�ho o•- ^d ,...-_"_�. ._._''___.�_.._____ ' _�:.._..� �.r:.___. _; ._._ .__'. '_ _... . _-._ _thesructu �s cr-ini d d�roff redfo- ale -" � '- , 1 t n c - -" .' + 1 � � �.�+� � • � 1 � (Scc.�7044 Disloeis�anaPror ss�onsC d�: YhcConirac� .�___ ` � _. ,~ � -- -'� 1-'-�- -� -�-. .-.-.- ��" torsUcen Cawdocsnotapply�foo �rofp.•perfy r—^—.. _ ' - r.- �-�"� - ---r- - I �I ! �'���� �'' � w6o 5�itd or improves }fo eo6 ond 'no docz iuch j _;. ' � . ., , 1 I � , , � wark�hlmsclf provided Ihot suc6 Imp.ove�ents:crc no� a - � ...,..._... ........- ."'..�_... . . .__ ._..._ . , . `. . . - �._�.:.- '--:--_"-.. -'.'--.___.�__.. ._ ..'_ - - .__�._. j intendcdor�ollor�dforsale.11,however thebutldngoi ._ ,.. � � � ... _-' � �1 � ' � � '' :.�L__ :.1 .. � ��c � �1 {:,; 1R provement Is sold,wifhin one yec;ol co�nplef on.Ihe �.. i . �.__ .. - 1. �_ '__ _ . _._ . -_, .ovn-r-:,v d.;rvdll�hc✓alheburd� ofp;ovin�l�Jhqd�d . . _ __.'___` ____.. '� i .�� �.. ��,.__-�����_��-j _..' „_ ' ��_.��, _.__ .i not b ild ardmp7cve 10 �hn purpose�o!scle,) , . . ._ _ ._ . , i . - . ..:. ,�..-----�---:— ' .:\ ' `. ' . , -_�... _ __ .._.__ ...,_.-._ �_...-.. '_�.�_....- ._�... _.___... , :�, I ^-. _ _ � � � ^.. i am t.xcrip �nOcr Sec .'. . . .... :,.� , �' L :-1 , � � i � � �.' .� .,.�. 1 . .�, '•� , - -- ---- -' � . --. _,_.__._ 6 f,P.-C:icr tnis�cason' � '� •� ;:'�.:. ,. � ��---�'-__.�L._--'---------------� --' - ' . --,_. ,...,.. , ., . . . , . �, � ___..____..-----�- -_._.. ..... .,,., .. L.� � � � . ..._' '---...__..__.�..._-----�_ �.__._ ._---`-` . , _, . �. � , ; . .-_—� —� . . i_ __--- -- __ _. .._ .. _ .-. �iF i � :— ''- ° "'�_ � --- -- --_. __ -- —_ _ � . . . `�...__�_ � --.-..� 'Si vre . . . . ...�_ _._- _._- . . .. '_ . . . � _ ._�__. __..i _ . ., i .. , _ . .' _. _ ____ . ._.___.._.'_ _._. . _. . , � . . �__ ___ � ! �h'f1Ef �_ ]' . 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