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HomeMy WebLinkAbout0928A (5) WaRKERg'�°^^�N�T�°N���AR^T�°^' APPUCATION FOR PLUMBING PERMIT . I hereby,offirm Ihut i have a certiiimro of tonaent to setf 78A887A , . _. . . I . . � � . insore,or o cerlificp�e o(Workeri Compenwtion Insuronce, - CE 817(REV.8/88) .. -� � � � •� � � � • � - � � ' � or o ce�Yf�ed c ther�of�°c.3800,lcb.G.) . . . . . . . . . . ❑ y O79 �' po Y S��fe FvQ� COUNTY OF LOS ANGELES DEPT. bF PUBLI�W : Polic No. om n � �, - . - �. � -�' � Certified copy is hereby forniahed. , y � . �. FOR APPIICANT TO FIIL IN(PRINT OR TYPE) BUIIWNG b yf Cerhfied-mpy is filed with ths counly building inspeo- NUMBER FIXtUREOR�TEM � FFF A�E� �� �� �- f' tion deponment. lp�pury ��m� . . (� ��, p� �y ' WA1ER CLOSET ... Da�e_S1�i1.LAppliqont .. . J . . [�R03�55T. � � l� . . . . CERTIFICATE OF EXEMPTION FROM WORKER$' , &4TH TU9� - (jD � � COMPENSATION INSURANCE . . � OWriER . . -� • - � -(Thfs��cffon m�d aof b�compMt�d N th�work imoiv�d by - S�weR � .. . . .. fh�p�rmit Is fo�oM buednd do0en(51001 or bu.) IAVAiORv �pqp,5,5 � ' 1 ceriify ihat in the performa�ce of the work fw w6ich this . , . permil is issued,I 5holi nat employ any person in any maoner SiNK Cin'� u`n ._.- so as ta become subject to the Wo�kers"Compenwlion lows. DISHWASHER ��AR� F�S��,Q P a _ �\i- APP2iCo�1 - CIOiHES WASNER OO ADDRF55 . . NJTICE TO APPIICANT: I4, after making Ihis Certificote of SwIMMitaGAO�OLRECEPTOR �^ Eaemp7ion, you shauld bemme subject �o Ihe Workeri � ��Ty . `.�(� Compensolion provisions of�he Lobbr COde,you musl forth- �AWNSPRINKLERSYSiEM e "- � � �th comply wi�h such provisions or ihis permit shall be ST�iE �`��[>� � � 'deemed fevOked.� � � ' WATER HEATEN �����' � �J ' � . UCENSED CONTRACTORS DKIARATION� . D�STRKT Np, PROCESSEU eY I Mreby affirm 11wr I am(icenaed under provisions of Chapler 9 GAS SYSiEM OUTlETS b'� � � (commencing wi�6 Section 700D)of Division 3 04 ihe Busineu .. pUTt£TS OVER . Q '�a�O �' ond Profeaaiona Cale,ord my Iicense is in full force and effect. 5 PEx SrStEM D�L VALIDA710N . v License N�mber��`-w�� lic.Class�lL_, �`� � ffi j . . . . , . a . FINAL � p � � Convoctor� F' .Dore H-�a`U� . BY � V j ❑ I am examQt under Sec. . � . � . � ' B.BP.C.ior this reason , � �� Z � Plan check fee :0 9 2 8 A k Date: . . . � p�UMBiNG PERM17 ISSUING FEE S �a JD � • • • . � � Signalure . �' 5 TOTAI FEE �, � ; i . •9a5o � �� Plon cheek applicom �; SINGLE FAMILY . . . . , • • •q 4 5 0 u I HOME OWNER•BUIIDER DECIARATION Name � ' � , . � ' � � 1 heroby offirm�ho�I am e.emp�irom the Conhactor's Llceme qddress � � � � - - -� � .- . . . � � 'C r�2� �8 7 lpw for.the followiep rsoaoe(Saction 7031.5,Bvslneas and � i-' Profeu�ons Code�: � City_ Tel.No. . . . . . _ . . . j ❑ I,os owoar of the properiy,wiil do�he work and the . � � � snuNure is not Inronded or offered for sole(Ssdion � - � -� � � � -� -� ; � � �� 70d4,Bu�iness and Profeuiona CodeJ. � CONSTRlKT10N LENDING AGENCY � . . .. .. . .. . . . , . . . . . - . . . . I hereby uffirm thoi fhere Is o conshvtlion lond�oq ogency for : � �. the perfo.manca of the work for which this permit is inued �- � � � - � � ' � � , " . " � � �- , ' (Sec.3097,Civ.C.). '. Lendsi e Nome � � lenderS Addre�s � . � . . . . . . . .. � . . I certify tha�1 have�sad thia appiicatioo and staie thel the . .. . .. . . . .. . . . . . . . . . . . . ' o6ova i�ormetien ia ce�rocl.I ogree to comply with all Couary � - � � � ord�no s ond Stv�s lew�reyulatinp Plumbing,ond heroby . _. .. �� � � - � �- � ou�h �xe ro fenlo�W of t Counry fo enter upon f6e . � I, abo • t d propa o ON�on p�rpose�. SEE REVERSE FOR EXPUINATORY LANGUAGE � i�. 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