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HomeMy WebLinkAbout0927A . WORKERS'COMYENSATION DECLARATION �. APPLICATION FOR PLUMBING PERMIT ,� ' I heroby,offirm �hot I have a ceriificate of conaeN�o ssif T8ABE7A . . . ' Insuro,or a cerlifko�s of Workers'Compensation Insuronce, --CE 817(REV.8/88) � �. I � = - � � � � � � w a cerni;«I co�py r�hen�af_(ssc.390�0,Wb.C.) COUNIY OF LOS AN�ELES DEPT. OF PUBLIC WORK Q�Y No�7 3 Company 1L��e Fvn� . .. ..' . , .ii- Lo}'aD . . . Ceriified copy i�hereby fumished. BUupING �j �- :��- ' � fOQ A9VUCANf TO Fttl IN I�INT OR TYPE) ,SpDItE55 J �� � � Cerlified copy ia filed wl�h the eouMy buildinp Inspeo- NUMeER flXTURE OR IiFM � FEE tAiondepurtmsM. _ (] LOCALITY ��CY\� a . �. po�e �S..G-P�[—�°�PPIiSone P �We.IERClOSET .. . 27� NEAREST � . ..CERTIFICATE OF EXEMPTION FKOM WORKERS' BATH TUe . � J o� Z� ���� - � .. COMiEN5AT10NIN5URANCE S�Ov�,ER . a OWtaER . ��'� .._ �-- � (Thb r�dlort nud not b�mmpbt�d ti Ih�work inwt•�d by . ,qq�i . . . .. .. , fh�pnmit b Ior on�hundnd doUan(fIDO)or lus.) UvaTortv a j) .4o�eE55 . . ' � I ceriify tha�in Ihe perfo�mante of the work for which�his SINK p - CiTv ����� . - s . �permfr is iuued.I sholl not employany penon in any monner � ao oa ro become subjed to tbe Workers'COmpenso/i0�lowi. i '� DISHWASNER � ' � COFITRAGf04. 'S �I �s ' Appli[onl - CLOTHESWASHER � ' ADORE55 .. . ' ivJiICE TO A�UCANT: �f, ofror makirp.fhis Cailifimte of : �� O �Exemp�ion, you bhOuid become �u6jeU lo ihe Workers` SWIMMING POOI RECEPfOR arr e Co J e =G3(o- ' ��Compensation pro�isiona of Ihs Labor Code,'you muat fwrh- LAwN SPRINKIER SVSTEM ' � i�h compfy with wch proviaiona or fhis pe�rmit sholl be � �deemed revoked. � ' � . � WATER HEATER �� ����� � GtA55 e.3 ' � � -LICENSED CONTRACTORS DECLARA710N � � MSimCT NO. PROC,ESSED BY - - I here6y offbm iFqr I om licensed unde�provnions o!Chopter 9 GAS SYSIEM - �OUTlE75 �. ' �Q'�n a ' (�ommenCinq wi�h$eellon 700D)of Divia(on 3 of the Business WRFTSOVER . . , � � and Aofesaions Code,ond my licerue is in full force and effect. , 5 vFR Sv51'F.n�t FINAI p � VAUDATION d i �r, ^ DATE S�3"�0' U '� License Number����v� Lic.Cloas�"'�� � - � � � FINAI ff �� O 0_ BY ��. � � Co�trac�w �� � 'Dare� � . ❑ I am eaempt under$ec � � �. fa/f 2 , B.SP.C.for this roaaoa plon chetk fee � � � . ' �O�e� PIUMBING PERMIT ISSUING FEE S 5t) . . '' �� Signvture �. - TOTAI FEE �O O . . � . . - � � � - Plon check oRPliton� . . - `�9 2'7 A �� � SINGLE FAMIIY � - . $�< •� • • �j �� - � HOAAE OWNER•9WLDER DECIARATION Name � � �- �� - �, -.. , �� I hereby oNirm thot I om e.empe from the Conhadorb Ucsnae A���� , � . . . . . .. , . -.� 1 • � Q(y�j Q� ' Low for�the followinq reason(Section 703L5, Bufiness ortd � Rofessions Code): Ciry � � Tsl.No. � .. . e • � �(�,5 Q= ' ❑ m I,oe owne�of Ihe p�operfy,will do the work ond the 0�.2� -8'] slruttvre is no�in�ended or oHered fa sale(Sec�ion . . .. . � -. � - � � � - ' 7044.8osines�ond Profeaaions Code). ' � . � CONSTRUCTION IENDING AGENCY � � -�-- � �� �� -� � - �� � � � � - �� � I here6y affirm Ihat ihere I�a conahuc�ion lending opency far . � '� the parformancs of the work fo�,whlc6 thia permit is issued - � � � -' � � � � - . ', (Sec.309T,Civ.C.). ' � . . . . _. . Lender's Ncros � � '�. � � . � Lender's Addrass � � � I ceriify that I haw read this applicm�on ond srote thar the . . _ . . . '� � � ► - �� . � obov infamo�ion ia correct.1 aqree�o comply wi�h atl County . �. . . � ordi on es ord S�ots lowa ropuloting Plumbinq,and hereby � _ . ' . . . . . . - � � aw enrot as o this Counly�o en�er upon�he � � � . ri abo o- e n inspect�on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - r��� � qnature of Permiteee Da�e . . ... . . . . . . . .. . � : - . :�r, �. ;s. �y. ..r- - . :ir�. :�... , ,_.�.. . _ .. . . . ..� ,._ . .�.... .. .. ,.. . � ., . , . .. _. . ..rf. q . � ... ,. . , . i : . . „�;�.. : . � "� _ _ . � . , nFikO'JrS� .. .,�nT �:SPEGiOR'S SIGh1TUCE INSr^ECTOR'S f��TES ' . _ ' " ., . ' n � ::.'� �l F1ck.0 ���i�1.i17 .... Ut:CER Slf�Ii L y�K, � � � � ...� :� '. l s . .. .� I.C� �c I i� I '��� t f O . !C C C.;;��5 ROUGr oIUMF�fVG._._._ ���� �� .�. ..._. ..__.,... ..� ._.�._._. ,..�,._ "' -'_'_'.___..,._.._.� �� N L f � r i1 n � '7 a nf(S rr _ I931 5. a _lJ .. _._ - �• � . , . ��GAS P;P^�G � - ' .� .'� . ." c . �'' . L' s�ness cnrl Prolc s Cod�� Fn�c�ly o,ccvnl�wh�ch �. _ i ';: , . . '' , ,)._ � _.. �_� ' .. . . � GAS VE�.� ;.. . �"�. . . i . _; � ��. i s:. � � y � equ've oa cr� �pro enso( . �_ � ., . ____. � . . � ___'_ '___" _ u ' .._.. ____ _ or-repa� y �� con fPub�f clie d �sh HOT V1AlEA HcATE4"--.. --.=.---_..... --'""--"--'- --•:�-^ . . . `, ' . .rucJ f Ssv '1 af o!c . _�.�. . .. ..�, . �...-. �-3 ,. .qoires f'� op�r,ant��o,..uch perm�t'lb.file�.segn,ed srate� FlUv,eltl�F.x7U .: :;` F �.. '� •- j � . ...... ..._ ._ , mC,t,lh If .I�tens �1( � rf Ih Pro sonsolfh� ' i ,' � �� =Y `_ . � G/+S tE57 2� �- (! .f-�-��- �- -:-� - --- - - -- ! 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