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HomeMy WebLinkAbout0919A (4) WORKERs'�°^^�N�,T�°N°E«"R^'�°" APPLICATION FOR PLUMBING PERMIT I he.eby,ofBrm tha+I hove a can'rftcoro of conaenr�o�elf 78A887A insuie,w a eeMi4icare ef Worken'Compemo�ion Inaurance, CE 817(REV.8/98) . .� . .� � .. �... . � .. ... . . .... . . i �or a cenitied copy rhe��of(Sec.380D.Lob.C.) . . . . � . . . ... .... . . Pnolicy No� '�9��i'ompany S�N�c Func� COUNIY OF LOS ANGELES -0E 1�OF PUBLIC WOR ��J Ce�lified copy Is heraby'iurnished. ' � � � ��7 3 . � � . . FOR AiPI�CAM TO Filt IN(iRINT OR TYPEJ BU�tOMa `�.1 � . Cerhhed eopy la filed with ihe rounfy buildiny in7peo- '�Eu � . tion depoAmeN. NtlMBER FIXSURE OR RFM � . F� �p�pllri � .. � /�- n . �^ � WATfRCLOSET. . . ( ��7 . .Da�e L� o�0'p7 qppliSant r1:SC��(� IUM�t%G D NEAREST % CERT�FICA7E OF EXEMCfiON FROM WORKERS' � � - �TM TUB . .. ��'�T' . �� � COMPENSATION INSURANCE. SH�R OWNER . n . .. - . ' ! (Th4 aedion n��d not b�eompl�l�d N fh�woik involwd by . _ , . . . � 16�p�nnfl Is for on�i�undr�d dollan(5/00)or bts.) LAVATORV �x' nooa[u ' 1 cenify thm in the performonte of rhs work for which�his ^ 4 � permi�is isaued,I aholl not empioy any peraon in any manner 51NK �tiV ' `� . . _ � sa�os lo{»come fubjecllo ths Worken'Compensalion Lowi � DISMWASMER � � � . � f �` . . . CONTRACTOR �• n E epplitanl � � CLOTHES WASFIER I i.JTIGE TO APPLICANT: if, afler mokinq �his Certifiwte of ��E� I � SWiMMING POOI RECEFTOR ! Exempiion, you�should become aubjaU to tha Wwkers' CiTY � � _� _aQ [ Compensafion provisions o(Ihe Lobor Code,you m�si forih• �AWN SVRfNKtER SYS�EM � wi�h comply�wilh sv<h proviaione or this permil shall be � � Stn1E � LIG. � �� � deemed rovo4ed. � -��� � . WATEB NEATER ����� ���_� 'i � IiCENSED CONiRAC70R5 DKIARATION� � D�STRICT ND. PROCESSED BY ' � GASSYSTEM 'OUT�ETS � 1 heroby affirm fMt I om liceroed under provi:ions of CFwpler 9 l/ ! � -(commencinq wi�h Ssction 7000�of Division S of�he Bufinass , OUAETSOVER � � ond Profsssioos Code,ord my litenae is in full force ond eReU. 5 PER SYSTEM FINAL /� � VALIDATION � ' DATE � rY P// V . license Number��3��3 Lic.Clou�� . � O . .. - � fi1VAL � • � Conhactor � �' te �%�D'�7 BY �l�.n.�ti W , -❑ I am exempl under Se[. . - � � � - d H e.sv.C.(or�his reason p�an check fea � X Dare: � PLUMBING PERMIi ISSUING FEE E �. ' Signaturo � . � TOTAL FEE � �... . . . . . - � Plan theck applimnt . .. � � , � . �' SINGLE FAMIiY . HOME OWNER-BUIIDER DEC44RATION � Noms� -- � � - �- � . � . � � '�O�i L 9 A . . I hereby affirm thot 1 am axempt from fhe Conhactor i l�cen�e . . . . I _ . .. $�+ •5 . , Low tor the followinq rsoson(SaUlon 7031.5,B�sines�and � Addre» � � � � � � � ., ' • ,� O Q 5 0 Profeas+oes Code): Ciry ' Tel.No. - � - ❑ I,os owoer of(he property,.wfll do the work ond the . � • • � �b 5�`_' shuclure i�no�intended or oFfered fa�ale(SeUioo _ . . . . . _ . . _ � � � � � - �$,2� �$7 - 7044,Businesa and Rofessiom Code�. . '_ . - CONSiRUCT10N IENDING AGENCY - � � ' � � �� � � � � � � � I he�eby offirm thof Mere is a tonshuc�ion lendinq openry fer � � . the performance of the work for which this permi�is issued � � � � � . ��. � �� � � � - � (Sec.3097.C�v.C.�. � ' - lender i Ncme . � lender's Addrau . .. . � . . . • . . . .. . . . 1 certify�hot I hava read this applico�ion nnd sro�s�ho�the . . . � . . . � . ► � � . � � - - � obo�e infpmo�ion is cprect.I ogroe b comply with olf Counly � , � ' ordinon aad 51ata lawa repulatinq Plumbinp.ond herebY .. . � . . . _ . . _ . � . . . . . .. . outhor:s e anMtive of Ihis Coumy fo eMx upon Ihe , � ' ' abov •m joi e pr r fe � x�ion purpo�es. � . �� SEE REVERSE FOR EXPLANATORY IANGUAGE Siynatvre of Permifles. Date .. . .. . .. _. . . � . . . .. .. .. . .. �. . . . � `.i < r' {., t - r.. - ..�i� ., ._ .,... - .. .. ,� � ... � r-� . . .. . . . . . . .� ._. � .. . . ., . ._ .. . � _, . c . . .... �' � �-. ,. . . � •�: ; i ' , . , . � � � APPRO\'AlG _.y�qTE�._.„I.cP�[(nk'SS'�ATURE I��SPECTOR�S NOTES �-.. � - ��f''._ ... . I "".,� � ,. _' r.rn-6uun�R�,[�C� ���t";y �=- —t ——*-- ., i ; L'n:DER S FO.�•AeK.. � T,� � I`.T�_}� � � � . _'__�l� uf� �t � I r ` �.�pt� �m i r C n c . ' ROUGHCLUid6;N • �.-�/�j,.� '- ...._ ._... .... _.........._._..-..J L a f tl �(�I �rc i .a� 703[Sf - �7 � _� ...�....__,. / -+ 2 L ( ��GASP�P�,vG • / 0 •_" /u�„1.�— ���I - - - - ''_- - �. . � � C G sme:sa lPro(ussron:code� nnyuryoraoinr�}4h,cn � GAS VE�Ji � - i . . ' -�'�q��r�s�6�erm.d id construcC�n7ter-Imp-ov�c,dcnidli:A � . ,.. ._.. . � -.-f.. "� -___. �_-_�.__ _'" ._... . ... MOTYlPSEG-NFq7co- �` "� . 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