Loading...
HomeMy WebLinkAbout0921A (5) '"°"KERS•�°""�"SA�'°"°E«"R"T'°" APPLICATION FOR PLUMBING PERMIT /7 I hsteby,offtrm Ihat I hove a cerlificme of consenf lo seH �g/�BTA _. _ � v�� insoro,or a ceHifico�e of Workers'Compenmdon losurancs, --CE 877(REV.B/68) ' , . . . _. . . I I .� .. �or a certif�ed topy therwf Sac.9800,lab.C.) - . ' � . � � Ll ❑ y �'�'�� �,,,SfP�e Fun{� COUN7Y OF LOS ANGELES DEPT. OF PUBUC W08KS � Polic No om n - � � - ' Catifted topY is hero6y fwnished. . �5�, � .3 �• ' FOR AOPIIGNT TO FIIL IN(PRINT pA TYVE) . �0�� j � Cer�ified copy Is filed wifh Ihe counly buildinq inspet- , � � liOn deporiml�t, NUNIBER FIXiURE OR ItFM � �fEf �,���p�, `°c""rv.. i z poro��Z1!_AppliSonr � wn1ERGW5Ei � . . � �R� - , CERTIFICATE OF.E%EMPTION FROM WORKERS' , o� BAiMiUB � - �� ��ST� - � ' COMPENSATION INSURANCE SH�q OWNER . � - . � . _ . � (Thlt wetten nNd nof b�eompl�t�d ff fh�work tmrolwd by � � ' � th�p�rmN It for on�bundnd dollan(f/00)er fns.) �av�tOar . �'�t. . ..- . . . . ADOae55 I cer�ify thnr in the perfamanca of the wo�4 fa whi�h�his �: ; ' � permil is issusd,I sholl nol employ any perton in any moaner SINK OTY � � - . � _ { , : : w as to beeome�ubjed to the Wo�kers'Compeowtion Lowa. . . J . �ISHWASHER j] CpJiRACfOR . r~p ' APPlitanf � � ROTHES WASHER . . � �ppRE55 S � � ' ��JTICE 10 APPIICANT: If, after mokinp Ihlc Certificote of , - � E.amptian, you should become �ubject to �he Workers' SWIMMING POOI RECEPTOR . � Compenfotion provisbna of the Lobor Cods,yoo mpa�fo�lh- UWN SPRINNLER SV57EM CIN � _ _� with comply wi�h such provisiona or fhia permit sholl ba STATE LIC, �� �deemed rovokOd. ' � - - � ' WqTER HEAtER �K�N��� � CtA55 .. -- � � LICENSED CONTRACfORS�ECLARATION � DISiRICT N0. PROCESSED BV . ' I hereby oNirm thm I om licemed under provhlona of Chopter 9 GAS SYSIEM OUitETS I �1 , hn�,�n Q > .. � ,�(commencing wph Seclion 7000)of Dlvision 9 of the @usineaa O�TlETS OVER �� L� ��� 0. and Profeuiom Code,ond my Icceme fs lo full fores ord eHect � 5 PER SvSTEM - FINAL VALIDATION � ' litenseNumbe. �+3�0�� Lit.Clou�l'� DATE y d�/� � � - � FINAL �,�/ /�. O � Confracb. • Dete ��a�S 8Y /���.tt**✓ . U � -❑ I am eKempt under Sec. . . W . a N B.BP.C.for rhis reown . � 2 Pton check fea Dote: � � . . . PLUMBING PERMIT ISSUING FEE S � . J 5gneluro ' - TOTAI FEE � -�.O 9 Z.� F � �,..,.... . . . . Plon check applican� ' . #� • y . •rJ �� SINGIE FAMILY . , � �' HOME OWNER•BUILDER DECLARAlION � Nome - � . _ � . i p b 5 0 I hereby effirm that 1 am aasmpt from the Controcror's Ucense � qddreu - - � Law for.ihe followinp reosen(Sec�ion 7031.5,Bosinea and � � � � � � � • • 1 D G 5 0 u G:� Professiona tode): . Ciy Tel.No. � . . . . � 0�i 2� �fi•� " ❑ I,o:ownei of the property,will da the work and the � ' � � structure 1�no�intanded or oRered for eale(Sec�ion . .� . � - - � � - - � � � - � - - � 70d�,Bwioess ond Fofeaatons Code�. - CONSTRUCTION LENDING AGENCY � � - - �' - � -� � � - I heroby offum that thare is a coosVuc�ion leadinq ogency for � � � ' �he performance oF tbe woric for wfiich this pe.mit ia issued -�� � � - � � -� � � � � � � �- � �- - �(Sec.30D7.Civ.C.J. . , � Lender's Nome . . . � . .� . � . � . .. . . . . Lender'�Address � . �� . � . . I cer�ify�hm I have reod thh appiimrion ond s�ate tho�ihe __ . .. . . . . ► . : . _ .. . . _ . obow ioformofion i:carocc I oqroe lo comply wifh olI Couny . �. �. � � " ord' es ord S�ote lows regula�iny Plumbiny,and heroby _ � _ , ' , . . . . . ou ori e esenm�i� �of thia Covn�y ro en�er upon the � ��� � � �� � , . a o e lia ed prop ry i apscYon purpme� . .. . . .. f SEE REVERSE FOR EXPLANATORY IANGUAGE j, Signalure oT Permdtee Dob . . . . . . .. .. . . . . . i .' .. � „.., _..; R_ � . � ..� , . � .. . F . , .4 � . .'� .. � ' .'.. �'', [ � '•' . `'� .� ...... . -l .. . , . , r .. . . .,. t . .. .. . . , . . , _ . � . ' . u' . . , . . . . . � RJSPECOR'SPJOTES '.`. . , .'- .. ._..�. '„O i rF riUl�L�f�.C i�KF Y .-., ' �' AFFFOVA S _D�TE , .)�SFECTO�'SSIGY TG1R- _ .. . . � _ , 1 ..--•--- - . s 1 � . � r Un�DER V'i5:'ORK 20 qrp.. . T . . .. ... "'_; c Cb4.n tr '� ��c t r ha-f�� t� C,n�r c '� � ROUGHD UNBItif .,..��96 .___J��.t�t/ . ..�. ..,..�..........,. .... ....., ...,_.. _ ..,... _.._..... `l�t . L f r f�l o n.n S t.o 7031 r5. - G�SFPN�, l �. /� ��� .:� ' • ' . '. . � Bus�nc;sendf c:fr.ssionsCade: Anyntyo ,nrp, h;c}� . . , „'�•.. ._.- , , • >, .. .. GAS VF1:7 _ . i' . _ i .... ,.:;�, ' r , .r . _... ' _'___.�_.,._._ _"' _____-. __.i o �rep..e�ry rr r� et pr�I toJ �s'zs co alsorre. ,. y.. HOi\:'ATEG-uEAiER-.__ _�.�' . ......_ •."___' •'..___ . 4..�-+ � . .• , . . ..�,. . . . � I . '.' - : ...'_.5'4!�^zktcepplcanr.lar.:uchpCrmlr-1a11! o7iqnedsrqrn� , � . . ..._ . .." -' -'�.... . � .,..__' - ,r Ihoi he 1 rensed nt ro rl - . . Y�hc CLU"7D',1,�Fixi'J�FS�.�.1. '� -� • ~_:�. n ' nso � . . _. � . � � .. . . I_._. � P GASTES; � -. -- �. �-.` "- -�- u----- ..�.� -- Corfrociars li . s� C ��C�.pt�.r 4(o enc�nq wirh ' -�. � '. I ..-.�� s c!aq�c0u) 1 D wn� t�f1 ��Fu :ond f'rores UT4ITYk0.N�DviED._._.._"_'-- ___ .__. ..:... . . �._._ I . , _ . , . . . .. . :r--�- -�--�--� '. -_--.-.-----. -.- ..�- .,-� .� �,.:'.�,�s n Cod�)r. flci��es.exprtpllh �c��oman3�t6ebdzis � C c7 � � � !.. I � " � � ' � for !h� aflcged e c�mFriud An� v oi�on�o! Sechon Flr:n� � ���C r..i(d:� � irnrd .�'', .I .., . i..,, .-__ —..__- . .. .�i �`—i .�.7031.Y bY.cny app?cmri'ia ,a`�m,n 'tJ rs thc'oppL� . ...-" � --. .._.__ ;�_.. ._ ._" . ...�. __ -- - . }--- '� -- ----- ---- - - '�c t lo o civJ pendl7Y�F nol, o�e'iho� iivo�bundred ,--�,-r-- � d�u�,��s:e�J _ �.NDUSTF�a;,_ ._._ ._.._u..,'_' •. '�... . . _._ _...._�._ _ _....:_... ___'.___._-_'_ .__._ - , od " ...v:_ .__._...._ . __.._ __._ � . ; .. . ... .i. �. ..-; i.]I,ai o�vncr cf the praperry w�ill dc ihc x;r�-" :':ASTE-i>FFROVl.t ' .-�' ' �,� . � ' �, . i -- .." -- nCr d - .. - .� ' ..'_� �_ ... ._._ .._... . ._._. 1 strU"Urt`7 I�c cr e rcret�fc-�,r �. -n--�'"'�---- . - , . .. , .� � , . _... ...._ _ .._ . .__ . , 71�4J'ffJ andF � ssonsC d � i m 1 -" ^ i . . r . . . . .__ � .. . _ .� T�e Co c- . -�:' ,'�_, ' <, .� � ��.: . �,. �, �' --r- �-.�-- ---� -- �-.... ' .IS s t censo�L cc es nof a�p7y io an ovmer of prdpe�rry �;'. __. ... ._.. ._ ___ • _ . �� -�,-._.__ i � ; ..: `.! . �'s wha.b4ilHs�ar I:nprovcs,thcreon, cad wno docs such � ' � � � � ' , work hlmsel/provlded thar svch Imp o i_...._...s f. .:_.,...,_.__..., .�_ -.. _�...=. .,_ _L_.- " .� , s(ne�fsaro�no� " � ��.� - ���� � ��r. �.- �' �' �' � -- -� `---' lnfendr:J o�oi7e(nJ ior saln_�li.however�Ihr bur'ding o� � .- .-_ � ... _ � - .__ � .-- . . . . � •'' � - : . ' . _;�j _! � �_ '� �I� ��.�.:-lmp.o m fls;a.dvi:lJ��nonqyearofcnplNion.Ihe �. . , '. . ' ' '"�� - " - --"' o}n tutlden lllhavo7Feburdenol�. vinD � __�___ - �. _".' _ '_-___.. ._ __ � : . . .r; i � .'. .._ i _ 1._._ ' __.... � ��'_ ��.+".n�f 6.rild or Improve-lc�.fho p�r�osc Cf s�'c..fhr I �_.� . _.__`._ [.� _ __: ... _ rh=dd � .. _ ._ .._. � . �..� _I • � � � • ,. . -__�___�_.______- ., .:..:-�. .._._,..._ �_.__.__�.._�--'. �____ ,.__, ..'� , �, ' '. . . . _ . . .. .. ,. . � ` � --`!om exemp undcr5cc t,;. � ,, : -;. ,` > -_...___�. ..___._ .,� i i ' �� .i _ .� 6 E P.C. for th s�reason _` .: �_�'..,. '..:_'. . •- -�--� _.._ .. _.._ . . _ - �___ ' : I i — --- ---- -_....__ _�_... . .. _ �, , _ ;. �_.r�_� .__ ..�__.__""'_"�______ _" : _. __ .__..__ . __ . ___ - _.. .___., � � , �. .�.� i �. . -�_. .. . . , '.._'._. ._._..__._�. .� .__..'_ '__. ........_..._._. " ..__ . _' _.....__-__.__........... ..__ .. [J�,rc --- _ . , _ _..___'___' .._..__ ., f . . ;'_ '�_ � � . _. . - . � . . .,....-. �;� . O.�.ner .:_` . . .. .. . , � . . . ,� . ,, . , . . ;_._-__.___._---_.._------- -- --. .,_-_ - - � _.—..__ -- --.... n�.'„�.�i-�:i-::��- .. . .,._.ii` . �� . . -.�,. ., ... „ '. • . . , _. -.. „ „ .. , ,-.' :� .� INSPEQOR'S NOTES ;---------_ _.---------._. . _----._ _._�--. _ � ., . v. . . _ , , . ., . ,. . .. . � � `""': -. -�:- ..� � . ,.- .. . �----._-----__-__._-' .--- -... .�__ ._--- -�.:._ . ..- .... � :<.: ; . �. ..'. ,c� �. _ .__. .......... .... ._. � . � ...? - � • . - "'- . -- _ .. . , _�.. ... �. .._ .. r... . � -- — �-- ._ : ... .,, .�� �i:� ---- � .:i . .. . . . . ..: . . -�i .._ . .. . . . . . . . . . .. . ,t _,. .... .. , � ., ,. .- .,._ ,...� .,_... . .. ..,,. _.. ... .:.� . . , . . . . . . .. --"" —. —._ . . _.�..__ �, i ��� _