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HomeMy WebLinkAbout0923A ' WOHKER3���,�NSAT��oE«ARAT�oN . qppLICATiON FOR PLUMBING��PERMIT I hero6y,aHirm fho�1 hove U certifimle of comem fo self T6A087A . . . � in:ure,or a cerlificole oi Workeri Companao�ion Insurancs, ��CE H17(REV.8/68) .- - . � � . - . - � �� or a[erlified copy thm�of Sx.98W,Lob.C.) . . . . ' . �-�p.���� �„�� Fu�d COUNTY OF LOS ANOELES DEPT. OF PUBLIC WORK i �P�olicy NoLfl�[LLL— o�,��Y . . . . . _ . . � [� a Cenifited copy is he�eby Purnisbed. �` � . FOR AVPLICAM TO Flll IN(VRIMOR TYPE) B�ppREu � .C.. � . . i�� Ceriified copy b filed wilh ibe couny buildi�p In�pea NUAAlER � F�MURE OR ITFM p FFE . �ion departmem. �ppay� � .. �j����p� f �ppte�ApPliGcnt� WA7FRClOSET - � � DD �./EAREST ' � CERTIFItA7E OF.E%EMDTION FROM WORKERS' . B�THiUe . . � 0 CRO5557. % � � � � COMVENSATION INSURANCE . . . � � , SHOWEF OWt�k . e (Th4�Mlon n��d not M eompltl�d ff M�work Imolv�d by �i� . . .. . .. th�p�rmM Is for on�bu�r�d dollms(i100)o•I��s.) 3 invqtOav � D qpp�u � - . .. i cen�Fy,�Ma�in the�periormance of the work for which ihis . C . pe�mi�Is taued,I shall not employ ony peraon in ony manne� SiNK - [t7vc �� � . ,.9(a _Is �� so os io 6xoma subjed m the Workeri Compensa�iOn Laws. . DiSHV{ASHER - - - �- � 1 , . .. CO+dTRACiOR. \ [1`P . ��. y ' srPlitaM � � - CLOTHES WASHER - O ADDRF55 �'., I O T� � . �, nJTIGf TO ACVLICANT: If, after mokinq Ihis Cerfiiicate of SWIM�.t�NGP00tRfCEP70R E.emp�ion, you ahould become subjec� to the Workers' � � CiTY('p � Compensa�ion provisions of ihs lobor Code,you must fo•�h• AQder �� 'P '�3�0' LAWN SPRINKIER SYS7EM wieh comply -'th such provisio�s��or fhis pe�mil shall be Sin7E uC, � deemed revoked. � � � � � WATEN HFA7ER LICENSE NO. 3� � � C1A55 �� �LICENSED CONTRACTORS DKIARATION � DISrR�CT r10. PROCFSSFD BV � 1 hereby affirm thot�am liceoxed onde.provisions of Chaptei 9 GAS SYSTEM OU71E75 �'v � ' . (commencinq wiih Settion 700D)of Divi�ion 3 of the Busineu . ptlT�Ei50vER . _ �4��� O � .ond Profes�ions Code,ond my license is in foll force ond effect 5 aEN SVSiEM FWA1 �/�.�� VALIDATION U �y +��� � DATE � License N�mbe� ��30�� t�c Class��_ a Q FINAI � � � Comroclor�hrQ�Dota S,Lr��g� BY YS""`"'� . � �� � ❑ �i om exempt under Sec, � . - � � � ' � a N � . B.&P.C.fw�his reoson Plan check fee - � � - � . � ? ' �O�O' PLUMBING 7ERMIT ISSUING FEE f ��, - �. - Signolure , � .. � . . . - TOTAL FEE � , . � �' � . " Plan theck oppiicant � � `�9 2'3 A. SINGLE fAMlLY {� �+ . � � HOME OWNER-BUIIDER DECLARAAON Nome � - � � �'I : }� ' � I I»re6y affirm that 1 om exampt from the Connanor':Liceroe � . . ., , - . _. ���'"�a� � ' Yaw tor�ihe tollowl�q rsa�on(Sectioo 703I.5,Bu:insu and � Addross � � � Arofeesions Code1: City . . iel.No. . . �0�2��8 7 � , �❑ I,os owrror of fhe p�operty,will do fbe work ond the � ' � . . Siry(tUlO i�nor inisnded or offered fu tale(Sedion . . - � � ► � �- ��, � � JOa1,Bu�ine�s ond ProSe»ions Code). � � �� �� CONSTRUCTION IENDING AGENCY. . � - �� '� -� � �- � � � � � . 1 he�a6y affirm that there ii a coaatruc�ion Isnding og�ncy for . � � �. fhe performonce of the woh for which thia permif is is�ued � - � � � - � - � . � � - -� � " (Sec.3097.Civ.C.). . � � � tendx i Npme - - � Lender's Addrsas � � � . . . � � . I cer�ify tMot I have�eod this opplimtion ond slate tha�Ihe . � � � � ► � � � � - - � . � obove infamation is torrxt.I aqroe to tomp�y with oll Counly �. ' o�dino es ond S�ate lows requlotiny Plumbinq,ond hereby . , _ , . . . . . . � . . .. . . auth i: repr nro�iv of ihls Gounty b en�er upon�he � � . ' 06o e• tio �ion porposes. ' IN �jr��-�r7 - SEE REVERSE FOR EXPLANATORY LANGUAGE -- O I ' ipnarure of Perminee Doro . . ., . .. .. . . .. . � w t W -, - � C t � ,.. : � . � t ' " , . �., , . . . , � , �' � `� . :i. .f:.: . . .:,.: .�"-...�.._ �..'4..� I . .� �� . '. �,r..' . .� . 1. ..� �� , . L�[�,,.-.'. . ., .. , .��. I . .. _.. � ` e.G�ROV:.IS. ,...DAt Iv$FECTqe551GN�TUFE INSFECTCRSNOTES . ...... . •� """ � .':� i �ilJ; �UL�cR,Ct L ��ili :. i. � unceaS[t,swoa� 0 �T .. : i�� � � . � � � ' � �.` v�r.i� � � �c.,, 1 �/� �.z�� � �yy� �_..Irc-CD G) _t' . p . . ROUGNctUM6Mf. �y � •••. ..� .-.. -- -_....-.-�-.- L � x t (or h f�l� � 3 y{Sr r�u 70715 � GA$PI.o-N�����. ��t '�! ' ' . "�1'� T -. � �_ B c 5 G AFrO(c O 5 C fJ ' IS y fy I� I ch GAS VE�a � � s., � requlr-5 o Fermir�t_ro sfrucf It i p o �.e� .f h. � .- - ..'- '-"-'-"' - . ..-- ' -' --7 or.repoir an/stru'I�re (�rior ra�its���iisucnce. olsa NOT V:ATEF HEATEF - - --•.. . .._ --. � � .. . � -.9u'ras ih �pl'canl foc u h p f 1���7 �n s�ne5lsfa�e� ` . ,, � �.` i.� .'._.. .... - - -'� meniih t he is Lce d uo r r rn� � - s ol rho FtU!.46fI�FI%TIIR'c:` :.�.t. .• . �..�. � .. ,ll . I '�` . .'."" . . , . .f�,P`o GAS iE57 � ;' t � ..._._..__�._.. _t� ......_._ .--�_ ;_....��_'_�' Conf�oclor ,siccn t v.(CFo t .9(<o�Tmenc n�with � •._� � . U'RITYCO:NOTIF;ED--�--�- --=.' .---'-.-- ' --� -,, ,.._._� __.....�....... ......__..__._.._"'- ._'___-'- Secfion70O)r i0 s �3�o!'ff tlusinessan[/Pro(es� , . � , � i • �sluhs C d)c b af Fc. � �cmrt fN rclrom o J ihe bcsis " . I f 7 ', r lor fh all ge�d �e yl `A Y ' lol'o I 5�-� I'on FtNAt ; . '-- ' ^ c7 .. � -"- � �-� -�LL� .... • � ' l037.5 6}�o y o�,p anr fo. a p r li�s ���i Ih �� ppl�� , - - ( v/�rw� _Yrnnl , .. "� � ��^-i L � '������� ���� 1 ; morc fhan 7 v hundred . � .__ ._...:._.. . .. __. _T _ '__;..�_. .,.. _� _'_.'� __'.__'_ __. ._._. 'i... '"cvnf��o a crvJ pen !7y pl,no'�. , . . .. � � i .., , .. �� dolfa�s(5500). - . _ . . .. ._. . '.NJUSTiI+.I----.___.. . .'.�._�:.. �.._.:J____"-. . ^�— ",.. __, �..-....-'.._.._._ :. _'_""._ ._. .___ .. ._._ - . �I,as o�.vncr uf the prape�ty will Jo tFe wor�^,.d `l;AST:l1P�KGVr1'. I_ .....', . ; �.�' !.:;'..�1 ;� ,'�..�:.... . �:..._.�_-. ___...... _.=.. �. . ,_ ___IY�C'SI'U^.1'JfCY:�Ct l. CnG��C�'Qft��r:11^r S�IC-..� . . . ......_....... _. � , . � __�_._..._�. _.__...... _..�_.__.. ._.__________.__.._i '� �� �, r,.,.,; ...,-- . .� . ....., ' •;�(Sec.7D34�E1�-,incssanAProlesslon;Code. TheConirao ( . . �. C�_ �3; ... ., .�t �.,.. .�,:. •. .� ...._..__-_ _. ----.-.._- __.. ... '_______.., .;'for"sLl[en lovidnesno�nppiyronncu-ner'o/property y- . ...,, �.,. , ' , .. _ .. . . . -�'- �- - I ' i '� � - ' �' ��' i �.�,who 6W(ds�ar lmproves.fbrreon, qnJ wh docs.sucfi � ...).• .�.�� . ��.' :, . � .....� . ..,." � work hlmsclf prov d d thaf such I provem nh crQ.nor ,...._.. . . . ._ __.�._..: ..... ,._..... . j,, � . .� , / ... . ' " -. '_ ' , � ��, � � ' �- � . . . . � .. 'mpra mc�f f c a�d� !�'n on ry� vofr<omp�c!ion.�h� .� ` / i t., r .--f.--- � ..�! t �-. . --. ' "-'-'- .'.--.:.:' . ��-�-� �-- � - ..awncr.buildcrvill.h .pfneburdenofprov,nc�ff�a�h�d�d ; ._.__...- _..__ .__:.�.. .. __.. _�.�_. � � "�"'- i �.; ' '-.�'�.�nof build cr im tove forlFi� osc c(sc(c, • '�. �.�J ry �r.��� " I � �.I... ..._�.___ .,'.__...�._"_"`_" _ . .^�"' f.._... __.... � P�/'r �� , . . . �. i . .. � � ' ___' _-_"___'_ r .' - ,�! � i -� \ � . � _ ..�. .."'""._... . _...__�., ... �� —i-� � . ' ," ^1 ..__ _.-._ , -..r'�. � . � _.. . . . . � . Y[:. 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