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HomeMy WebLinkAbout0798A t "'°RKERS•`°""PE"SAT'°"°E""""T'°" qppLICATION FOR PLUMBING PE IT - r I hereby,�affirm�rhat I have a cerfificate of consen�b self in- ���,A�vW aie7 -� n 'i sore,or o certifi<ale of Workars'Campensation Insuronce,or a {E 817(REV.8iB6J . � � � - . . . - . V I I � � �� �certified copy fhareaf(Sec 3800,Lab.C.J . -�� � � � � - � - � LJ - � � ' Policy Nof�Q�'�fCompcny�A�,F BA� A!S• �T�tND. COUNTY OF LOS ANGELES DEPT.OF.PUBL�C WORKS , Q .Certif�ed copy is hareby furnlshed � . . , . , _ � euitDnvG � �.fOR APPLICANT TO FILL IN(FRINT OR TYPE) /+ �� Carlifiedcopyisiiled�withlhecountybuildinginspection ADDRESS V ✓Cf � - dapart enL � ,�i/J . NUMeER FIXTURE OR ITEM @ fEE ��A��T� p .�Q� ,.Dp1e,��Appliwnf G . C.. WATER CL0.5ET ITOIIET) . I � NEARE57 / � ' ���� CERTIFICATE OF ExEMPTION FROM WORKERS' - BniH TUe � � CROSS St. �/,Q r(p Q � � � � 'COMPENSATION INSURANCE � - � SHOWER � � . OWnIER � � � �� (This saelon no�d nat 6o compl�t�d if}h�work fnvolwd bY MAa � 'th�pvmlf i�1or om hundrad da��an(SI00)or I�ss.)-� LAVATORY � � �� - � (�D ADDRE55 � � � � - �� -1 tertify�haf in Ihe performonce of the work for which 7his per• SINK � ' � �� � - � . mif is issued,I sholl nof employ any person in any manner so CITY , � . TEL NO. as to become subject�o the Workers'Compensotion laws. DISHWASHER � � - � � ' ��� , , CONTRACTOR Dote '� " AppllCanl ' � ' CIOiHES WASHER � . ' . , �:E TO�APPIICANT:If,oifer moking ihis�Certificme of Ez- � ADORE55 '�.��' � t. ,,rion, ou should became sub'ect to the Workeri Cam en• S'NINMING POOL RECEPTOR �, Y I P CITY TEL NO���aI �solion provisions of the labor Code,�yoo must torfhwith comp- LAWN SVRINKLER SVSiEM . ly wi�h such provisions or this permit sholl be daemed revok- � � � STAtE � /1�j uC. ed.�-��, � , ' . � � �-�� WAiER HEATER . � /r�\ UCENSE NO. [.��7Q � CLASS c 36 � - UCENSED CONTRACTORS DKLARATION ��V DISTRiCi NO. PROCESSED BY ' . GAS SYSTEM OUTLETS � � I hereby affirm that I am licensed under provisions of Chaprer � . �lc7 . , � 9(commencing witb SeClion 7000)af Division 3 oi fhe Bosiness OUTLETS OVER . and Professions Code,ond my license is in full(orce and ef- 5 PER SYSTEM FINAL � �/ IDATION �' fec�. . .. . �PATE ���f/� a /� ���^ O � License Numbe�3� �Y � Lic.Class� U ,./ �q FINAL 6 � ; ContraUor � '�Dare�' `�``3'�0 [ .. . .. . .. . SY � � � O � � _I am eaempt under Sec.� � � . � � � . ,W ... . . . . , . . , � e.aP.c.for ih�s reoso� . Plantheck fee ► z - . �Date:�� " �,PLUMBING PERMIT ISSUING FEE 5 �U - � � � � Signature - .. . . . . TOTAL FEE- . �' � . ' � � SINGLE FAMILY � � Plon check applimnt �� ' � � HOME OWNER-BUIL�ER DECLARATION � � � - � , I}v+t¢by affirm ihal l am exempf fram Ibe Coniroctor'S License . Neme - . - � , � � � , '.`'O 7 C,��A - I for the following reason(Section 7031.5, Business and h..essions Code]: - . � Address - � � �. �j. o . 6 5 � � � i,�as owner of 1he property,will do the work and ihe City � � � . � Tel.No. � �, �� � �� � � F�J� � , strutture is not inlended or offered for sale(Section 704d. .:. . . . � , � ' Business and Professions Code). . � � , / �� '� � '` �� � �E t�w'�j�J� � � CONSTRUC?ION LENDING AGENCY � � � ' � - �� �' � � �� � � � � - � � I here6y affirm that�here is a tanslruclion lending ogenty for � � . � - �, � ihe performonce of ihe work for which Ihis permit is issved . �� - �� � ' � � - � �' �, - � � � � � � (Sea 3097,Civ.C.). '. . /� � ! . . . . �.. lander i Nome . �� . b"S/(.• ` . � . . .. .. . . .. .. . . ' � . Lender's Address - � ' . . �� � � � �� �� I certify that I hove read this opplitotion and slate thot 1he � � � - � �� -�� � � �� - �� � ��- " � --� � � obove Informarion li correct�I agree to comply wi�h all County . � S �� �� � ordinancas and$�ate laws requlating Plumbing,and hereby � � � � � �� � - � � ' � � � � � � �� � - � � -� - - � aulhorize representatives of�his County fo enter upo�the , . ' � � ; a�-mentioned proP rty ior inspection purposes. . �.. ..� . . .- .. ., . � �i .. .. . . . � 7�r.�1�3 SEE REVERSE FOR EXPLANATORY LANGUAGE � SignaWr o Permi�tee Date � � APPROVALS .'DATE� INSPECTOR'SSIGNATURE INSAECTOR'S NO7ES � � -�� OWNER BUlLDEH OECIARATION � ur+oea sus woaK �.:, . .__ _ . `.. .,, �:: i hereby atfkm thnt i em exemDt hom tM Contnetors ROUGH PLUMBING ., -'LIC9nlB Lnw fa tlw followinq reaeon(S9Cfion J031.5, � Buslness and Proiessions'Code). Any c!ry oi bounty GAS PIPING .. . . . . .... ... . ........ .' . . ... .". . . . .. . .. . ..,_. . _ . ... . .- which requfies a permJf to construct;efter, Improve, cns vervr .. �, � •, • - demolish or repeir any sfructure,prhr to iis rssuance, Hor waT�a HeaTea also requlres the applicant tor such permft ro file a slgned PLLIMBING FIXTURES ��J ��' - � "� � -, ' �� . . . . . .. . ' SIBIBfl1@/1I(I16t IIB IS IICBlISBO pUfSUBlII,�O e rovfslons GASTEST ` � � - . ���OIIIIBCOIII/8CI0/�SLICB115BI..8W(G18�B/J�CO�encing with Sect7on 7000)of Div7sfon 3 of the Buslness antl Pro- un�m co.NOTiFiEo •�� - fessions Code)or that he ts exempt therehom and tAe _ . _ ,.basls tor fhe al(eged exemptbn.Any violation o/SectJon �� F�NAL 1.. .... . �nfa�on�}ronf . . . .._� �.• .- . . . . ." ,•,..;�t oba cfv!l�icant tor a permit sub�ects:the appll- ,_ ; penaRy o/not more ihan five hundred :. _ . . dolJars(�).. , INDUSTRIAL . � ' . �..._ . .. . . .. ...... . ❑I.!6 OWMf O��IB PIOpBRy WIII f�01hB WOf�C.Md ShB WAS7E APPROVAL�.� � �� ��� � � 81NCtU(e Is 1Wt 11It80tSBd Of OH6f9d fOf 6818. � (Sec.7044,8usinessandP�otessknsCode 7heContrac- tor's Uc&nse Law doBs not eqoly to an owner of pr^-ry , . -.. _ _ who builds or imp+oves thereon.and who does suc,. ,rk � himseli provlded Mat suCh lmprovements are nof rntend- . , ,� ; • - ed or offered for sale.It,however,the buNding or(m- _ . ._.. ' � r , - provement is sold withln one year of complet(on, the � owner•hullder w711 have the burden of proving that he did nof DuNd o�lmprove for ihe purpose of sale.) , _� _ _; - t 1 em exempt under Sec. , ; _ _ _ B&P.C.for thla reason ' `� .._ _ Date _ _ Owner INSPECTOR'S NOTES -. ,_.___ _ : ; _ . _ � �