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HomeMy WebLinkAbout1168A (5) ____ ____ .-r.____...... ���.._.-_ _... ._ .. _ ...- --.-- _-------- w�KKERs'�o^^�NSAT�pN°E«^R^T�°N APPLICATION F4R PIUMBING PERMIT {� � I hereby affirm thot I have a certificare of consent to xif �y,�667q �� insure,or p certificare of Workers'tompensolion Insurdnce, . LE 8V(REV.10/81) . '. _ . � or o cerfrfied copy�hereof(Sec.9800,Lob.C.� COUNTY OF LOS ANGELES BUILDING AND SAFETY �� D�Y,,�co 3�o���( Dk� _ Certified copy is here6y furnished. , ❑ FOR APVLKANi 70 FILI IN(PRIMT OR TYPE� BWIDING Cer�itied copy is filsd with the county building insper � AooaEu lio�deporlmeM. � � NUMBEIt - FI%TUrtE OR ITEM � � FEE ���ITY ��� '- . , Dale�Appli4anl��`���`"`��`� WATFR CLOSET � �AREST . . CERTIfICATE OF EXEMPTION FROM WORKERS' enrH iUe Ca055 Si. - � COh�PENSAiION INSURANCE � . OwNER `,Q '.,IS � SNOWER ' (ihh s�etlon n��d noi b�romplN�d lf tAe work Inwlwd by ��� �' lO ��6�p�rmle is ior on�hundnd dollors(5100)er Ins.) UvniOev ,aZ aoD¢ESS 1 certify thot In Ihe performance oF rhe wmk for which Iha , . pe�mit is bsued,1 aholl not employ ony penon in ony manner S�Nc OB 11t� CITY TEI.NO. � so os�o become�ubjecl ro the Workers`Compenw�ion taws. D�SHWASHfR . . � CONiRACTOR�\� i" � ' pa�e sPP��«y�� CLOTHfS WASHER - � qppqE55 � NOTiCE TO APPtI[ANT: If, ot�er mo4irg�his Ca�t'rfico�e of � SyyIMMINGP00lRECEPTOR Exemptfon, yov ahould becoms subjed ro�iM�Wo�ke�s' � Comperoorion povisions of the La6or Code,you musf fonh- ��TM iE���� � winc �omply wtrh fuch provistons or �his perm�r shvll be wWNSGNINKLENSYSiEM srnrf uc. � deemed revokad. WATfR HEATER IICENSE NO. C1A55 LICENSED CONTRACTORS DECLARATION DiSiRiCi r�.� P SSEO Bv . I bereby.oRirm fhol I am lice�sed undar provisions af Chopler 9 � �� GAS SVSTEM - . WTLETS � �' (commencing wifh Sec�ian 7000)of Division 3.of tfie Bosiness pUTlET50VER iond Prolessions Code,ond my licenee is in full force ond effecr. � s PEa SvShM FINAI Y/1� ATION liceose Number �T��v�ia Class� - ` � �A�/�����{ Q I � �����p.J FINA� U ContraUa - Oate_11�.otn BY O � - ❑ I om exemp�under Sec. ���,,n� _ . �� B.BP.C.for Ihis reason � � a Plan check fee ' D ��,�-,q— PLUMBING PERMIT ISSUING FEE E N s g�o��—���-+� � D,ILY f !a :1 1 b.8 A �. f TOTAL FEE ZZ #!.,a . • e 5 . . . . . .. . .. Plan check oppiicant . . . � SINGIE fAMI[Y � � c 3'2 2,rj� ' HOME OWNER-BUIIDER OECLARATION Nums � ' � � I heroby affirm fhol f om exempf from the Conlracloi s Litense � - � , � •�r'J L!J�Q c=.� law for the iollowing reoson(Seclion 7031.5.Bosiness and Address , . . . Rofessions Code�: City Tel.No. i . (J�,�Q��S(7 ❑ �,os ownar of rhe property,will do�he work ond rhe ��� � � � � srrocture is not intended or ofiered for wla(Saction . . 7044,Bvsineu and Professions Code). - " � '� CONSTRUC710N IENDING AGENCY .. . _ . . . . ��. � . . �heroby offirm ihot Iharo is o consrcuc�ion lending agency io� . �he perlormonce of�he work lor which Ihis permit is issued _ . _,. , _ _ . . . . (Sec.3097.Civ.C). . � lender's Nome � �' � � . lendei s Addreis - � � � � � � I caraily Ihat I have read lhis opplication ond s�a�e Ihol the � � � � obove informa�ion is correcL I aqree�o comply wirh all Co�nly ��� �' � � � � . � . � � i ordinonces and Sra1e laws regv�ating Plumbing,ond be�eby � �. autharize represeMai7ves o(this Counry ro en�er upon Ihe ��I obo :men�io�ed p� p ty o.tnspecuo�p�.poses. SEE REVERSE FOR EXPtANAtORY LANGUAGE `y.__ _� _ � Signorure of Perminee Dare � �i . � .INSPECTOR'S NOTES " -OWNER-BUILDER D:CL.4RAiION�� APPROVACS 0 TE � OR'S .GNATURE . � , . . UNJER SIAB WORK �' � I hereby affirm Ihot I a empt irom Ihe Contrenor'; � ROUGH PLUMBING � - �. . . . . License Law for ihe followcng reason (See/ian 703L5. , GAS FIPING�� - � �� � � �� - -- � - � . �guziness and Prolessions Code;:Any clty or covMy wirch � GAS VENi . - - ... . . . . . requires a permif fo constrv[f,alter,Improve,d=molis,`�. � - � or repoir�ony sfroefure, prior fo !fs Issuance,ofso re- HOTWATFRHEATER -� ' vtresiheo ! vnHorsuch f!o!ileost nedstele� . . _ .. . . . . 4 Pp rc permi � PIUN.BING FI%TURES - ��� - ' menl fhaf he Is Iiconsedp�rsuan�t to the provisions oi!he GASTE57 � � � � . Conlracbr's Lkense Low-{Chapfer 9(commencing��•ith UTILITYCO.NOTIF�ED � � - , Setflon 7000)af�ivisio�3 0/Ihe Buslness�and Vrofes� , . , � s(ons Codef or thaf he Is exempt therefrom and Ihe bvsis " ' ' � - � � - � � � -� � - - .. for ihe aqeged encmpflon.�Any violal�on oi.Sflciion FWAt- .��ilcr on'�.on! . .. ��,� .. . .. . . .. ... _ . . . 703L5 by any opplicanf!or a permlf subjects�he appB� " � . cant fo a civil ponolty o{not morc�fhan iivv hundred .;:.�.. -.. � ; �.� ,:. . ,: , , . . _._� dollors(3500).: �� WDUS7RIAL � � ' � ' . . ❑I,os owner of ihe property wilt do�he work,and wASTE AFpaOvn�, .� � " ' � � � �he struaure is not intendod or offered Sor sale. � - ' � � � (Sec..70<I,9uslness andProfesslons Code: �The Conrrar . .... � � - ' " ' ' �� . , . -� � � . ror i L�rense Low does no�oppfy to an owner o(property � - � -- - � - � who buffds or�Improves fhereon, and who does such � �•� , � � �- �-��- � � , , . ' work h(mseN provldad ihaf such Imp�ovemen}s ore no� � � � � � � � - � � � � Inlendsd ar oilared for sale.!i,however,1he 6ulld�ng or � � , � ' � ' - . . . . . . . . . � improvemenl Is sold wihhin one yeor o!mmpletion.Ihe ;� � � - � � � • - � ' owner-builderwili have the burden olproving tha�he did � � � . - � . nof 6uifd or Improve for t6¢purpose of sole.) i' .. . . . - � . � . �. , - , _ . . . .... . . . .... . I om exemp!under Sec` , ' , � � _ ,. � . . . . �.- . .. �. � . � � - �� ' � � � � - � � � � 8&P.C.for this reason � � � . �, - � � � - � � Oate� ' - � � � _� � Owner WSPECTOR'S NOTES _