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HomeMy WebLinkAbout0858A WoaK�as•�o��r�NSAT�oND��LARAT�oN >6A66]p qPPLICATION FOR PLUMBING PERMiT � I hereby efficm that I have a cert f cate nY covse,nt to-self ce ev�z-so �� insure,or a certificate of Wo:kers'Campensation lnsurance,or ' � . � - u certifled copy tliereof(Se�.3600,Lab.C.) � � , � - � . . F'RFMONT TN F.�7ITY COUNTYOFLOSANGELES BUILDtNGANDSAFETY Policy N�g.],jj..$_��ompaay_ _ _ _ ,�..T.�� � ' � �.Certifiedcopyisherefiy.iLrnisheA. . FORAPP�ICANTTOFILL�IN-�PRINTORTYPE�I - �BUILDING �- n C�erti'ed cu is fi1e�w�th e;.Count b 4fldin NUMBER FIXTURE OR.ITEM • FEE ADDRESS � , py y g'nspection �� �iepa tme [. �' `�� ,/� LOCALITY /y e �p ,�.��[,� .... WATER CLOSET �b+ � ��� ¢�'6" Date�.`�, � Ahk�1 c�i'Li��s..s<""_'r 'E �'....,,.-.. ._.__ �_____ ._. . -1�lE-AR€ST� . . . � _ � � eATH TUe CRO55 ST. ' . - �CE'RTIFICAT��OP L.XEMPTIOIV-FROivI�-WOR.KERS' � � � - L'OMPENS_ATIONINSURANCH . SHOWER � � � -OWNER . � � � � p� LAVATORY � - � - qDOREBS 3177 HAWKWOOD � (This-section need not be com leted if tfie work-imolved . by the permit is Yox one hundred dotlazs�(5100)oi tess.) � � - � � . .. _ . .. SINK. . CITV p.I,NUT� TEL.Ng9C,_`�C,4'� � . I certify that in the performance of-the wo�•k-for--which this DISHWASHEFi - �r permit is issued,I shall not employ�any person in any ruanner CONTRACTORWALNLIT POOLS . � - so as tu bectime sobject to�[he Warkers'Compensation Laws. CLOTHES WASHER � qDDRESS�����21450 GOLDEN S�RIN � I7ate Applicant �� - SWIMMING POOL RECEPTOR .-•�y(� � `NOTICETQAPk'LICANT.If,�aftermakingthis�Certificatenf � CIT TEL..N�_�CJ�'�.CJ4�'7- � Exemptiooi, you�Should becmn�e��aubjecf�t6 U�e Workers' . LAINN SPRINKLER SVSTEM - -- - ,�r _' ._ �Compensation provisions of�ihe Lnbox Ce�dc,you must forth- STATE 31g618 LIC. 53 .,,, WATER HEATER LICENSE NO. CLA$$ . ivith�comply with sUch pruvisiona ur this permit-sha0 be � , Qeemed cevoked.. , -� GAS SVSTEM OUTLETS � ' �Lk DISTRICT NO. � PROCESSE��BY ` . IdCENSHDCONTRACTORS��DECLhRP.TION - OUTLETSOVER � � I herebv af4icm that[am Licnnsed under provisions o�f Chapter 6 PER SYSTEM , - � �. 9 (commencing with Section 7000)of Division 3 of the Busi- � FINAL VALIDATION - � nesa and Prufe�sions Code,and my.7icense 15#n full Yorcc und : -r� �LC' �� DATE �--�;���� � - effect. � � � � � ^ ' � � . � � W.. Licens�Num ��Lic.(:lass � ���� � BV A� �e�� . .� ` Cont,�'6 L�4 ��Date �� ..�. �i`";,,`� - . � I am exempt from tlie licensing requirements as[am a Plan check fee � . : �licensed architect- or n registered piofeasional.e2lgineer pLUMBING PERMIT ISSUING FEE$� 5i� - � acting in my-prqfessional capacity-(Section 7051, Bus- . � inesa and YraYessions Cbde). . - � �TOTAL FEE E<��� . Lic.ur Aeg,No.� Dafe Plan check applicant � � HOMN:OWNBR-BUILDER DECLAKATION Nama - ,_'Q��5,8 A - i here6y affirm thnt I am exempt from the contractor's Aaaress �]:45� GOLDEN $PPi=�G.ci �j o �.m a,e j . License (,a�v for the fullowing reason (Section.9031.5,Busi- City WALNUT - TeI.IV�9��j—']rjQ7 � neks unS Profeseions Cnde): � � � a-��,rj�� - � I,as owner of the property,am exclusively cotttracting � � �� ,� s- �. with licenaed contracYoes to consfruct ihe pro]ect `d�g G G.�,J(,�ca �� (Sectiort�7044,Business and Professio�ns Code), . . . . _ . . . . � ( ?,�a 1 "�1 � �CONSTRUCI'ION LE:Nll[NG AUf�:NCY � I hereby affiim thxt therL• is a construction lending agency - � - � � for the performance of the work for which this permit is , � �� �. issued(Sec.3097,Civ.C.). . � Lender's Name � . .- l.ender's Address I certify that.I have�read-this applicatinn arid xtate tliat the . . . � -. abnve infurma�7',on�is correct.I agree to comply with all County S��REVERSN,FOl2 EXPLANATORY LANGUAGE ordinances�aii-d Srete [aws regulating Plumbing, and hereby � . � - � - �- - -� au[hoxiz�;�'feprescnt„at}xes of this County to enter upon the . . . � abo e;,iiCentioned�i;Ffperty�hr inspection purpnses. - � .. - .� r s C�'Td'�,� dfy^,, �%."�,'`� `�� � � y��''Slgnatufe� `Petmittee Date . 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