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1623A
`"°RKERs"�°"'PE"5^T'°"°E��^RA"°" APPLICATION FOR P_LUMBFNG PERMIT � I hereby affi ihpt I have a ce t�ficate-of consent to self -. �6n6S7A � � � � - insure,o a ertif�afe a#Workees Compensahon tn5uronce, - �CE 817(REV:�70/81� �-�� - --- � �- - � � . or o certif ed�opy ihereot_!Se<.3&06,Ia6::C.) -. COUNTY.OF LOS ANGEtES. BUICDINL'a AND-SAFE7Y a�yrvofi084266 Company Gr. Americap L�, �. �-� - ___ �Certif ed copy is hereby�fum shed ., -- BUito�NG `� ^ �. � . - FOR APPLIEAM TO HLL 11V�(PRINT OR TYPE) _ � qDDRESS ' - I__I Ceri'fied copy s fifad-wiih the county-bu�ld'ng�inspec � �- d - � 44� +�ondeppriment .. � . -�NUM6ER-- FIXTUREORI7EM� Lm FEE LOCALITV � � Dafe� �-��-�4 Appficont LPa'472r'tOri- �6 �--�-.WAS�RCLOSET- �-- . --�� ''� NEAREST � � � - . CERTIFICRSE OF EXEMPTION FROM WORKERS'` . ` BnTH iUa- � � �� ,.; , CRo55 ST.. � � � . � ', � -COMPENSATION WSURANC€ . � � OWNE° - '� (This section need no1 be complafed i,i iNe-work involved 6y.., SHOWeR � � �'�-.. ^'- POricI@Y�082 HOI11eS '� �� fhe permif-is�for�-one hortdred`dollnrs{5100)or leaa:)-- � � � LqvqTORY � �. MAIL-�� � �: � � � _ .f,. ADDRESS �' � . I<eriify thai in-the-performance af ihe wo k far whicfi iFis - � - � -� - . _.permif is issued,1 sholl nat Amploy any person n ony manner � �SINK � - - � -,-y,: CITV� .. � -TEL.NO ��-- ; so as io become sub�eft to ihe:Workers-C6mpenspiion.Laws. DISHWASHER � � �n - � y _ _ _. ���__ . "" CONTRACTOR�-Leay2rtOP1��BIOS.� ,IC1C. Date Applicarlf -- CLOTHFSWASHER - g�� �� qDDRE55 � " -_ - �"'CE TO APPlICANT: If after mak ng ih s Certif cate of � -- _ - � - - ��i��� $ 1� -- - - ` E ption, you sFould become sub�ed -to the Woikers' ��'�`IMhtINGPODLRFCEPTOR-'� --� - -. � -���-Compensaiion�provisiont of�iheipbor Code,-you mus�forth-- . CITY 7Et.NO _ . LAWN SPRINKLER SYSTEM ' ith com�ply with�such:provisions or }his permil-shall be . 5TA7E�� �- �� uC, deemed�revoked.� � - .WATERHEATER - . � LICENSENO. 1-9�-969 �� CLASS � C36 �' � - LICENSED-CONTRACTORS DKIARATION - . � � 9 DiSTRICT NO. . ROCeSSED eY . � �i here6y affirm ihaf I am I censed under provis ons of Chapter 9 � � GAS SYStEM �- OUTLETS.� ,�, � � �� - � c mmencin .with Seciion 7000 dFD�visiob 3 of ihe.8usiness - "�`� � ( 9 .) � OUTLETS OVER . - � � � . g, 0 = -� and Professions Code,and my license is in.ful�force and effect� �5 PER SYSTEM -� FINAL�p��� ..(� � � �VI���DATI�N �_� � �,- � � � . . DATE / ��T uce�se N�mbe� 191969 Uc.Class- C36 ---� 'r�` �r 1 Lea�erton . 2-13-84 FiN����h.��- � Coniracfor � -0ate gY � �� . . � . . . .. . . . . _ . � I am exempl under Sec._ � ": B.&P.C.forthis reason.... - � � ? _ Plaacheck fee � oate: � ^� 6?.cS A � -� � � - � � �PLUMBING PERMIT ISSUING FEf$ (� ..=°,g",(r/' - . Signature` . . . . , �,���o �, � _ � . . . . . � TOTACFEE f .� �� � �`�� � - � - - � � �� Plancheck.applicant � - �� - � . � . � � . � 1 `� � 7 ��� . , .. . . - S7NGLE FAMILY � - � - '( HOME�OWNER-BUILDER DECIARATION ._�.Name__�. - � ,.. - ._r.�_� __._._ _._ `� ,.-;���,,+,",#' _-----� - ._, --- � . __- .-_-._,.._ . 'eby aff rm that I am zaempY from the.Contractor's License Address - � `; . .J for the following reoson (Sethon 7031.5, 8us�ne5s pnd � � �'�`2, � �,°"�Ci� Professians Cade}r: � - City � Tel.Na. - ❑- �I,�as owner of ihe�praperty,will do fhe wprk and ihe ' . . - . - . .structure is not m�ended�or�offered.for sale�(Sed'on ' . � , � - � . � 7044,8usiness and Professions Code). : : . � . � � . � . � - CONSTRUCTION LENDING AGENCY � -. _ ,._ .. - . � _ _ � - _ . . . � -- I hereby affiim iha+ihere-is a consirudion lendi�ng pgency for - � - . ... ihe performance of the work for which�his permit is issued , ' _ . _ � - .. . � . . . _ . _ �'�� (Sec.3097,Civ.C.). . . � . . . . .. . � . . � . . � Lender's Name.. . � . � . .. . � � � . . . � � Lender's Address . - � .- . , -_� � I cer�ify th t I hdve read ihis applico(ion ond state�hat iha� _ � � � . � � above info malion is correct.l ogree to comply with all County _ � � � � . � � - - . ordina es and State laws reguloting Plumbing,and hereby � , - . �_ � � authori represen-�- es af fhis County fa enier upon ihe � : . �-� - � - - � a6ov entione�ro rty for i�ipecfion purposes. � - � � � - �-� - � -� ,-- �/�� SEE REVERSE FOR EXPLANATbRY LANGUAGE- � , . . 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