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HomeMy WebLinkAbout0838A ` w"K"r:Ks��°"'PENSAT'°"DE`LAR,�T'°� "A68>" APPLICATION FOR PLUMBING PERMIT � � I hereby affirm that I have a'ccrtificate of coneept to aelf cE ev(z-eo� insure,or a rertificate of Workers'Compensation Insurance,or � '- a cernfie copy thereof(Sec.3800,Lab.C.) ; ,�� ,(�,���- COUNTY OF LOS ANGELE3 BUILDtNG AND SAFETY � YolicY Noaf�(Cumpany—=(�J� _ _5 . ' / i� ,� �.J � ' Y�- e � Certified cupy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TVPE) BUILDING B �Certified copy is filed with ttie county building inspection NUMBER FIXTUFiE OR ITEM • FEE AD�RESS 2 j 7��,�J�f/¢j���t�' �3/e�pxri�m[a��rt�.i� WATER CLQSET D� LOCALITV � Date�Y"��"`APPlicunt�� � �-�— NEAREST c 1 ° BATH TU8 CROSSST. � '.'�", '�5'�"�: '' t CERTIFICATE OF EXEMYTION FROM WORKERS' '� ` . � � COMPEN5A"I'lON INSURANCE SHOWER OWNER �� � LAVATCRV MAII 3a - 8� � iJ N s,G`! 1 (This section need not be comple[eci if the work involved �',0 qooRess 7; by the pennit is for one hundted dol(azs (5100) or lessJ i ` � N ____ I SINK ; � (r') CITY� ����..-__—_TEL. '�..� '• 6 � I certify that in the performance of the work for which this f �ISHWASHER � � permit u isxued,I shall not emploY any person in any manner �� OQ CONTRACTOft �vM�/�� _.-_. � 6o as to beCome Subjert to the Workeis'Compensation Lnws. CLOTHES WASHER I `� , __ G ADDRESS O � Date Applicant_ .._ __.. .__.._—..— I __ � � CJ SWIMMING POOL RECEPTOR i NOTTCE TO APPLICANT� [f,after making this Certificuke nf CITY �f�� Q� TEL.NO3'Ss� � Exemption, you should become sub,jec[ [o the Workers' LAWNSPftINKLER5Y5TEM STATE LIC. A � Compensation provisions of the Labor Cude,you must forth- n NrqTEft HEATER LICENSE NO. � � CLASSL",�j� � with comply �vith sucL provisions or this permit shall be L-. i ' � decmed revoked. GAS SYSTEM OUT�ETS �', DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS llECLARATION - OUTLETS OVER ,�� `� !;r,�,�..t_,� - 1 hereby affirm that I am ticensed under provisions of Chzpter 5 PER SYSTEM ��� " � 9 (commencing with Seciion 7000)of Division 3 of the Rusi- �f FINAL /f ness and Professionx Uode,and my license is in full force and � . Y'F . DATE ,��1�'y_�„ VALIDATIOI�1 ePfect. � � �8 LicenseNumber / Lic.Gass�_ PWAL y/ BV �.-,�Q�lh,y�iitl� Contractoc}+� Dnte�L}J O/ _ -- �,� � I am exempt from the licensing requirements as I am a Plan check fee J licensed azchitect or a registered protbssional engineer pLUMBING PERMIT ISSUtNG FEE 3 acting in my professional cayacity (Sectiun 7057, Bus- in�s and Professions Code). TOTAL FEE I.ir..ur Reg.Nu. Date Pian check applicanT i HOl�1�OR'NER-BUILDER DECLARATION Name �C,�J�� i � aad�ess I hereby aftirm that [ am exempt from the Contractor's �.�e a e • o S l,.icense Law fo[the�following reason (Section 7031.5,Busl- ��ty Tel.No. ness and Pro£essions Code): 1_• 1 .' �rJ G � I,as owner of the property,am exclusively co�tracting with licensed contractors to construct the project o��y �� �� L�,�J� (Section 7044,Business and Professions Code). � �.�Q��7 CONSTRUCT[ON LENDING AGENCY . . i hereby affirrn that there is a constructiori lending agency for the performance of the work for which this permit is �iss�zd(Scc.3097,Civ.C.). Lender's Name Lender's Address I certify that I have read this application and state that the � above inforntation is correct.I agree to camply with all County SEF.REVERSE ROR H,XPLANA'fORY LANGUAGL: ordinaitces and S[ate laws regulating Plumbing, and hereby auth rize representatives of this County to cnter upon the ab -menti ed p operty'for inspection purposes. t re o miCtee Date / S— T � C � '0 2�,� � 77 C r�. z -{ �' p� ''m.'',.(`� �� j� D r c�» 'i 3 -i I tDn cAn � O rn r � `I ,W ��l< � �G) mID � �- m-I , m I Z r'`m i�_ ����� � +Z � D 70 �i n � �G� m " z � �� 7P . �D .'O � �p'-i ��Ir �ri� . . �r • z x .�;;: � c�D� < �� � ,�.p � � m�� I �� ,y � �, � C D i .� 00 �'r ..�i<� � � �, y -� -n 7�, m� Z O'�� � r �' i0 umi .� � �� z , I�', � m � - ,-�-�: � +`� n Q ,�q % `�� O � ` � cz �i } I I�-i � , m � � � z � f � -I , ��._ 0 O �,, t'' I f�v n.,1_ � Im �� � �� . � � I �\ `� �{ �� j � � I ���I� I �„.<n .p� �� � �� {' 4:� ��� � _ - ( �� ,' � , �� _. : m .X=+ � � �,. . � s � z � � m n � O '�' � . � '.' .,,� � . � � rn cn ' Y ! � � � ..�`. � •� � 6 � �.-' -,� i . , , , ; � p �; . _ � ; � _� . ��o �s� ti ���' c� C S,�d�'��.�y.�E�Wr"� _ - . ."w' 4 .� c�s�O.A �o N �p�G�C m » O O � p � ... � ti .K' , � � +! � w o�e`o.?�a �'� o ' „O�'� pw,� � � a:� �s��.� .-' �� � �-O.�� O � �. � v C ..� . 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