HomeMy WebLinkAbout1615A (9) �"°RKERS"`°"^PE"S"T'°"°E�`"R^T'°" . APPLICATION FOR PLUMBING PERMIT �
;e hereby affirm that I have a certificate of mnseni in self .:76nbmn
�" insure, or a cerfificate of Workers Compensation Insurance, -:GE 817(REV.10/81) �
or a certitied mpy thereof(Sec 3800,tab.C.) COUNTY OP LOS ANGELE$ BUILDING AND SAFETY �
. �cy�vo.6Fi73t��,'��mpa„y S'i/4T� FtJA;!? �
Certified mpy is hereby furnished. �
� FOR APPLICANT TO FlLL W(PRINT OR TYPE) BU�LDWG �} i „/
Certified copy is filed with ihe-counfy building inspeo ADDRE55 ���-I ��pf�ti ����� 1��+•
tiondepaftmenl. NUMBEF FIXTUREORITEM Cn FEE _
�/ LOCALI7Y �}��/1,1CJ�I] 13A�
'�- Date �j Applicant_aC•�ti�_(�'j{� Wa7ER CtOSE7 _ NEAREST } �
CERTIF�CATE Of EXEMPTION FRO ORKERS' BATH TUB CROSS 5T. Q���p r D I�IFl lUC �
COMPENSATION INSURANCE OWNER (,J f(J�Ai VfN� �
�- (This soction need not be completed tf ihe work involved by StiOwek Rl C'M g�
. the ermit is Eor one hundred dollars 100 Or Igss. MAIL f �
p {S } ) tAVATORV ADDRESS.ZrIL`) fN(JfRN G'lQC�IG �C(Y �.
- I certify ihai in ihe perfarmance of the work for which this rt
permit is issued,1 shall not empioy qny person in ony manner SINK CITY �1���ti,� 17��lC TEI.NO ;
$ f-/7
so os!o bemme subject to the Workers'Compens�tion Laws. DISHWaSHER �
corvTkc,cTOR 5•{J/�i.3E�NG ��V CfJ�S%�
. Date .__Applicanf CLO7HES WASHER ADDRE55
NOTICE TO APPLICAN7� ff, atter making this Certificate of t«� �.`L!�}l��/'�f:l\:1 f��,
- Exemption, yov should become subject to the Workers' SWIMMINGPOOIRKEPTOR
- Compensafion provisions of fhe Labar Code,you musf forih- (qWN SFRINKLERSYSTfM CITY d7��AA�Mi� TEt.NO.f � r�� �
with mmply wilh such provisicns or this permit shall be e �� �
. STATE t IIC. p
dee,med revoked. WATER HEA7ER LICENSE NO. '�'7�'�.Z 7 CLA55 V
LICENSED CONTRRCTOR$DECLARATION DISTRIQ NO. �PROCESSEO BY B
1 hereby affirm that I am licensed under provisicns of Chapier 4 � GAS SvSiEM 1 OUTLETS � � �
. (commencing wifh Section 7ppp)of Division 3 of fhe 8usiness OUILE7SOVER � {!
-- and Professions Cade,and my license is in fuN force and effect. 5 PER SYSTEM OA E� l� � VA IDATiON � E
� License Number�l�^ �� ! lic.Class� � � V �
- .5 iJA/SONCs ` �j � A fINAL �� / ' � I
Contracror �L/ �(-'t?NS7R Date� BY �yV�.� � � �
�- ❑ I am exernpt under Sec L �— � t
� �
�
B.&P.C.for}his reoson � �
Pian check fee
Da1e: `�
PWMBWG PERMIT ISSUING FEE S j ��`G .�1 0 1,5 A �
Signofure �-
. TOTAL FEE � �f w a o +, m y, �
� Pian check appllcant �
�
. SINGLE FAM��Y I * ���,::�(':
� HOME OWNfR-BUILDER DECLARATION Name � -
i hereby affirm ihat I om sxempt from the Controctor's License °C��{'�i
Law for fhe following reason(Section 7031.5, Business and Address . s�¢
_ P
Professions Code}: [i�y TeL No. ���•�-�`���''J
❑ I,as owne�of ihe proper�y, will do ihe work and the
- siructure is not intended or offered for sale (Sedion ►
- 7044,Business and Professions Codej. � �
CONSTRUCTION IENDING AGENCY - .
-I hereby affirm lhat ihere is a mnsirut'ion lending agency for
the perfarmance of the work for which this permit is issued
(Sec.3097,Civ.C.). �
Lender's Nnme
Lender's Address �
I certify ihai I have read Ihis application and state ihat the � ,
abovc information is mrred.I ngree io<omply with�II County . �
ordinances or,d Stote laws regulating Plumbing,and hereby
. auihorize representafives of ihis County to enfer upon the �
cbove-menfioned property for Inspection purposes. .
SEE REVERSE FOR EXPLANATORY LANGUAGE
� 7 1 i . �� ]
Signature Permittee Date . t
��
>� o o s v
U •- V C
h c '� � � 6 � � d c �S �
� �S � - O a,� a G fl H p'D o q .
r -c ` "'+�3 0�° � °� � v io �, ' d}
� `� : � O '0 fL��-�
_o MS o 0 0 o c� �� �� � �s o o�y E � 6
, o r? >.�o ro � v-O o > m o�- y.� E u O N
m � o c �� � z ,n c 3 m -
� _ cro � o,�, v N o � �" � m 3 a e`s o n.o
0 0
v . o ai � � o � ,n �° �a �°o °c ca.m o o m ...
u t' � D.a � � O � �� .�'9 U p n � � 6l C O .
� CJ 0 � 4a tl O 0 - p� N ._ O y, N �'
,.+ Q S tn � Q N� m� p) •>+ m Zi � c O C y,S �'1] -.
r, " �' £ o�o� m m � o Z'.`� ° r�a�a �••= c � Q-
Q o o " �- t .. o �u� c `� E c� ° � cL .n� °J-° cu �j G
�-N- ,-`r �O � d '- m'S', a 0.." O Q � O r..G- O CF S' t +- . C) N
Q � 4-.. O � C 2 O. � D �p � iy L +- , l3') Z} .
CL O Gt � d O � C C a' 01 t1.8 ✓' vo . d.O� 8Y
� � rn�ro� os �u� m�o p �"d c � � �a o m
U a -L -0 3 �
C -a y y 'U N
CY b ?iV .+-- n'NQ'?i p !^_ £ c � o C � OQj N H' � 7 r
C� �� c c °' �� '" t x p � m� � Q m 'L° }' E �. O
� °O ou �° '" m .? mcid GDpc3 a.� w.
`> > o '" o " � m �� s-a a� .. 3 N � J oµ- °c"m,o � � �
o• K
� ss o''� � O� ; ° a d c V p o °�� c�D �-e ��ro � °' o O
Z �°°. � c�u� �o�o °y, �..,:u`r u �-�'�O o d.S� p '°2! p
� � 3-o n_o �s-oo o m'� � ��`o �6� m a 3� - dy
C7 b � oo � ,�a vcU.s.n - �y mci_,_,� oc � o �
-� � � 'o -�. o o � - � `� 0 3 � • '
T m 0` t1.�" C M � � S� �" �
9 N c . fi� � C e u p Q o m v
G: L � °_ � O � �..-R�-�
� � 7 N p �'�V cn
s m
. �`
[
�k
• �t
`
�
O
Z
�o
O
w
a.
�
Z
!
�y 1d!
Q �
� � :i N
w �` �. Q
N �
� `
� i.i, w�
¢ G N
�, , z Z
2 �.n �
r
�� � n
w ;
�
� � `� CJ t �i
� �, � __�.-
U� � � j _�_._ —
u- . i � � ___ ...
'Y � '_ ' oG . _ _-'_
.� c� Z �v x O ��.,� . 6 a .-._
� O � � t2Y�„ � �.,, aY 4 _.,.,.....
.----_
' L W�lJ 1-, V N Y ._---
a � .�.� Z Z Q'Z W Y ! Q p4 _ ,..
'" r
Q W = a' j �i'` N :� -; Z 2`'�i � .
U ? aaa.� � ' , ti _._ ,._
Z a c� �
� _