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HomeMy WebLinkAbout1265A _ . _ _ , ..,.. . - �.,.:_ _ _.__rv.. ,., ,�-. ., , yWORKERS'COMPENSA710N'�D�CIAkATIC}N .."`..'" � ... �.. : . . � . . � .. . ... ...._. -.:. ` „A66,A APPLICATIO '�� T� I he eby � '�� 20-002t�PV✓E7g7�. J'� �("�"���j ff�m iho�I�haJe a ce tf'mte of consent to self�n- . N F"vR p�V'Y1D��G sure or o certif cote of Workers Compensohon insuronce or a �� � � � .��� .-�� . � . - � � � � � � CE 817(REv e,'86J .. ... . . ..�. ... .,.... .. cert�fied c�py ihereof(Sec 3800 Lop.C. �'' - ,, ,; ._,._.._ . , ....,..,. ._._ . . COUNTy OF LOS ANGFTES" Policy No �� '� Compa � '" DEPT.OF PUBLIC WORKS _.. . �� Certified copy is hereby fu nished -��.b �.:.��� .:�;r�— � .. � � ._ �,.. ....- . . ' .:.. ....�-.,;.;n�,.a,.....�.,:+;.".:.,.a ,..,.<...:,.;�s,:.. Certified co - ��� �� 'FOR APPUCANT?O FiLL IN�PRINT OR T'/�E'�:�'� '�"" BU LDING py s filed w Ih he co nty bu I �'-- nspection � � �-�-��� '� -�- A��2E55 �_ �y department. NUMBER F,XTURE OR ITEh1 ` } `G_ , !. C r.E .CCALIT� Date � � WATER CIOSE'!TO!LE`;� ,/ " ^� � Applim . .. .. .. ; . h'EAREST ' �� ��, CERTIfI'tATE OF��EXE7�Pfl0 ���RONi WORKERS'���- � enir+iue � ceoss -� �m;r��v� � � � �' .- � Ct�MPENSI(TION I � "RANCE �.....: .... . � .. '+ � _ - ... . O W NER (This secTion need not be�compfeTed.if The work��involved by � SHOWER :i . ¢—t �y��� ihe permil ia for one hundred dollars 5700 or less. � � � - � � I "�'A�� Z Y. ��'\ � ... � � � LAVATORY AppRE55 .� � ,,,_ . I cert fy that In�ihe performonce ot ihe wo k for which thla per- - � . mit s issued,�l shall no!emplcy ony persd in any manner so � � SINK � I CITY iEL.NO.� 'as fo bemme sub�eU to the Workers'Comperrso�ion Lows. DISHWASHER �� 1 /�+ ^ - � . . . ' . .. .,.. ;.'_�.:. . .;,. �... CCNTRAC':l /`lP''6 f' r' Dofe � Applicant - � . CLCTHES NIASHER � ' �� . /} � � ,... ..�.. ,.:_ s. . ...... .... � ADDRESSC� Q` •. r . NOT10E70",KPPLICANY'I(,`ofier making rhis Ce Hficate af Ex�-� . emptio��you should b�ecome�s�bjecf to the.Workers'Compen- SwIMMING POOL RECEPTOR � � CR' . TEL �(�f'�,.��r e � salion provisions of•he Labor Code;you musi forthwith comp- IAWN SPRINKLER SYSTEM - �,� 4�"�-�� —! ly w th such prov s ons or rh s permit shall 6e deemed revok ��ArE ;�� .. � ed'� � - WA7ER HEATER UCENSE NO �� � CLAS �' �� . � IICENSED CONiRACTORS"DEC'LX��R'F\YIO� ���� �;���� r,q5 SYSTFM OUiLETS ' CISTRICT Nq� ��' PROCESSED�BY- �-� ���"�- - I he eby affirm tnof I om�licensed unde pro�isions of Ch pfer- I 1 9(commencing with Section 7000 of D.i s o�3 of the Busmess OUTLE7S OVER � ���� ��� and Prafessions Code,and my license is in full4orce�and ef- PER SVS7EM�-�" �, � � � fINAL � fect j,/' } �"_' �/� � �= i !0'2; DATE I,���/�fr5��"�. ALIDATION a r `, License Numb� — �. Lic Clasy_-. ..'-�� � \ . .�' � U , ....... _.. .,. , r l ��, ��6,, �`^ � FINA� :�' % �Conrracto � �j%1Cr.L7�-, . ♦•..Date� . . . � BY �,r�� �.���-'���- O F � I am exempt under Sec � • � V - B&P.C.for this reason � - � a Plan check fee ► Z __. _ �� � . - ��.Date pLUMBING PERMIT ISSUI.NG FEE S �O �S� Signarure .. . . . ". ... ... � .� :. . . TOTAL fEE � � . ;�..� SINGLE FAMILY� "`�� '" . � -�. HOME OWNER=601lDER�DE�tARA7ION�-� �� �"�-� P�an check applicont ' I .�U,J�fi � . . . ... . ... .._.._ _ I hereby affirm thot I 6m exemp}from the Conirbctor's License Name � � �;:m c a c a�h. Law for the foliowing reason,(Secrion 7031.5,Bus ness and� � - � __.._ ,. .....__.. _ 'ProfessionsCode): - Address � � ��- � � , . . . . ..... ..._ � -��E � G..�:;. � I, as owner of the proper�y, will da the work�and?he ��}Y � Tel.No �- � � ���,` -- siructure is notintended or offered for sa!e(Section 704q�� " - ' -""' ""'"� � � Business and Professions CodeJ. � � , O u:� i 3.�. _, . . ,...._ .......,�... ,.,_,....... .._._....._.... ........ . ....:...... ........... CdNSTRUCTION"LEN�ING AGENC�'��' �.'.� �� - . � „ , ,. . . _,,._ _._„ , .,. I hereby affirm iho!there is a consiruc�ion lending�pgency ior � � - the performance of ihe work for which this permit is issued -, . . (Se<:�3097;Civ:�C.l. . ..... . .. .. .... . . Lender's Name� . .� . . - .. . - . . ' . .. _. .. . . . . ,, . . . _ � . _._. ... . � . . ..� . . . . , � : . � . � . �. . . :..�,. . . .. . ..... . .... ... .. _ .� ��.. Lender's Address� � � - � � � � � � � � - � �� , ., .. . . -.. � .�..... ._ .. � . ' '. ' � .. ",'I�.� �. � . �.. . . . ... . I certify thai I have read ihis applicafion ond�sto�e ihoi the � � � � � � . �► - � � � above information is corred I ogree.fo comply with oll County ordinances ond 5}afe-laws regulafing Plumbing,-ond hereby � � . - . , au!hori� repr seniatives of t ' County to enter upon the above-m lio ed perty f insp tion purposest� �. � �-- , Y � r.� � � . ....._...,:., ...:_.....;. .. ... ....�.... ...,-.. ,-1 ���'l� SEE REVERS�FOIf EXPLANATORY'lANGl3J�iGE �_.�, � Signotur of7ermiiiee � `yDa�e �' � � :.M� -. - . _ . _ . . - . , ' ._.. � . ... . . :... �.,.. ...:�. ,. . ..:. � . ....,- _ _,. . . . .;,. .. �- . ;,. ..... . _ . ._.a,.:. � .. . . ��s�..�"� ,,.��.h:;.. .._ .,d.K:' ._:�.'„�,.. .<:.... , � -. -... . �.,.. �...n .�'_F 4 .',:. .. <y.... . . . � r,, :�; . - ,...f�"vgI31:�"Y�'�?'S 1�6'�ES 1 nere�y�W�ER BUIaDER DEC!{RRAT bN,...,. s __ P.PPRGVACS'"°"��u>� DATE � INSPECTOR'SSl4NATURE� �„�_,,,,__�,.,_._.-,_.,...,_----`- �,--�.-'-^-_.,,,,..,;..,,....,,,,,,..,...,....„....�t�,.:;,... ... ..>„ � , . .' . . . .... .��� � -� ' sxempt froeRi the COMraotor's tiNneas�AawoaK � - - � � ;.. ...�.,,�, Licensq,law for the following r&asan (Sec{Jon 7031,5, . ROUGF;PIAIMBING �- � " '"""' ""' �us�ness an�'"�rotessfons eoda}. Any crty or couniy caSQi�fw�� � �� ' � � � .. .K,.,.:;,�. . whrch raquirss a permir Po�const�ucf, alfer. rmprove, .. .."``"< ..`� � ,`.""""„" ��"'.�' �-� ���� dgmolisH cr,repeir any sYructure,prior io its issuance. �as uENr � � � . . � al o requires t»e applicant for such Aermit to trle a signed ......,.__._ . — ,.__�.w _ ,—; «�_.-,�s.:� ...:._ rso�WA7ER HEATER � - �� ' �'"�"""" "��"§�a emenf�iPiat he is li'censetl pursuartt fo the provis ons r�uxaeiuc F�xTUREs ' oi the Goniraeior s Licanse LawLChapter 9 f6ommencing � . F...,.-.:..:,M�.:..><..,�,,...., w..�..,.,,,,.a�. � �, � . �hti Sect�On"`30d0)of�JiG±siori�3 of the 8usrn,ess and Pro- _ GAS T[S� �a f� . . - ....- fessions Cade)or Fhat he is exempi iherefrpm and the UTI�I7YC0.NOYIfIED� !— ' ' _�.-..�._ ......... _..._....,..._. ».a..a:..� z.. .._.....».. ,.._._.. "' `'� 6asr's for the allegEd exempticn.Xny_c�iolatiort of Section 703i 5 6y any"applicar�t lor a permit subjecis the appli- , ..Gy ..��.,�.M.,... _._..�— . -. .,_--.. .:. ,..:.a. r!MAL � . . '�nfe.oa.?/'UnE � � ' ..� CBRf�O 8 CIYlI��}B/13IIY Gf TIOI/A.r+(B.ttldR/IVC�YIUl7(I(BCI _. .. ... ,.,.-.,�.,,�:; dpllats{$500). .._.__,-- ...... ..__,...._. ,...,_ ,::..t�.:. ....�_..,,.,.. . ..;i � " ❑i,as ownar of the praperry ws�i da 5i�wuifc,and the � ����--�-� ---�--•�--�-�^��-��^`�x. sdructure le nat intande0 or aftereC fae sele iNDUSTPIAL . � —.--:— . . WASYEAPPROVAL _. . �_. � : . . ..... . � .,..... �."..-... _ .�.-:...• .. ($2C.7Od4,SUSIRB�SBA(�P7DfBSSf605.LOdE:Ta6_C6Rh8C-.. _._,_.z ,..,:::,;,,..,,,;,,«..�,�.,...Y„,�.�,.-.,w....,,.....,.,...:.w.,,,.,...�. r.,w ...�.,,,,..n.,,, tpr s Gcense Law do�s rroP apply to an owne;ot property � � " �..;e. ... �.vxw...+�rt.f'w,...'.-'.. . .�.reF,..:.. h�iw.�,.F ..n �..n.w....�+.....�. � `who bui(�or impro�as thereon,ertd wFia does sucA work :� . ' . „ - -- � � � - � � __ �� hIm581t p�ovided that sucb fmprovemeflts are ttoi rntgntl- . . .... ....._,:,.._.....,...�...� .,v�.�..�+,,,..�. .�..,<.e.:.,:. ..o.,.,w - - - - - _.. �d or�offeretlYor sale.➢i,hawever. the buifding or im- -. ,, � _ � �� �-' � �- �� � � rovemant is sotd witbkr orte�ear of comp(eiron, the ..:.. - . .. . .. .�--,� :. - . .... _..__..,_.. . .._;.,., ��.,.-i.:. .. ,,..�...�.:>. "o'wnervbUiltlei wiAhave the durden of proving that he d!d - nol7wiid or improve for the purnose of saleJ - . . � � --- ..�..»s.�.:... .. Mw.:+....� , ..�:.,:,-.�.,..._.,,,�;:w_ .um.u.;>:..,. ..,,..�, .,....._�:.��,:....� _. . .. . ... . . . . . . . . - _..,, .,: , �,,.k:. ..y._A.= i am axampt ur�der��. .._._._�.—� _..-. _,�-..... . ..,.�. . .__.... __ �.. ,.._ .:... _ ,.. . 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