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HomeMy WebLinkAbout1265A (6) _ . _ , ..,.. . - �.,.:_ _ _.__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 �� /�+ � � - � � CCNTRAC':l r f.,6 f. r Dofe � Applicant - ' � . CLCTHESNIASHER � ' �� . /} � ... ..�.. ,.:_ s . ...... .... � ADDRESSC� Q` .. . ��y 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:' ._:�.'„�,.. .<:.... , � _-. _... ...�.. ...m . '_1 W .',:. .y... - � `� ��; : - .•(�vg131:�YG"�?rS P�6YES 1 herehY alflrm ?hat i am R EClfRRAT�9N,...,,. p4NNEli BUILDE D s -- P.PPRGVACS'"°"'�d'� DA7E INSPECTORSSl6NATURE� �„�_,,,__s,.,,_..-�,.,...-_------ ..�'.:-�— .,,,,.,,�,...,..,,,,,,,,,,,,,,,,,„..,�,,,.:;... .... ..>,. gxBmPt TIORI thB COMfeCtOfS tiwoeas�AawoaK �� � - - - ..�,�, Licens§;law for the following r&asan (Sec{Jon 7031,5, . . . _.... �_ .. — ..._.._. �_:.._,:., ....._.�_..�:._.. .�.. . �..., ROUGF;PILMBING �U51li9S5 an�"l�iofessfons Coda}. Any crty or counfy caSQi�fw�� � �� ' � � � .. . .K,,.:�. . ,which raquirss a permir Po�const�ucf, alfer. rmprove, ......,... , ,r�-,,.�v, ,,..w.. .,._.�. ... . _ � "'�` � demolish cr,repeir any sYructure,prior io its issuance. �as uENr � � � . � al o requires t»e applicant for such Aermit to trle a signed .....,.._._ . — ,.__�..»-F.«�_.-,�rs.:� �; �. _ r+o�WA7ER HEATER � �� ' �'"�"'"'`" "��'§�a emenf'fhai hs is fcensetl pursuartt fo the provistons r�uxaewc F�xTUREs ' � � oi the Goniraeior s Liea�se LawLChapter 9 f6ommencing . �. . F...,.-....:,M�.,:..><..�,,....,,,.�:.;�..�..,.,,,,.a_� �, GAS T[S� ,��j_f'�� - ��tfi Sect�On"`3�Od0)of�Jiv±siori�3 of tlie 8usrn,ess and Pro- - ,.....- fessions Cade)or fhat he is exempi iherefrpm and the UTI�I7YCO.NOYIfIED� �— ' ' _.�..-..�._ ...-......... _.........,.. ..,.».a..,:..� z-:..., .._.....».» _..,:..�,_,,. � ' ' ' �-� '" 6asr's tor the allegEd exempticn.Any_violatiort of Section 703i 5 6y any'applicarrt lor a permit subjecis the appli- _ ., ..cd .��.,�.M.,... _.—.�— . _ -. ,_—.—.. .:. ,..:.�.. r'bA� � � ��nfer on.tront � � � "� caRt to a'civi!penalry ct nat mr�re.than tive�trundred _. .. ..,.-.,.�,,�:; dpllars{$500). _,-- ...... ..__,...._. ,....,_ t�.:. ....�_..,,.,. ,;i � " ❑i,as ownar of the praperry ws�i da 5i�wuifc,and the � .. ...:.... .-..-.--..-_...^.�^��^.'�Y � sdructure la nat intands0 or alfereC for sele iNDUSTPIAL . � —.--:— . . WASYEAPPROVAL _. . �_. � : . . ..... . � .,..... .�....:... _ .�.-:...• .. ($2C.7Qf4,8USlRB�S8AdP7DfBSSl605.LOdE:Ta6_C6RtI8C-.. _._,_.z_.,.,;-,;,,,,;.,,„,,,,,,�.,...Y„�.v..,,w.t..,,....«,......,.,..r.�. r.,w ..�,,,..n.,,, tpr s License Law do�s rtoP apply to an owne;ot propsrty � � " �..;e. ,n �.vxw...+�rt.f'w,... .-'.. . .�.reF,..:.. h�iw.i v ..n �..n.w....�+.....�. � wh�o bui(�or impro�as thereon,ertd wFia does sucA work _ . � . „ . - -� ...}.u.:,.,µV#�.�::, �. � hlmself p�ovided that sucb fmpravements are noi inignU- .... .�,,.. -- .�..,<.e.:.,:. ..o.,,w - - - - _.. �d or�offeretlYor sale./i,hawever. the buifding or im- - ,, � _ � �� -� - �- � � rovement is sold witbin orte year of comp(eiron, the ...:.. - . .. . .. .�--.:� :. - � . _..,._----r-. ._>_.., �.�..„t:. .. ,,..�...�.:>. "o'wnervbuiltlei wiAhave the durden of proving thai ne d!d - nol7wiid or improve ior the purvose of saleJ - � � _� .. _..�..»s.�.:... .. Mw.:,..... , ,.�:.�:�.._.,,,�;:w_ .�.m.u.;.....,. ..,,.�, .,....._�:.��,:. _. . .. . ... . . . . . . . . _. ,, . .. .: ,_:. �,,,W:. ..y._A.= i am axempt ur�der��. ..�._��� _..-. �-...,... _..,.. . _.... . __ . ,.._ .:... . _ ,.. . B&P.G.�for thla r��&ost „ , _�- _.. . ._,.: � .>,..... .,-.,:_ .,„ , �_... ;. -., . �.,.,. __-___�------ ,:�.;,��;�r.�;.<,,�..���.,.,,..�,.:..:_.93ate . �- �._.._...�.. .a«A.,...;...:.-.:-.�...-.,,�, ._a_.a.. —....__�.�. :��--:�._ ._..�._.. �-�..,�.��.,�.,.rF�-.,..�m.. 42wner ..>_�.,. ,._..,..:. 1N8PECTOR�NOTES _ . � � „ ... . : . ::.::a,z;�.�.x..., -' ,,,•.,_Sr.>., ..,......,.,�..v,,....�.:. �..,.....:..�.,.....w.::�=�.:w:w;a�....�..__<:.:: _e.,...�..:....,�..,u.,:...,..„.�..�..w:.u.b�,��.�-,�.�.,_a,K.,ww;.�,w�cw�-,zw .:.. .,. . ,.. . , . _e.. ........_�. �"^ ,� .-...._.""" .-,.�.:...�wY .,., �.:.::<.-3,� i �.�:._,. ...�.:.. �,'t. , ....r,... _.�..-�:'.:..r.�......>.....':J�`..., ��a.�. w, _.K�,.....xX'._. .....,� t.. .:. . ' . ' . 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