HomeMy WebLinkAbout1783A `"°RKERS•�°'"°E"5^T'°"°E«A"^T'°" APPLICATION FOR PLUMBING PERMIT �
I hereby affirm iha�I hove a cerrifica�e of consent to self �bq6y�q
ins�re,or o certiiicote of Workers'Compensafion Insurvnce, . CE BI7(REV.IOi81)
or a cerNfied copy thereof�$@�BpQ,,,L C.) � •
��v�'C�C�Z.��76� ����j� COUNTY OF LOS ANGELES BUILDING AND SAPETY
POol��ty No CompanY .
Cerlified mpy is hereby furnished.�
� FOR APFIICANT TO FILL IN(PRINT OR TYPE) qpDRE55 L J '
Certified copy is filed with�he couNy bvilding inspeo-.
lion depaffinent. . NUMBER FIXTUREORITEM p' FEE
��,�J � lOG4liTY (,.
�a�eJ�LApplicom WATER CLOSET NEAREST ^',
� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB � CROSS Si. � !� ��d J��t
COMPENSATION INSURANCE � - OWNER �l
SHOWER
� (Thb��Hion nMd no1 be complated it tha work inve r�d by MAiI '�p�qr
eh�p�nni�is for ona hvndrid dollan(5700)or le�s.) (AVATORV ADDRESS
I cer�iiy tha�in rhe peiformance ot ihe work for which this
permit is isi�ed,1 sholl nal employ any person in any manner SINK CI7Y f.r+L`In /J TEL.NOt�-�� �
� .�.C�
so as to become subject to the Workars'Compensalion Laws. DISHWASHER /+��` � ��.
� � � CONTRACTOR L�����/
pofe ApplicaN �� CIOTHESWASHER ADDRESS // �i ��J�� /J
NOTICE TO APPUCANT: If, of�er making this Cerfificote of � �/a 'jT�lilOe�
Exemption, yo� should become subject lo ihe Workers' SWIMMING POOI RECEPTOR
Compenzation provitions of 1he lobor Code,you musl forth- UTY r/j� TFL.NO.
IAWNSPRINKIERSYSTEM � �4
wilh comply i1h such provisions or fhis permit sholl be STATE �j 7 T'- LiC. �y �'J �
deemed�evoked. � , wATFR HE�TER IICENSE NO.��// C.�� Ctq$5 Li CT�� .
LICENSED CONTRACTORS DECLARATION oiSTRiCi nro. E55eD Y
1 hareby affirm Ihot 1 om licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS . � •
(commencing with SeUion 7000)o(Division 3 of ihe Business ouitEi50vEa
and Professions Code,ond my licanse is in f��l fo�ce and effect. s aeR SvsrE,�n FINAL VALIDA N
�/'� �� /p DATE p a
License Number"'������-/✓ Lic.Clasi.�� r r��� O
co�„a��'�'`�'�''✓���, 1�7``67 eYa` c�.
�
❑ I om e:empt under Sec. - �
. w8.8P.C.for this reoson plan check fee ► �y�.
Da1e: pLUMBING PERMIT ISSUING FEE§ � Z
Signature � � � ,
TOTAL FEE �+*��A��
Y
� � Plon chetk appliconi � j (,
SINGLE FAMIIY • • I 7C�v?
HOME OWNER-BUILDER DECLARATION Name-� � � Q�,O H—S^I
I hereby offirm ihat I am evempt from ihe Comrodor's license "
i.. ,r.. .�..,�_ii' --- - -- --s ard Address
r-y re..,,,� (S �,�..�......�...,w.���e, . . . . . �
Professions Code�,� �;iy Tel.No.
❑ i,os owner of the property,will do the work and the � �
s�ructure is not inrended or offered for sole�Section � .
7044,Bu4ness ond Prolession5 Code). - � �
:ONSTRUCTION LENDING AGENCY
I heraby nffirm ihot there is a mnstruclion lending ogency for � � � �
� ihe performance of the work ior which this permit is issued �
(Set.3097,Civ.C.�. . . . . .- .
lender's Name � � - � � ' - '
lender's Address � � � �
I certify iho�I have read this oppl�corion and srate�hat the � ,
abvve informo�ion is conect.�I og�ee�o mmpiy with oll Covnty � � � � - - - � - � � . .
ordinances ond S�a1e Iows regulat�ng PIum6�ng,ond hereby � '
authorize representotives of ihis County�o emer upon�he -- . . . .
obove-mentioned property for inspection purposes.
� } � � SEE REVERSE FOR EXPLANATORY LANGUAGE
�
S�gnalure of Permiuee Date � - � � .
� o i
.. ' ...�- p T' � G O
w� G u, m ` m .��p � � �
L .�
.i _-... . ,t Z 7 i m Y Zi Z C tP A
�,G � n a Z�i p � � �Z °c
. � � m� 0 '^ 2 Z � .y-
. �T ? G � � �c N
�� O T p
L �" �
• y . o
\� �
_- �
. - ;,
, �� �
. . . c
�� � � � � .
' ., c �
2 p
� ' N
n� i
� �
, A n
N � ���
Z r�
� O r , .
� ' i.l' "
_ , . -
. :� .
N
�o
R.
a
A
U'
� �
0
m
�
p��
. � � � D y, ?� . .
N �0 �p C �,7 U� � .
� . . p-Q G a a i 7 � N'�9 �N N�-{ .
� N S O � ,w„ �n O Q S�.�.Q 0 p O .Q
,.. . � � � W � G tJ�N np� r. D �y. ', ...• �
. .. . . . _ = O '� �O 0 N � �D N O tT 6-O�.'3'4 7 n .o � Z-
. . , • �,0 7'fl ;F a.�`Oi i��y Q'� p �q� m ''00.� 3 p� :S ._v
� . O Q�O m?C.m i^ N 0� � c� O �v' �� .. � SO �
' � .Q SF � ' �. 6.lL LL� LS.N �m 0�."� 6.�,O� G�.� O N � � .G .
�
� � � K o a�� m,o o '�"•��. a���� � o o^ �?°3 �,
�
� � 3 `•; �� � � °� o �o ��.Sa-� `-' : �4 , ``a
' . ' �^ .O 'D 3 'n � O 3 Ll.N O � � v� � '�G-p n�p � O..7 O
.'� .� 7 J. ? � ^ �
� g K 'O �-^ �y n
S' � �o o�� a-� 7 a a"�' �� ? n =n° �o °��9 `+'
, , w p. � � ., N o :,c �' .o � p a .� , 30 � , a ... .A
� - . � 'O . N 1 ?'?� O'T� �O � O� � 1 l9 �. O � N ' �. 7 �� ��
�" m sm � 19N ��No �-'- 3 '� mw '°='o •3 ,� O
� n .� v� ; �,� o�`' � 4 � 3' Sp°.:.o'° '^�^ ° �o. .2
m T � o � `° 4 " ` ° �
. ` m.t o o i'i a; 's� S° N 3 0 °? �`�^, ° o 0
< �
. . " ''Up � G W-3p•j � R 4' 7 N O p �" � v` �u'� � .p, � �'
• " m �. �o �'� W, � ° — .^•� � � �„ o n ci9Z o°
, � � . p-p ��„ m 4 7 a i� e. N O O-,CL� �, Cy—0 �t u'�
. . O t+ T� � c9 � S � 3 'O�:• O �� � "
�7 3 � j O � n 0 C n N Q O S �? �j ? 7-!J• �•
p �.,v a— c :. sn
� �7� �N N'�, o . T °n.� o° � �m
p " �p � � p N -, > 'Jn
. ' . ' 3'7 7 � C ^ n �]' � '���
� � O ?'�'
' . ' � ' O��Q ..
�-
��