HomeMy WebLinkAbout1413A "'°R�Rg•�°""�"�„'°"���^R"T'°" APPLIGATION FQR PLUMBING PERMIT � �;
I hereby affirm thct I hava a cernficata of consent to eelf �yqyyq .
innuro,o�a ce.��ficqte of Wo�'kers'Compe�o�ion Insurance,� (,p 817(REv.10/81) � �
or a cenitied copy thereaf(Sec.3800,106.C.) COUNTY OF LOS ANGELES . BUILDING ANDSAFETY . �
a��W9i �l1711047 �oi++��y F+reman's Fnnd 296 41DR Lot 66 �
Certified capy is hercby furnished. BN���
� fOR APPIKANT 70 illl IN�PRINT OR TVPE) „��1389 S. A I
CeAified topy�s fifad wirh�he counN buildin9 i�spet- NUMBfR FIXTURE OR I7FM � FEE
tion department. .
8/.4/83 w�r�auos�r 1O��TY�Wland Hei hts ;
oafe nPpi;co��RCR b : .4• j � �Ssr.Colima � Ra idniew Dr '
CERTIFICATE OF EXFMPTION FROM WORKERS' � y BAiH TUB � �
mnnativsnnor�iNsuu+N� ��R �R Presley of So. Calif. ;
(Tht�s�dlon e��d not M eompirt�d tF th��vork�nvoM�d h�r �" ��
- fhs parmlf la far ons hundrod dollers(3100)or la».) uvaroRv � � n�cort�ss 4600 cam ue Drive �
I cer�ify ehvt in fhe per(ormance of�he work fp which�his � � � �
pprmit is issued,1 sholl not employ any person in arry monner 51� � CD ��TY Ne ort Beaeh '��•NO� 540-0500 r
�— so os ro become subjCcllo Ihe Worken"Gompensation Lowa. D�SHWASHER +
. Q'� OONfRACTOR r r �
o;,, s�,i;�a„� CWiHF5WA5HER oD ,��12785 Magnolia Ave. �
,_.NOTI�TO APPLICANT: If, after making rhi�Certificate af SW������� � {
tion, you should become sub'ect ro Yhe Wwkero' ;
i GT� Riverside TMi���371-SOOD
,`'k..� penwrian pro•�sions of�he lobor Gode,you m�f foAM UWNSPRINKLERSYSTEM �
wi�h comply with such prov�sion�o. thie perm�t ahall be S7A�E ��
deemed revpked. wA�ER HFhTER � �+s�� 336428 C-36 �
UCEN$Ep COyTRA�LpRSDECIARAiION D�5�r10. RtOCFSSED ev j
I Aereby atfirm�hef I om licerrcee}under provitiomof Cfnptm9 �S SrSrFM WttEJS � � J �
(commencing with Seaion 7000)ot Oivision 3 of rha Busi�ress pURE75 OVER �r . 4 !
aid Prof�sions Code,and my license is in fufl ferce mid effeci. 3 PEk SvSienn � FINfLL / VALIDATION Q 1
license Number 336�{28� lic.Claaa -. C�36 OAfE '��`�'� � ;
flNAI O :
� .;
co�no�ro..rcr Plumbing �, 8/4/83 e�' w
❑ a+ . �141.+A � 'r�
I om exem under Set. -
B.BP.C.far this reason •� � � �
Plan check fee �.• • • •�
oa�e:
RUMBING PERMIT ISSUING fEE S � �'.���� 7 p�1} i
Sigmtu.�� .. . .
iOTALFFf � Q'� •;+�i i hf;d�
� Man check applicont � '
SINGIE fAMiIV . �u�[�—`i: i
HOMEONMER-BUIIDERDECIARATION Name .$@C-�'.-:R.C.R. PLAI�ffiINO, INC. � i
"-jeby affirm thal I am eaempt from�he Conhactor's Licanse �m� 12J$r1 (�8 alia �Ave.
j for the fcllowlrg reason iSection 703i.5,Basiness and � � . �
�'r�ofess�onsCode): G�y riveraide rei.No. 371-5000 i
❑ I,as owne/of�he p�opeNy,will do the work andlhe , '
snuUure is no�inranded or offmed for lale(Seqlon
7W4,Bus�ness and Professions Code). - �
CANSTRUCTION IENDING AGENCY � - '
i
I hereby affirm that there is o mnstruction lending agentY for
the performonce oi the work for which tbis permil is istyed ' . -
(Sec.3097.Civ.C.).
Lender's Nome
Lender's Address . � - j
I cenify thef I have read this applico�ion ond srofe tha!tha . . �
above informo�ion is corcecf.I agree to comply with all COu��y �
ordinances ond State lows regulWing Plumbing,and hereby � i
authwize represen�ativ�of rhis Co�nty fo emer upoij fhe "
abova-mentioned property for inspetlion purposes. -
SEE REVERSE FOR EXPLANA70RY LANGUAGE
gCR by:�'7(„�,�.lc*.,✓�,,,,,�� 8/418�
S�gnorure o(Perm�n e Date '- ,
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