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HomeMy WebLinkAboutNo Permit Number (126) � WORKERS'COMPFNSATIONDECLARATION AQD' �"ATI/1w CAD �� 1 Aa■ I��P rfP �p� j I he�eby,affirm ihai I have a certrticote ot consent to selt in- 76N667A✓'�YV 4���/ �� � ��y^���1� !V 1\ A L�VN�\�ttr`J r ��,YI1� i I! Y sure,ar o rertifi;n�e o't Wcr4ers'Campr.n}ntinn Insurance,���n C[i317;kEV,S;fi6) I i r.r.rfified wPY inerenf(Sec 3800.Lab.C.) � g 73TJC0050�ia�n�[� Nationwide COUNTY OF LOS ANGELES DEPT.OF PUBIIC WORKS Policy No.__..._._.—_. �76 y__---_ LOt 28 Plan 24 Tract 42578-8 i � � Cerlified copy is hr,reby furnished. . _ FOR.4F�L!CAM 10 hfLL�N(PRINiOR NPF.�. Hll'�.,>iNC; � � 9—�ied89 sf�ledwilhthemun�ybuildinginspection -- r -- --- - --��DD�i5,896 S'. L2ylHrid DY1Ve pyi department. NUMBER� F=x1i1RE OR 17[M �FFF. � _ _ .. ._._.. _ T—�LO����IiY � Dale`_ Aoohcant Neca�Plumbing .'"� �va�rh uoser,roue�;--...--,-- i � --��F,fST D ----- iamon Bar "� , � �N;s;;, Grand Avenue ' CERTIPICATE OF EXEMPTION FROM WORKERS' {�G eA!H iUs J ___ ___ .._-__-___ ! COMPFNSATION INSURANCE � �� � -� ---� �� �'.v'�FK ' , s�oweF i ��' � Bramalea Limited �� nhisssesued I shall ot�6e�om leted if the work involved b � SiNK �� � i�'7 � ! � I P Y �7 U.nu � � The parmit iz for one hundred dollars(5700)or less.) t�VATC�RY '�. �aL`L'NESS 3]_51 [ilYNi3Y �_1VeI_1ll8, 5ll1tC- N - g� _ . ' '_.—..._ I certify thal in ihe per�ormance of ihe work for which ihis p..r� �� � I y t`.,�` � �' y<,�y pe�so���a�,y���„„P�,� __._ _. ._i Costa Mesa � 850-1001 j oisHwnsHER � j� � oore I_ a�pl�canf_�.p � c_o�nes was�re ` _ � i T *�- ^�'RP�T�� �;ew Plumbing Contractors,Inc T as to�become su6�ect to tne Workers'Com ensahon Laws. � -- _ __ _ __ _____ ' �co t--} }d �'ss -.._._.. . . ._. � _ _. t� �—---21a� NO?ICE 7C APP!ICANT�tf,ofrer mok,n his Certi`,icaie ul Ex- y � „S�DuPUI1L DY1V� " n t on, ou should becurrie,sub ect to the Workers'Com en- 1 I SWIMMIN.,POO_'�-CFPTOR I - 'P� Y I P �_ .___.__ _�---_---�'i�Y !hL.NU. � �.: P .... .. ._��lJA-EN HtAiFR _-�� � satior�Frov3ions of the Lo6or Codo,you must forihwith mmp- ��WN SaRiNK�ER SVSTFnn� � - ly with such provlsions o:rhis pennil shall be deemed rPvok � r"nTE + ed in F,us tio. 426109 ',iHss C-36 � UCENSED�GNiR,�CTOKSpECLARAIION -- �-- � � UiSrkIC1NU PR0�f55iunv . GAS SYSTE/A (,:UriEi i � �� `����y,��,,_�� i hereby nf*inn!hot I om!�[e��.sed;,nder provisions of Chcapter t � 9(c mrnmcing w;?h Sr.chon?WO'�.of D:ei;ion 3 nf ine 8usiness �OIiT�,FiS UVhR �"A�•5'`� and�Professions Cade,aod license�s in f�l! orc�a:'nd ef 5 NEk SYS7EM � � / my - �--- FlNAL �- a - - � YALIDATION e k ,�:i. i ; oarr ��3-4 t'� � �" � License Number 426109 Lic Class C-36 - -- —�— �-- � 'a 5-31-89 �-- — ------ -- --- rwn� , er i -T�— BV �j..- .. � ; co�r���fo� New Plumbins�_o�rP � �c.- � , -- ----- <a � � I am exempl under Ser _, - -.� . . .t._ �= � �'' !.... .. G7 J __...._—_- .- �. '� 'r. fA. B.&P.C.for this reason c � ;; e ,: „ � � -- Plan check ee I ' ` `n - " .' -- — -- ---- n �� —�--- --� ---- �a}�� PLUMBING Pt12MIT ISSUING FEE S : j a `j , � Slgnature /�y �� _ —___._ 5 SWGLe FAMItY _._-__ _.. OTAL.`C—_ �_�/, ��' .a ..� i !�.,>';�� "?- 0 � _ 1/ � . .. . s - F HpMF OWNER-9UILDER DECLARATION Plon chr.ck npplican! �,}',C' __' _z ....._-.. ___ : . � I hereby affum�hat I om nxnmpt from+hc ContraUor's Li<ense Name Law for!he followmg reoson !Section 7U31.5, I3usiness und - -�--- ---� ---- ' Professions Code): Address � _ - . - _ .___ _... _. � � I,os ownr.r of tne prnperty, will do !hr.work and!!ie �iry Tel.No ; structure is not inicnded or offered ror salr,�Ser.hon 7044, - �--�--����-���- ----- --- : Business nnd Frofessions Code.) j ► i CONSTRUCTION LENDING AGENCY � I hereby affirm ihat ihere is a ccnsiruction lending agency for : the performance of ihe work for whicn ihis pe.rrnir is issued (Sec.3097,Uv.C.). lender's Name Lender's Address I ceriify that I hpve reod this appliw�ion and stote ihat the obove infr rmotion is correcf.I agree b mmply wrth all County � , ordinances and$lote laws ret�uloting Plumbing, and hereby � author e representahves o! this Counfy to enter upon ihc abo� �bned property for inspeciion p�rposes. . �� � ��;'ry9W�.y'',7 SEE REVERSE POR EXPLANATORY LANGUAGE �--- � S rin ur�of Perm�..�e � Date . �:.m�:,cP..:s4a:.';::_;r��;,:�.u::�.:;s�s-..s�.*.�.q....�r ¢ ��E �x r, n!��'._�A� *. ! 7 � :��.^-.''�:Q D .?c'n l:Z -:g ! ` n��; . i. : �r iC':�C, t:� ` �:V° ,1 � 7 � i i. 3 �d ������ i - � '..^j m;�:�..�� 'i=`Z i' 'IE, � � � � i � � � 5 [ �y T-,��'� ; i '.-,�<n y:,T.'� �. 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