HomeMy WebLinkAbout0373A (4) ; "'°�'K`RS�`o^^�E�sAT�o"°F��,�RA,�o" AF'p�.I��TIbN FOR PLEJl1��iIV� PERMIT r, '
I herebv nffirm ihof I hrnr,o certif;rntP of rn Pnt tn zPlf jI i
76ALL;A ._ _. ..: '
� insure, or o certificate oi Workers'Compensahon Insurance, CF BU(REV. IOifll) ? Y'- �U�t J l�J�r �-1
o�u certif:ed copy th=reo4;Sec 3600,lab.C.1 �pUNTY OF lOS ANGELES BUILf�INf's AhiC7 5�F�TY
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Pohcy,Pp c�mpan�Y['mC)nt TnrlPmnit } T� �/ ��
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P � Cerl��:je�131py8 herebyfurnished. ' '
-' // / 7� U PORAPPiICAN?TOFiLLIN(PRINTOkiYFE) ��ILDING��r� � � � ,F._�,.
nCerLfied coFfv is�iled m�iih�tµA�pyn',}�r�Lildin �insper - --------------�—_-- — ADDRESS,'?F��j �,.f,.5� � f�;,:�_.7
� tion denartment. � �� �' N;lA1BEK _ fl%TUR(OR ITFM (n. FEE LOCALI?Y
q � `.'Aq+�k.'� .�JIL. c =i,� � �� WATEI2CLOSET R il '_�
� Daie _-__.._App!icani - .i-- ______ _'?;. _�tiEAREST � •
� CER7IFICATC Of EXeNPT10N FROA+�WORKERS' � �; �a:,ii{iu3 :',�,� ZCI ���r������ip
CO(J�PFiVSATION IVSURANCE -"--- -"�-�--"------------ - : ,. 5
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TsHavEe �wNEk The Anden Group
; (This sectinn neeA nof 6e cnmolefed if fhe work involved by • � � � - --
.._.i . . .___
{ fhe permif is for one hundrpd Coliars(5100)or less.) I nva70Rv , _ ...._ ADDRE55
� I c2rtify ihat in the perfo�mancE:of the work for whith thu "-�Y-- ` ' , - �n�/ D$Y'�E--�rTt'@[�C7-_--- .
! penni!is issued,I sholl not emplcy�any person m ony manner �! SINK__ --— =T ! _ CITV Covina ?EL NO. n�
—_�...__. J��� 7 _
t so ns lo berome su6jecl 10�he Workers'Compensafior,laws. � , ❑;SHvvaSHER r � j
�i �_,__�___ �.! -_�('ONTRACIOR
' �e AF�� ��m _ �c c r,e�wasne�z � � ' � I noo�ess ��.R:T�� 1.ng�nC. _�
TICE TO APPLICANi It, aftPr mcsking this Certi°icatc of � "-- —� ` x� �l G!��
^'^,.'ior, yc� , 'i ,�-ca•:�e 's�f��_�• •c� ^I';e: �du'� .ei � �' V`MM'Nf;v00.FECFP70R �—I Li���1�Bl��J-_--�
t I ��C!TY ?EL \p
: �omuensanon provisiens u(tne�qbor Ced=,you musf*orih � � TT Riverside 371.-500 �
with comply with such ,r.rovisiens or Ihis permii shall be �'�PW�vSrRoVKLER5Y5tEM � -----.----.----_.____
�-___ ��. . STATF I IC.
� Aeemed revcked. J7_-�r�r:ATf.R i�EATER � I I �!ICEnISF NO. ��; ;'!A55
� IICENSF�CONTRACfORS^F.CLAkA?ION �--- ---�--�-�---............:— � —�=�---���d,��- ' � =ao:FSSFo T-�� .
S 1c^r-�rnencin �v`th$e[tio{7qQ��Vnder�ruvi,inns o`Chapte:9 � i� i GCS SYSThM OliTviS T _ j ; ,
rereu• oifirm rhar!q�i'.c�nse�s 'g �
(� g' ^�oS�i �sion 3 oi'he 6ua ness t3 L:J7i i5 GbrR '� ' � � I � � -
� �r:1'r��Ec.��ans lu� n5e�s in iu�l tar�a���fec'. 7 �' C Y,�iEiJ � -._.._..._ __ —i _7 :
� 3642'� � -- — — � ��n F` !z,-tS-�.G � �rs��.s��,•r�ar� �:.
° License���r.p]..,7,7,j�'� Lic.C o. --'--�--�--- ,�.
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� f_oNrar,tor'__......_.."_ Dcte_ BY :.,.`.;
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I om enemp+;;�idr.r Ser_ �.�`
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l3.8P.C.fnr ihis rensn�____.__ g
f --'-------' P Pian check fee � �:
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� —_..__.-___- Duie�--� 9 , ��._ :.',�,.:
'�,;M31;.;ii^�f;fY�ii!SSUitv6 r'EE S
� Signa�ure_._.__.'_--' --- � ---�-----��'-- : � <.i.-,../ .� _
i I 'o�Hi =Fe j `, I- ,;:`1
� -- ,�:a a �;: -
�,Plpn check appliconi ,
7 SING!E FAMII Y _ - - -- --- ; � o- f.`, .
# • HOnAi OVJtieR Bl11tCiER DtCtARA'tIUN }g-Nr.:ne ' �` �-
..sreby offirm ihat I om exempt from ine Contrador's Licens'e '�Cdress w.���� i t -
� Law for Ihe folioviinq ieoso�� ,SecYon 7031.5, Business and ! � " '-
Professions Code): '
i` : ,. n c'._ .t.,:
� City Tel.No. �,:,, ,. ,,:, .
..._. ._.._..._...._...._ . . .
� I,os owner of ine proparey,v�ill do rh�work and the
S ,}rucfure is not intended or offered for sale (Section �
i
ry 7044,Business and Pro4essions Code�- �
� CONSTRUCTION LENDING AGENCY
� I hereby nffirm thot there is a cons�ruction lendieg agency for '
'��e performonce of ttie•n•ork for which tnis permii is issued .
(Sec.3097,Civ.C.). .
� Lender's Name_ _
� Lender's Address
I I cerlJy�hnl I hwe rer,d this applicatlnn and s�ate�hai ihe � �
1 �bcve mfon�ofion is�arrri�t I n<pco�o romnly with oll County '
iordin��nces ond Stuie lowx re�ulotinp Plum6ir.g,and hcreby -
authnn�e �ep�c'sentotives of this Counry to enter upon Ih� .
� above-me �oned prup�rty�for inspection purposes. _
i R � ','.� ;•;`� � i � � � SEE REVER5E FOR EXPLANATORY LANGUAGE
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