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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 � �rEP8h2313R , , Pohcy,Pp c�mpan�Y['mC)nt TnrlPmnit } T� �/ �� y j.. �` y;j.� 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 C 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. --'--�--�--- ,�. � ��3�8fs— —-- ` i � : Fi�un� i �� � ' �---- � � f_oNrar,tor'__......_.."_ Dcte_ BY :.,.`.; � ---'_. I om enemp+;;�idr.r Ser_ �.�` j -- � --�------ � l3.8P.C.fnr ihis rensn�____.__ g f --'-------' P Pian check fee � �: ° --__._-----F--- � s,s � —_..__.-___- 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 � � rv �. ,�. , . �y;� -�I , ��.e y 5 ynniure or Permiitee �� i i Uate I R �• / � �^�t C�i;���!i{�>i'�)�F f_� ! fc T c� � D ��-I`O" E(�1�V o�l I;^i � 3�i� I 1 T)Gl�� m�__ Y{ � � � I 7 i f1 I�',�?F ir's����,Z I�°I�r�D � J I , ( � I � I I � I ' � I ;�''+ ' IO � ,.� '�` l,� �� I i' �U%I�� I S j � '7.1 'Ijx' 2I ;;,'v JiQ � j � � j � � , #� � : 'r� j�E�� �� ?jn�`.� i I I , � ! � i i �1 ' � 1 7 ( I I I�� � ' I � � � I ' ` 1 �� '�`�-- -�-;..�_ i—'-,.���.�r�`� . � _� ,_ � �.i.. l � � � i� `� '; �� ��,;� �� � � ; I �� � � � �� ��� -+�:�_::.. �� I . y ' I`i I i m �V �� i '+_, �l`�;���1 i � � � � �� i� _i_�_��_.,_ -r- _ � } � C,Z . i i� �--- i� � i �� � 7 I � 1 � �� i z � , , : � ! � � ��: � i � � C i I I �.-�: '�,=�:. � � I � I I ' � ; i"�; i ��;,'.,,..,, ,��m 4 � � 'h � � y"I !I t n !t � �n � � I 1 , � � ti� � � I ' 4 . v I C � I � I �D I a I I } _ . � I I i� I 4 I i ! - . i j I �� I i �{ ; ^ " I � � ( 1 I.a� ` � i E � z �..��,.a�.,.�_, �. �..w.1�.� , ; , i � , ...__. ; . � � j i . � I ' ` � � � � � i i � � � � � I `� � �� ► , i : � ► � I � � � � i � ► ; � � � � � , . , � � � k � � � � � , � � ► � ' ' � � ' I ' � � +; ; ; � 1, , , , � ' ; � '1 i , � � � i ' � , , � ; � � � � i � i I , ', � , , � ; , :, � � ; � � : �� � I � I�'. ; : ; �, � � � ; � ' � i ► � � � � � '� ; ' � I ' , , � y I��: ' i r�E ; i � � ' , ��� � � �! ; � I'I I ll j i � 'i ' ' 1 ! ` ; ; � � �I � I � ; I ; �r I � ��, ; ; � � j � i � ; i j . � � I � � I � f i � I I � I 'I �, i � � i ; 4 ! ; 1 � i i i � i 'i ` ''� � � ' 4 i � � , � I �� I � tl1 � � � , ; �, � ; � � I I � � ' ' � I i � I � ; i l ; , � � '; �, � �, , ; `; i � , � � � i � I I ! � j ; j ' �' ' � ' ` ' ', ' I , � � , � ; � I ' ` ' � I � i ' � , � � i � ► � II . 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