HomeMy WebLinkAbout1303A �� ?r �� u '��4��,� T ',�� � `v�.,�`` �- �_ _ .�; , �,,� t� ��`.� �t � a :r� , � a�.:� .� =k'a �.+¢r �ss �,��4xr ft''�a x - , s.. .u E.UV�RI�E°R �tO�EY�SA�I .��:;, �a'�'�.+�:t�a�.'",w,ra;.�,.6. e�' ""'�...�a.�.w— �a�aL..s �.�» - �,+;...s.a , ...... w. ...-..:-r. ,� � . � �.._ ... APPLICAT14fV �OR�PLUMBING PERNIIT � he eby afFirm ihot I have a certif cate of conseM to seif 7fiAd67A �^� ins re o a certf cate of Workers'Compensahon Insurpnce, CE�8i7(REV.l0i8�1) " ��� �-�� ""..- ,. . .''.� , ' " `.` .,.,." `_ .. . . ' y�k ot a cerhfi d cop thereof(5ec,38 0,l�6.C.) �Poli�c�y N'� C- omPa�y ` � �����,� S ANGELES BUiLDING AND SAFEYY � �s � �fi�p � ,. .,�❑ Certified copy is hereby fornished �q,�. - � CY� - COUNTY OF LO '�� .w.,w�x; r.. � -.W..�z,. ..._, ........._.._..,._e-�•�,-L�,,,� . .. ....�.._ _ �?P��al.'�+k'tt�?.�-��'��"sz�'::,a..�xz�v - WvrL�x:. :x� i-,,.� Cert fied copy is f led wrth ihe county bmld ng nspet FOR APPLICAN7 TO F tt M fPRINiOR TYPEJ � �UILOING ��,{ �'�°�� W 5'' f on de a tme t � � " " ADDRE55 / af";� � ,� 7�.� �. . q , r� y � P ,...,. . , NUMBER FIXTURE OR ITEN FEE. .. "'"��a 4- ��.�L•-l:�� ��f'/? + ��s p�3' h��'l �'-��1 � +�,�t �"�� IOCA _, � �Appli[ant '.+ C c r :- ` WATERClOSET LITY "��,^4�����;� Y �� r.,�� 'E:`F" '�'rn'�.` . . .".,..'., NEAREST !. °� �E12T�iCA�E OF EXEMpTIUN fR0 WORKERS' - "� BAiH 7Ue CROSS57. F �`� � ����fiAPENSATION,INSURANCE �� � - f-`7 >IY � .. ... .. -7 �C' Lsa ��, Th's setf on need no}6e comple}ed R the work involved by .�.- SHOWER OWNER ' . ......... � �the permft is for one hundred dollqra(5�00)or less.) - MA�� fk� t L.J^ �'� � �J . ,5�I ce hfy thof in ihe performonce of the wark for which th s � �AVAiORY ��7 � - C`C1 AODRE55 Gi�i'� n ��LJ �- , � 7'".�lfjv��,f� s��er t s ssued I shall nof employ ony person in any manner SINK ��TYA p"sb c5 to become su6�eci�o the Wo kers Compensol on�a s � � -��f�p.:��+�;' .�,�_�%J 7EL.NO.� � F M�.,•�,��y�'r�5f,C#vrr� a - - �FF�'�'''3€^.'�-�dL�'X h -.m.,�;,h� e.�„s'.a � �ISHWASHER � . .. .,,. . r q Dafe ppl cant 'i '� �' CLQTHES WASHER �ONTRACTOR ^^>��� �• . �G�r'y4 y'4` l.. u-Yr �� d`fICE�TO,APPLICANi: If, ofter makm ths4�Certifirot of � --� � '� ADDRE55 � 'y�tj �N y�E�emptia'n;yoo should become subject to the Workers' SVr9MMINGPOOTRECEpY'OR� � � " y � > �'� F �-� ��%'� r�! Compenspfio p ovis ons of ihe Lobor Code,you mus forih "�"" ' ���w�h comply ih such p ov s ons-or th s perm t shpll be LAWN SPRINKLER SVS7EM '/�(�'�`�1"e"�� 7EL.NO. .yf£f'; CITv ,.. 'r���q�ee�mted ievoked t��p, �, - "� - �•� STATE ^�i^ - ���� �` M� Fs f' a�s""f�'T� ;" '" %y'�'x�J9',�"�: exe ..�.�..b�"�. � WATER HEAtER .. .,..J �.°�[+� LICENSE NO. � 7 F��'� CL455��� ^5�i IICEK�S�CONTRACTC)KS'�CIqRATION P � OU7LE75 � � �4r 1�e eby off rm fhaf I am licensed nder prov 5ion5 of Chp ter 9 GAS SYSTEM C' DISTRICi NO. RO[ESSED BY ai�N�commenc ng w th Section 7000)of Div s on 3 of the Business OUTLETS OVER �.� '6nd P o�Fessio�ns Code and my 6cense is in full forte bnd effed 5 aER SVSTEM ��' �x .;e s� , ,�...w. .... . . � ..,, _. �. (1 C; �.. license Numbe f'^'���`+� Lc Class L ���«'�' DA7E� y �..� �� VALIDATION . � / Conlractor ��� I��f3��� Date - FINAL , � ., ❑ I c m exempi unde Sec 0 � ���.t!. s`�°�rf �, w�`-��ei+r- �a.� � �..s . ta B 86 C fo this reason �'�,.,Y.����������� ���v„�,������� �"`t * � Plan.check fee a, Dare � � �x.��' �" 5 gnaW e�� � � � � PLUMBING PERMIi ISSUING�FEE�$� � �� b � ,n�,� - Y'Y�'� -g Yr+d��� �mx�a'��w� �;r��i^l��sh....�, .y�'s ,... TOTAL fEE . N$.�,?�'�R st�-x�'�r�.�,v i.������ ���� .�, ._ . ..... �,a�� W � � '��'�'"�' r„�%-�,� y �S NGLE FANiILY� ` ':�� k " '�-: Plan chetk applimnt - �`-`"` HOME OWNER-BUILDER DECL,4RATION � Name � �.�z x.�e'� . . . � I�ereby affirm ihat I om exempt from ihe Contractor's�icense F� Low fo rhe following reason(Section 7031.5, 8usiness�nd Address - ��1��0,3 A � �o#'ess ons Code)� ' - --. ., ._:. �g �"� City � � � LJ I ❑s owner of ihe proper}y,will ao the work and rhe � e1-N " � a ° " � „�h {�P ;�,r s9ructure's not„imended or offered far sale(Secton T o ,J�� s��: �,�.�, 7'044 Business and Profess ons Code) � o � '� i 25C 3 :�m�'��a°�+*'� .ia }�rz�',i�, o-�� ..�.:a: ..,..:.,.,, ,.. .>.., v_ ......, .;.;w-.�,._v .t�aT� ., ..;,n�:��,�. ,...„...� k t�,'"'y. , �,�.��_�CT�N�DING�AGENCV �. .. . c W 1 I L i Q� � 'r f�ere�y oftirm ihot rhere is o construUmn lending agency for' � � � the performonce of ihe work fo wh ch th s e m�f is ssued � � ; 8� ����, (Sec 3097 Civ?�C) P .� pr � �i?�,g'�-�:'t��:s,'�:�';�3'�'�.F��.,{iu'���T'.+�'."7��as,.°�.¢?,���'3�.�.+°,�h,'�"'^.�w;e,3". �'.'L'G,s�.'��?;�'�afik'"?""���.�'''i�'*,�1syy`..�,.�"afi�'�`�:'-��'�."t'.,''��.��.`�'".�y�s��.,'�k.Tx��,$�.�.a'�'�"++�`.��.; G k�s.y4 k�•,�t,,.:,.�..}� �'c.,--� . . . a � - . . ., .. .� .f . � �. Len�er s Nv{+o�me � a�.r, rom��sa�+ .� ,v�:.s �+rom�., u'�c a.�sr. > .��, a..+�r :x e .f.p�i.`�'�'�':k�„`.,."�,'����'�a:.�a:.h�.'�',.�v��r.��...;:if 1.7>z?,..�i3,'�.�, ..s.:.`�uaat,&,$�.v�s.x�:.������Yb.�'u�'dY"t NSs6:.a%:.in�:.?:'..�-'�s.t.. ex�«-Lrox.�.2`�..;Ks.�.,wt�3t.rr �.�. ... ..e M,�,��:, ....,...-. . .,.�„. . , . , � �Lende sAddress r,..�....��;��zrm�,a:�*.,w�aae.�w�..�.�»...�mow:<:<:.,v.w,-.z��,...��c=�.�..«..3�,<a...:.o-�.:.�.k�«.�,w..�:.�.�::..s.,.,..�,,.,..�.�,..,....,....,,...:......N,...�m.......,.,.,....�. ,� I ceA fy that I have reod rh s applica+ion ard store thar the 3,,:�obove nformalion is correct.1 ag ee to comply with al�County � .",��> fiaino ces ond State laws regulot ng PIum6 g,and hereby � gLiho ze ap ese tafives of ihis Counry to enfer upon the �,� aboG�me ho�ned p operty for inspection pwposes � � ��s� a - �, -9' - SEE REVERSE FOR EXPLANAtORY(ANGUAGE � �" -r � ;�' }'�'"-`�`•�` . �s "� , .�{.��, _ . �? gnature,;pf PefmittEe Date .., . «,...<..�, . ....,..�, ...e..�........,.,. w.... . . ........�.�,.�................... . ._� _w......,.......,.,.,.....,_. ......_..-«..,.......»..»....._... �f s ' j , �'"u=n"�,i,i,��.�dr�,.ax,k.:i;�. .T_.',s.:a.f�.. ..�.,, ... . - ,..� �f ,s:.�� .» _E.._.r, .�,_�,_. .__ .,,. . ...,. �. ._... . ......... ..: .. . ., ,��.s.._r, r `�.' � ' '` � ..._�.:.. .. . .: . .-, . .. ,.., . . -,.�..���...� uV+ ��,�'fs '#'�vxH , , �<ia!yFe..-..'.�.z �'r:. .�.r .,.�.: ......', :.... .� . ' .:r. ....++mm. v..� - Y.. a'� ,, . __ , ,, . .,. ,... �:; � a r � � - �l �s F e�'�v �¢ � b.�.- 'L q� 'a+$�` < n. F+a�d, ��� � "� ro . . .: � ..:" '� '.. '} .i�.; � ,,'' . �� � �' � � � • � -�1NSPEC?CSRSNOTE5 ` � � � �'' OWNERBUILL� R�DECLARAT�ON .:.g DA7E" �INSPE.�,`'R551�NAYURE - . . .. - ,�.- ��� �. .. . .. .. �. �UNDER WORK � r �B„� � here6y affirm f'� 1 c'n sxemp rom ihc Cont ocfor's �icense Lc�v *or 'b, follo•,ving �a on (Sactior .'031.5. ROUGH PtUA48ING ` J � 8usiness and Frofessions Codej:�ny city or cour.ty which GASPIPiNG .. ,.. � .���.,�.... .�.,.-,�,�-. ��..- � .•��:, ;.�:;��::_.,:� requlresapermitTpconsfrucf,a�ie:,improve,demolish, ' '�- or rOpalr ony slruct�re, prlor�o ifs�ssuonce, viso ra- � �� Ga5 VENT . . .. . . � � .;� � quiros tha app!i<ant for surh permif so fife a st�ned smsa- . . _... � .. ,. . . ... .. . .�.:��.� . . :�:�-� HOT WA7ER HE4TER � � � . menT ihat he is(lcansed pursuant to fhe arowsions o`;he � � . .� .. ,. ..,...,.... .. . . . . . 7iUMBING FI:'fURES �� f . .� „� ..... .. .. ... ...�..,�.-.,;-. ...-.�...�. Cont�actor's Licens�i Lav✓(Cho�Per 9(comm�ncing v,�ltr, ...... . .. ........ .. .. .. . . . .�,. " Ga5?EST � Settion 7000)of Division 3 cf the B�siness and Prolas� '— - �""���^"" �,�. ....„ ,.�: .�.��� -sioos Coda)or rhaf he is exemp#therefrvm ond+be�asis ' UiIL'?YtO.NOTIFiED - � �� � � � � "� � � . . . . ..., . . . . . . z . A • ' .. for the alleged e emption ny vioiai�o� of Se�fion . . .. .. �n -- . . , . .. ..,.. . ,.....,,_.,..,. . . .......:.... ... . . .. ... ...., ..�: �..�.: �.70.37.5 by any applicant far a permit sub�eci.�tha cPp i- . FINAL (��.(e�an ��'unf .. canf to a civfl penoffy of not more than fivs hundred .. .. . ..,. . ,,:. � .:�, �. . . . . ..... .. ..,, :- ... .....: ... ... . .._ ,.dollars(SSCO).. " � � ' . - � ��!,as owner o`iha property will dc the work,cnd . . .' ....:..�. _.�:3,.a,,... . _ .�.;,.,.;.,._... . . . . , . . ._ .. MDUSTRIAL � �����` - , .. .._�........ :,._-„: .,..,:.>:-- �%� � �:::,...: �the sfiucture is not iniended or offered for wle,, WASTE APPROVAL (Sec.i044,Suslness and Professiorts Code: The Contrac- - ' ' .. � . .. . ., � . .., . :,,,if f - . . -.e, �..-n� -.�::::•.�����--. - .-�:�r tor's License Cdw does nof a ply Vo an owner o �roperty P , /;1//�J�J� uN�e/,r9s'G�� �p�i� — _ wfio bullds or improves�}hereor. ❑nd wha does such %� �� • - -- work hlmself rovided ihaP sucB Improvemenis are nci � -p�� (�,f��� �7"/,f,�QOD� � �nfended or of ered lor sate.If,howevor-the bulMing or , � ..- . .. ..a.::: �.: ;:��';, .;. . • .. ._ ., .. - .,r�..� .;�:.�+ . ...: .... ��::..:`improvemertt is sold w'rthin one year ob comple3ion,the � �F� r , ?�L ., . t �:,,: -.�owner-buifder wdl have ihe burden of proving ifiat Fe Cid .. . ..; ., ,. .. . .: ."- � , .,: � � � �' �" � � __ . . . .. ., ._:._,. . .. � .. .. � . �� ' .�,��... -.-r.��'•-� .:�:inot build or lmprade for tfie�purpase of sa!e.j . . , . . :,.�, ,., �y�. �, ' � � � _ .•.,_ �_.... . ��, ..���', .. ,, .. . .- .. .. ,.. .. . � � � . -.'��s.�' , �I am exempt,under Sec.� ,. , � � �,...::.� . . ' .�, , . .,, ..;.�.:, . .;, . ., . . -- ._. _ .. '.,„ . ' ` �� ..... . ' , _ . : . . . ': -, :' .. B&P C.for this reason ., _ .. . : .� . ,• - .. � ._ ..,;.: .. r; - . .... , .: ; , �.. . . � .. . . "t ...!.;t ��''.+ � .�' ..�.>-: . . � �Date � — ,. .7_r., i: l' .. ;,. �w � �fs . ,.e - Own�r , ._, , � . : . ., . . � .. . . . , :,: FY - .. .,. ,.r ..-.�.. . .'. ...''. . , �,: . .� .. .. .' . : '.,: . .., . .' �' . - ..'s ... . .,.,. . •.,.. . .: .� . . '.. .. ,. ....:�.... -. .._ .:.�. , . ...�. '.. .. �. . . -.�: . ,. . .,; �. . ...�:�,.....� . .. . . ., .:� �...., r -.:� .� �. .- , . � •� � ���. . . �. .. . . , , . . . , ._, .. ,. ' " .. ..... ... „ . ,: . . , .. .. � . �' "' }'::- .. _.. .v�.n-. Tw�W�'-� - . ,y, ...� �.�.,,.� .x'..... :, ?';':1NSPECTtlR'S NOfiEB , ,. ... .....:,. ... ,n... ..._....�.., ;".`:a.+- �• " a 1 - .:.:: 1. f� 'Y 5 . .' . . . , .. . . . . ':.. . ., , '; . .., ', -....' ::�� . .. . 5'.�:�. '. . . . . . �. -: �:� G i .: i �.-. . ii' - ." 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