Loading...
HomeMy WebLinkAbout1206A . _ _ s4 �- - WORKERS'COMPENSATION�pEGLARATION . . . . . _-��Pl��Fi�tOrV�FQii-�LU���i�G-/���CIYIrT� . � � ..�-� - t hpreby affirm that f-tmve o certifitote of�mnsent ta seR��� �bq667A - . . . . - . . . - . , . insurB,�4r p Gerry'ficotG.pf Workers'.Compensation Insurance, � CE 8U(REv.10/81) � -. . - . - . _ � � or a cerkified copy thereof(Sec. Lob.C.) � - - � � � . � r � COUNTY OF LOS hPIGEtES BUILDING AND SAFETY ��� ; PQaltcy tJo. -. �mp�,y . - . ,_ . . ` :Cerhfeed copy u k�aiehyfurwtaf�ed.=- - --. .-__._ . .. _. - - - - roa aere+cnw{�o�+�t iw{aRiw�oz�aey :_ aw�ntr�c. _— � -- __-_._. .. �Gerrified cepy ts�tetact vstth ehe ronmy burtdtng-7nspec- -. NUAnaER�:. ....FlS�iuRF oQ ireas -.. noU2ess - ;{: Oa -.. . . tian departmenL _. _ _ . - � � tOCALCN� . . . . - �-�te •�Appli4ant � . y�-_ WATER QfJ5E7 - - � � NEAREST '�'-'*��-. � �. . . � � ��� - .-.--.CER77FIGAtE.4E.EXEMP�t4I�FRQhh wr�arcac�. .. __.. �,'_ eair�.N6._ -._... -.__. .... �._. L� .�—. CROS5 ST. .7 _-.-, .. ,... -----COMPENSATt6N}NSURANCE -�:.. . . .- . � . . :� I QWNER- �- � j . (T1lifEAEtIORFiwh{-7�'LatCRIpIYhd�fluwrrk-�ernlvadll�.� - SH6WER_ . .. . .- .. _ . . . . . . ...� .. the pQrrat3 i■far�_cns kwdr_a.d dolloes j�100J er�eft;� - �4ynTORv � � y uwLL. � : .____ ._ ___ �- -� . . F� �� ADDRESS -.� 'Q�,(f . ' 1 certi{y thot in tFse perfaem€�e of th�work#ar wfiicF tAis . . . .. . . . � . . � . -_ _ __- _ SfNK . .�- C17Y ♦� . permiF-is issuei3 t sksctfi-not emptoy wty�person�'rn-arrysnar�rter � �f/jr_� �� .� -TEI:NQ.�. . . . so as to become subject to the Workers°Campensption Laws. �DiSHWASFI€R � � - - � ["��7"�Q� � � ..� �. . � t� CQNTRP.CTOR �'�.� . . . - patn nr���,���.1'j - CtOTNES WASHER � - N �� 'E TO APPCICRNE: if,-afte€makuEg�tltis CerFifi€ate af - .. . - AD4RE55 .. _ ' - E� Hon, yeu--sheuld-besai€+e s�t te't�--SAEo�kars` ..: , :-- 51MtA�M�.AE)L3E BEG�REpR ,�_ . � . '<:.� .�.--- . .--.' . .. _ - � .' . ,-:.�. - ;;..-:.� � Compenwiiort pravisions o€Ehe.€alaor Cada,yov must farth- - ��n � � TF����� . Ul'A'KSPRINKIERSYSfFM � - . . ,. with comply with such provisions ctr this permif shul! be. - . STAT€ � . ��5$ . tr deemed revoked. � � � WATER HFATER ,� ftCEKSE M1tC3. � . . i�c�vsEo carne,acroas�cua.�ria� o,s��cr n�� +�sss�ar F hereb aff�m.lha�k am fEcensec#cmder � . :. -. GnS SYSi€Aa ���.�LXIrLEFs.-� �-. .... � � �_ _ - � - Y provisio[rs of�}ippker 4 - . . (commencing wFth��fion 7G06j oF Qivision 3 of the Buseness � �t�fEEFs pyEg . -. . � . . � . and Profe�sfnns CQde.a�d my_.license�lrtfsdt fnrceaadeffect . . 5 PER SY�IEM - . . FfNAL �-. ._. _ ... - �� � .Cicense�Number �. _ +a-: -tic�Cfass'_�...W...... � .� _�, ..:_,__. ..:._ _._. � .., AAif 1;i: q !""'' . . . _ ... . .� u--.� HAt1Q It3N � � „'��� � . . HNAt r- " . .. � � -� Centcador - Dato . - 8Y +; .. - . .. v . ❑ I�arti exempa unde€Sec, - � .. � . � - . . . �� . tu B.BA.C.for rhis reason _ PIa[t cEkeck#ee : _ � _ Z � �_ Q �t2Q6fi � � � -� � � PLUM&!NG PERMIT t55UING Fff S - - -- Siqnatur .. .. - .. . - � .. � � _._ . . .. - :�. _T6TAE FEE .. -�. - . . . fF� n. . .� . � " Plan check applimnv ---.� - � SINGtE FAMtLY - I • •�FL rJ(1 , -� HOME QWN€R$Et44t)ER DECLARRFFQN -� Name . .. _--`_ ;.._. . � .. _ r.� -� I� iy affrtm tFwt-I am axempt from the Gort�actaCs ticense .�� :. . ' -- — - -- :_ __ _ = �"-�--�£ ��- . P�essi�w+}er`af fhea�o� �I�do the work and�he .. � CAckfress .- . Te[.No. --� ` �. � '- .� ,�•� ���- � Q'j�Q g,"�J� .��� oiFawA*9 f � �fi" k . - - sKuciuce is not intended o�affered for sole(Seciiori - . . . . .� . . . . . _.� . . . . . � 7d44,Business and Pro€essions Code}. � � - -� -� , . � ' - - � _ - .� ;��-.. � � CONSTRUCiION LEN6�NG AGENGY -.... .. .- - . . . . . .. . - . . .. .. ' � F here6y af€irm ihai there is n caestruction lending agency for� � -� - _ � - _ - - - - � - .. - - �� -_ �� . - i,. the.perforrtwnce of fhe work for which this permit is issued . , - � .__�_. -� . - � � .. � - � �-� � .. (Sec.3047,Ctv.C.}. . . � - . � . - _ . . � . . _ . � . . . . . . . . . . . �Cender`s.Name.. . - , � .. . . .. . . _. . . _ _ - . � , -- _ . � �� _ -., . _ - . - _ . . . - . . � � Lender s A�dress .. . � .. . � - _ ,. . . - . �. �. � . . _ - _ - .. - .� � �- 4 cerlify tha+t.-have read fhis npplkation and state fbat the. ,_ . -. . .� - . - . - -- above.in#orrrwtion is correcL!c�gree to compty wi�h atI CouMy- - � . � -, . - . . - - . . � ordinances and Srore laws regvlating Plombing,and here6y �� . � - . - �� -- . : autharize representatives pf fhis Caunty to enter upon ihe - � � � � . � - - . � �. - - -- . : . � ( , � �� above-menlianed prope for inspection p�rposes. -- - �-� - ' � - . , � :" S�'� tS� SEE REVERSE FOR EXPtANATORY tANGUAGE � . +h .. . . _- ... i ature oi-Fermittee - - Date � . . . �.: ._�- . -�� . . -. . - . . . . . -. . . .. _ � �_ ✓� L m� ' u+ [ ' �t1 "6 A.0 ` m� . . . . .o�L,� m b� 3� .o o�m a a � ? c �,�� r �o �,,o � �o � o-o � a c Y ' o y m � c.�'c �'a . � ^ � IDA G� C � a .'C.. y�L O. O.O ,y'_9 O O . . . . u p,j'O-, ..Ul N 6Ci p c � ,��'„ j ,� m S �� �G"C CL"`-'� , � . � � N � �y O s,°oo �,00 � H £ om� � °~ �rE� o •� n . � -- a .gao � oa.po ,� ae+ 3 � i " o Q E � E =�= m:.-y:o �w "'� °v ° mono .. d.' O p �' w Q t o,m � .> y .r;�U p b Q� o p � . . . U Q.�Q m 04� O L 0i-�•C• C� � •� a O � G E � �•� fy t � . , "' E :.;p "' E � a= Q °fa£ m� 'h2�°�s �,-a ` " A/ L � � X C� � O Q.�.t O E O O p O� �m n� O� O. ., u, � 3p � a� �v.a, x ; o,� Q � ° ,� oc? emw �� � E° ,v, � � a3cma"` o m�'aom� ,°�w= � v ' o a� c � a; �� a � � � � �, w�eh �'U ` 3 >° , 'n' .y � � - ° °u �,� h,., Hm � o- ,:'- amom,Q o � �a m m � ou ca� >-� x„-", ° ° � No `'�° �°` m`,'" u m w: � s=�'�.. ,ti,°�"o ��co 0 m ao �...�y�'" ma E o� �- ° � '� . . � _ . . ., V - � -oba C`'� � 3 m_ 3a s O '� 3ro a a� �o °?� a uo#�o u �J „m � �v � ,.�, o .., i m ,n'O '"L° '�^-O y o m— o • •�- aa. u�iy ;-.� � ��o �.o°��"=u� m` E'oa�i,e? x ti � ,o : "m m a„'.�. a avS�„ ° �[}�t'n."".,°o�� o t � °` Q; � r.` `s � � d�`� roou.QD000 , �� ".e °c �3o a� '�� m o O . v _ _;m � o�a-E t��n „•..� u ro �:,.� 3 3 o e - � � " O , Z � nt O � ', M Z � , , �,� ��I ��� 3j., " 'r,�.�y� . W / a � .;: Z . v�-i � _..,. ` � O �.I.. ' w.,.� .. � � � ' ,� �ry �� w y".,a ._ �.. ' O . r Z ti `.` �� (y ��� . . � '21! v " u � f� . � 0 � , � �0 . . ': . � � �, Z o, < � � '� � ��' LL � z , . � � o � o m , , . � � _ � Z " ° .. 4 g a Z �-" �- Q a ' ' w a � Q Z �n � �Q � � = a 3 m '�-u } . r-+F .. . , � � �n r � Q � -<. Z3 _ . . � � (.�.� � 2� � l� � u- .