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HomeMy WebLinkAbout1210A (6) _ _ _ _ _ _ _ _ _ __ _. _ _. ...__ _�__ _�_. __. _-,_3s_...- ,��.�o�,�,���,,,,��„�,�,�, .._ __. _, . _APPLTC�ATIO�N=F�Q�FLUM�ING P�RMlT �j !, � here�y afficmYhat I hava_a carhficate a#cansent tc se# -� 76a667A-.. .... ...- ........ .- -- '��, insurg,ar p eertificqie of Workers'Compensation insorpnce, -_ CE g17 FREV tOlBt) . . . � � � .� . or a certified cap�thareof{Sec.3800,Lc�ryC.j n [Q�p}jy Qp-LQS ANGELES � 6 U I L D I N G A N D S A F E T Y �Q / � `.- PokicY hfc� _... LemPanl'_��-! '�" - . vY� .. . -- - . _ _ .. - . . �Io 7I' . l .. . . V �LJ J �-.- �'.4:e�iifiedcnpyishereby.#urwished.- -.- --�_ ... . - BUILWNG � ._ ....�.� _ . � . ..�-. . � � � FQR APPIICANT TO Fltt tM(PRMkl�TYPEI . .�a e . . �:tertified_copy ts f[letl..�ith the.caunry building-inspec- _ , - aoDRESS-���. - � ,� � -fion departmertf. - NUM�R -. � FtXTU2E OR iTEM � �FEE ���� t --y�--t=C�4 _.�■l�,j..j.�._ 'I�i WAT€RCLOSEt - . i Ooie__- . li nni '�f . . � �� �2 r�Ea2Esr � . . ' e€RnFrcar���x�nnFrioN r�aoan waaKEas ''�/ gAFk Tua l2_ -- caoss s,. �Vt A �-G i'y �- - COMPENSATI6N tNSURANC€ �- - . . ��R �. . . �__- - � - (Ttvs a�+im�d�b.oomptar.�.iE.h�weh-rm!alred by srrowEa . . . . � . . N�gQrmt+b far aK lwndr.d dotio�s(iiea}or Iws j � v.vaTOQv t --- aRess '��tJ ' 1 cedify lhat in-t6e performance of Yhe�wark farwtuch��his-�- - � � --- - - - - � ----- -- -�----------- ---- -----`- --- -- ------ ----- -___. �- p�rmit:�ssss�e3,`Fs�wwl�na�emptoyanypei�sanir�any=manner 5�--- . - � � C�tt. - TEC.NO. � - � ;: sa as fo 6esame sub�ect to the Ydarkers`Campensation Lows. �_ DISFtWASHER -�� � � , . ... _. j t !�� .. . ��' CQNTRACTOR r.. Date:���� ficant� �S � .. CIQFttES WASHER �� � ADDRF55 11 ��.. � � . .� . �CE TO APPLICANL kf, Qfter�ewking thws Ce�hfitata of - � - -. �- �,a� - � � ...�T prfan, r?�_should 6ecame wb�ecr ra xt�e-�workers• : . 5wraqaatNG rooE RECEvra2 :-, , < - „ .... ._. .� - - '_ . . ..,. ,. -; ;,'.`�;:- . . � --fiFt�' — --' - - iEL tR7_-. --- - :,' -L..�pensOtibn��tt6viSt0Yi4"6fiTA2ta6Zir�'Cada,Ya'il�rrt�if7aitFt-`�-_ . tAWNSPRtNKkERSYSFEM - wiih mmply wHh secF+ provisions pr this permit sha)t be S7ATE � fA pC,- ,� -.. CIEBRt6d.IfY6{ted. - - - . .- WA7ER HEAtER . ' - . .�- LICENSE NO.� � V �Eq� . . - . . -CtCE1VSEDCONTRACTORSDEClARATtQN - Q)57FtfCFJJO_ F�EESSE6�Y- 1 heve6y affirm that tam licerssed vrxferprowsiors nf CF�pter4. � ,... GASSrs"FEA�t -�. WN.ETS �� . . ./� -- _ - . .. . � (commenc€ng-wieh Section 7000J of t}ivisiarf 3 of the 8usir+ess -� 6UTtET56VER - �� .. . . .. �ar - � and Prafessions C�e.c:nd mY Eicer�se is m fulf force arid e r. . - 5 PER SYST€nn - . - .. .- � . .� �, �4�R� va kria+� � . .. ;=��� ,... � . __.._ . _ .._ DATE +;-� t:��r*- �.. � -�I. Eicense M1tumber-- tic Ctass - . . . � ,.-.-'� ��---::�,;> � V .: :� � . . .... 'y C' � - . . - - � RNAL �..� � � , � � � �I � Conhqctnc . . . < _ _pate�i ;J:-'-_� ._ _�_ _.._ .._- - � �.. �f -�--..".'�?'--.xc=-�^, . -._ -- . .� � � - . Q i . __..__. ---- --- ----- --- --_. -____ . „ U i : . � I-flni exempt vmfer Sec. - . ._ � . . .. . ..� � B.BP:E_for this reoson � . - � . . -. . . . � v�f. � f an checkfee � � := < tzar�.' � ':- .. �- � � . . �. -P€UMBfNG PERMtF#SSUlNG FEE 5 C�_ . . � � -: � . .. . � ,- Signature - . .. � . � :- . . ... _ . . . . . .. � tOTAL FE€ . . � . . . - . z� �S.G A "-- � - :" . .. . � � �� i.� . •�yc.. . . _ . - Plan check appticant -::. . � .. � . � � . -�� .._ � s�n�G�e�a,miEv f • •�2 5 Q � - HOME-OWNER•BUItDER DECIARATIOt�I_ Name i �6y aN�rm thaf,t om e:empt kom the Corrhactar's license � ,.,�a�,3,� .�'��y... ' �� .w�ihs fc4iowieig-rwsorf�;{s��+an_JQ3i.3 6�ssiness end -,:.Ac�a�,:,., .�k.�=. ..�.:; .� �-�._ ...,.,�.� �.�..��.. .. �:- _ _,. g�..,._� . -.� �.�� .�- . - -- - - -_. . _. _ _ � �Professiorn Code): . . . . . Ciry � . Tet.No. . - - . � .. -Q 7,�1 C^�,�- i ,' Q- I,as owncr of-the-prape[ty,-witi da She work and the . � . . . . . ��� �. ..- � � . ; {� - shucture is not iniended oroHered for sale(Section � - , � - ' - . . . .. i f�r ��T444�Basiness�arid Srafessions�eodej.-..___ .. . . . .. .. " " � . � i �, .�- C4hI5TRllCTldhf LEN6IlVG AGENCY �. . -. _ . . . . . __ - , . . . � .: ; t hereby t3ff'xm�.}hW:lf�ese iaa consirucFiort-fertdiag agency far..:. f �� the pe�fvimailce ot the avork�fav wf�ich th�s permit is issoet!� . .. . . - . . - �. .. . .-_ . . � .. .:... .� �' : (Sec.3047,Civ:�C�}.. . , . _ _ . . . . . . . , .. - . ..--_ . . ..._ _ . � _ � � . . . . . . . . .. � ... . � - Lender'a-Nome.. ..,.. . _....._._ .. - . � . . . . . . - � . � � � � � -... - � ; tender'�Asf�ns:-=- -_-�.__ _ ___--- ---_. ..._ .. . � - . . . . . .. _ - - !, ' F cMtify that{have read ihis applicatian and staf�ihal ihe - � - . - . � ._ - .��. . .. �- i � above�infwmat4on ia correct.1 agree Io comply with oft-Coanfy . � - _ . . . . ,, ordiric�nces orad Surt�laws:Feguiafirg Ptumbing,and�.hereby�� _ . ! � -avthn�ize reprP��n*••��Kezof_Ehis Goun#y.Ja enteK�pon+he--� _ abav meM+oiied-{tr for�-inspeciio��PwPoses.�... . . � .' � SEE REVERSE fdR EXPLANATORY LANGUAGE ° u ��S^� _ i 'g .ure of Verminee _._ . . --� - Qate-_-.. . _..-. . . . - : � . . . . . . - � . r'��...._ . . . . . . . r O O.�c� - _. � . ,. . � c . �n t c a m�� �' °n.° o ,°a vi y c �,°s � � p ; � `O ^ ,L �n � O 1i � O C X � y ��O O wp , . �M �� O M in O p>p�, �1 N d S O �.' �].p �j m� . 6�.�>,m p� � C 't + m . � � m�a C�p.�^ . . - . c � [v c o c cv � � > « o�� � D m,t E c m _. 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