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HomeMy WebLinkAbout1230A (6) _ _ ' '"°RK��•�o���,t�o"oE""�„T�a"` APPLI�ATIQN FOR PLUMBING PERMIT _ �� I fiere6y offirm that I�have`a tertificale of consent to self lyqbp7A - .- .. . , . . . � �. � ins�re,or a certifkmFe of WorRers'Compensation InsuronCe, �. CE 8tJ iREV.10/8!}��-�� -� �� � . ��-� . -. - � ' or a terhfied copy tbereof($ec.3600,�ab.c.a ` �p�}�yFY OF tOS A(�tGELES BUlLDI�NG AND SAFETY � ��y�ua.���,y �/��.�11.�rd/f- . . � �� �fieti topy is hereby furnisFred. . . '. . . . . . . . . . fQR APPUCANT-TQ FIL1 IN(PR4MF OR TYPE) . � -� BUItDING (,f.� /!} ff G GG/� ` . . �. ��Certified copy is fifedwitb the�caunfy buiiding inspec-� � � � _ _ ADDRE55- � <.� �fi4P departmeN. ' . -. NUM6ER �. .PiltTURE OR ITEM � �.- S �.� � � - . . . ... . c p /� �,/ LOCAt17'Y �- � . �. Date�J 6.S j�li4ant G-'���/�` -� WRTER ClOSEt - �. . ��� '"'�"r -�. :. . . . ^ NEARE$T , ceetrF�caie oF�rrow Faonn worucERs 's sarH n,s � .- caoss sF.� L 1J,! E�t/ eor�e�€�sArior��.wruwce sHow€R owr�a _ (tfiis�.«�iaa waa�ioe 4o cq�wpla+.a ii.uw wwk Imealr.e bY. . .. .. .-. .:.... .. , -.-�_. !ht pYrmit is ECr onY hundrYd�dollncs(;lGO}O[IYu.} LAVATC?RY MAit .--. aoor�Ss �. - _ t certify that irt the perfcumanca af�the-wwk#w.which ehia�� . ,._� . .. - . � . � permifi is iswed,I shvlf nW emplay trny persnn inany manner�� ��� ��K� . . - -�-�� `� � - � CRY�' .����-- � .. T�y:Np. �. . . . � go as to becoma svblect to tha Workars'�Compensakion Laws. � : DiSHw/�SHER � - ' � - � �� .. . ..-�j (''��y� �1 ���/. .. ..�-� C6NtRACfOR - . . " Qale,.,,,G�L:.��J nppliwnt f` ��/��� � CIOtNE5WR5F+ER �� ,rR . - - . . AD�R€55 � ' . - f'`� iGE�FO APPCtCRNT: lf.�nfter ma4ing ihis Certifimte of - � - ( iptian. ya� chould become wbject ta fhe�1Norkers' -� 5wiNVutFhM.POOtRECEPTOR � Campensatiurt provisions 4f tFie la6r�r Cnde,Y�must tarth• . - � �- C�` -. TEt t,��� . � with com 1 with�svch ori;it+ns ar t�€i� - ����KIER SYSTEM �- _ - P Y - ..Pr _ R�mif�h4�F 6C „ _ . . -� deemed revaked.-.: .._ :-- . � -: - . . -- � -.- , _. . .. �`� :' r�l ' -_ _ - . WA1ER IiEASER . . � �:, .` ^�_.LKENSf Nfl:�. -.� � .:_. C 5$ �. .-. .. � �� _��CQN�A:CT��S..�Fi_�x.�RT�.RZ�..._� . _ _ ..... . _ ._ .. . .. _ , ._� _. _-.-. . ... ,� .:�I,RRpC'[ -:.t _ -�., ,.�fRQCESSFQ'BY_, :��- ��. - � � � -=t-t�t'g6Yt�Ifiu�d��_CGc� . �_ ._ � �,_� �-.�� � -_ �. ��,-�.m�.��.! �� (commencMg wttb Secewn 7pOpj of 6iu�sion 3 of the Business �p��g� -- �arxkPetsfestionsCade w+ctfirtyt�censa+surlu(t9osceani#ei€eet � -�S�RS'�SFEt� �- -- - = -��_ _ -- ��- ... .. _.,. , �.: . . '-- ., __ .. .: _._ :';,_.. . .._ r . .... :. F}NAk, . . j /��_ . .. .=i _. . . �. � { ,��r .:� ..`C - " �� ,� iF EtQATIQN _ � '� Licensa Number��L���� kic.GIQss� �ATE�1 . :y ;v� - ' ' :_$U._f _ . . _. r . - ' -- _ - , r - - -`-..��#� ` - -�'�/� .�._ �....�-�^'''" __ �� --- - --- -_ � __ __.__ -- _ _ - - -' _ �. � � � �� e�e- 1 ; .:...-�Cantroctar/"�����7 . ,Date� ��„",s-' -'- - - � @Y�.._ .;. .,_, _ . . .�: .�::Q .i o � _ � ; I am ezempt"�nderSec � � B.&P.0 far th�s reoson - . . .- - �� - _ _ _, ��t]t1L�,leGfcfB�'•'-= - - - - =- .Z -� �-. � �''-�`��-���� , � .�-���i9I�'FERAM1#��.StHPKi FfE$:�- - - - _-.-� : _... t.E1 �� .: � . , : � _,:. - , . , n . _..�:_ tlJ . . ��� - . ' � _ ._ __.. _: ... ,. , _. . ..-..._ . ,.. :.i .,,., _-.. . ._...>.._..�... �- _. .. .»...<....,. a . . .._ 3f31r3E,EEE.....,_._.__ � ..._ .._...» .._ . ,:_._ ..,_ '. _ _ ..:_ .,._..�._W ! � .. , .... Ptan check oppticant. � . .. .. ' -- . � ` -'c I L�.-l�F� . , s�rac�Faan«r ` _ �. . .5 . � � , HOAM1E QNtNER-SUILBE&DECtARAiKXv .. Name � - . - . .. .... .. . .. � • . " �y aff�rm that I am exempe from the Caniractar's ticerus - �p �e ���,�� �:� . .�. kddress:<. .._ .�:.. �.-_ ..:� . ��_..:. ._.F.� .:,- ,_�,.�.y.. .....,��.u,.�.u� -" for.the foltowiFlg oeason($ectiow 7031.5,Susifless and " �"°� - _ '' ��� "'� �..��'�`�� Profeuio�Code}:�. - Giiy - Tel.Na. � •�a 1 El Ci:i:f�xx, �..: � _�.. ' _'-` �.::: .�__ ..._. .. , . :.. _. .. - . ..�,._.�_ ....� :.1,as awner of tbe property,will dv the wor�pnd the , � � �� structvre is�noY in�eoded or offered for sule,(Sectinn � � _ � � _ �'],Q 9-.fi 5 , . . 7644.Busineu and Professlons Code}. '. . _. . . . . .- . � . .- CONSTRUCFION FENDtNG AGENCY -- . .,. . . . � . . � . . --- -.��.J ' � 1 hereby affirm ifwtihere is n consiructiart lending pgertcy for � -����� -� - . --- - -� , - - --.� . � tF�e perfarmance o�the�work for.which this permit is issued -_ . . . . ' . - - � .. � - ._ . �._ �_ � � � � (Sec.305r7.Civ.C}. : _ _ � lender's Name .. ... . . . ..- - _ - . .. .����� . � . . � . . .. . �. . _ .. �. . . � �. --� tender s Address� _ . . - . . .. �. . ...-.. . ..-__ __. . ... _ _. - . __�.' . .� . . _. ... ._. . .. ... _ _ .. i�certify tha(f huve read this.oppt�m�ion and stata thai the - .. . . . .. . ...� . � . :� . above information is corred.1 ogree to comply with al!Counfy - � - - - ,' � - .� _ _-. -- ordinances qnd Stote laws regulating Pl�mbing,pnd hereby. �� - - aolhorize.representatives of Ihis Caany-to enter upon the�� --� --� �.� - ' -'.�- -� - � � � -� �� �-- " ---' obove-mentioned pro forinspecKon purposes: � - �� - �� � : - � . � � I - .� SEE REYERSE POR EXPLANATORY LANGUAGE ! - �� ��� - ag ure of Fermitfee � Da�e � � -. - � � �� � - - . . : .. .� . � . - --- ---_ _ __ --------� . _ _ __ _.... � . �� . .. . .. N�+1�-G N � N.0 � C .�17 � S•V '�"O �Q.m'O , . , . . ; . h � � . 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