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HomeMy WebLinkAbout1222A , _ 4.o - -WORKERS<<a;,,,PENs,,T�oK o��,R,,T,� � � -�APPEICAT[ON�FOR PLUMBING PERMIT � - I hereby affirm that! Fwve n certificate�of conaeitf fo se4f- ���7A. - . . � ��� insure,or a certifimte Qf Workers Compensatiaa Insurance, .� CE&i7(RHt:tUi81) � �.- . - � �c t�f copy rhar�of�(�c 38tto�,taib.C.} COUNTj(OFi:OS/1NGELES BUILDINGANDSAFETY � yp '� Po(_Y.. �Co pany ��K+Iito .- . . _ �rC_ .[ �'� .*__ Cerrlfisd c y , `�pU Z oRY is hereb f�rrnished.- - BLLttDiNG._-�/ .�y _.. a ..y. . . KIR.4FFit�AN7 TtYFik 4F7(FRl�FC3ft�F :-. �Certef�ed copy'ts filed with the tounly bvild[rtg�i�npec- . � ..._ - ..AQCfRES4 �^t d* . -Jron dspnrlmenl. -. .�.. - NUtde€R�� .-. - FlaR[tRE c�tttEa4` -.� � .:. � . '� .�Q"� �jy��- � -. ` .�. LC�CRUTY -: . . --..'. lkate���Appli4art1=�1��. �. .. WATE12-Q65ET �. - �. /� �� , - � . . __... _..__ .._ .�._,. _. _._..__ __:. _, _.�.__.. _ _„_,....,.__.-,_ .. .. _.___ ,. _._ __ _"'__.. __�.._ N€AR�F.,� ....,�... 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BY � E f+erab}e.9ffk�-tkt�t i arts-4�tensed un¢¢rP�aY�SiQ+aS 4€£kwpier 4 _ . -.-.-.- GA.45YSSfM '�_--OUilETS� - �.:[.. •-�-. . ... f�y . _ (wror+�r�ir�q w[th Section 7006j of U+viswn 3 of the-8uu�ress QUTlETSOVER - - -=.�sr . -. . �C•! - -.. orrc[Professipos Cede�a�my kFcenae rs en full fcrrceand effect. � 5 PER 5't5�k � . . � 3- ���tAt Vlll D/lTfOt�t a' � _� . t�} �y .:�_ �`�� ( . . .... :.... . .. - .. t3ATf t.s,=;� ,.n.._ . . . u � . lfce�ie-Number�F f�Dq lic.Ctass� . . . .. . .. -,'.� : -r � FtNAl � . � � __,._._ � _ . . . LY Conmscttnscto Dafe� �� � - - BY ' -. � � ' CS ❑-�I-am exemptvadei � � � .._ ' _ - � . . ... . e- _ _„ ._. _ _ . . . � � ._ -`--- --- -- -- -- __ �. .` . . _ _'`_ -- --- -..._ fl.BF.G Eor�hcs�eoso� Plan cheek fee � 2 � .- � - €?are: .. PCUMBtNG-P€RMR ISSUENG F€€$- �� .�� . . . .� . . . " - Signoture . � . - �.. . - � ,:.- _ .. � . - . . . � T4SAtFfE . . ��.!"r'3 . _ - . . . �1 Cc.LA � e . E � - . . � . .. ' � Pfan check applicont� . .. . . - .. . . . . {'�o s�s s r J� - � � � �� SINGlE FAMltX � � � HOAhE OWNER BU1lDER DECL.4R6,T14N _ _ Nams _ _ - � �a 4 J � I� 6y�affirm thnf I am exempf kom 1he Contractoi slicense �� - ....i- -:. ..F._ ... - .: IYddc°cs z.:._., -,_:.._ -�. ..._: ..,. ., � = . _ .,.., �����_��1 � � l orthe io4iawing reoson�Setnart 7Q3t 5:B�sineu and` .._.: ...:� . � �. ,.... _,. {, ��U>G --- -- � Professfons Codet: . . : ... CYy - . Tef.No . : � - � � -.�� ❑ �7.0�=�5 � � t,�os ovrneo o#the properF�wt!!do��Fte wak anc#the � ,_- __ -___ __ _.____ :._ i __ _ . . cvCWre--�sfiot-iwte ��� - r e(Sec-Fiofl --- --- ---- ---� ----- - TU44,-Buslnessa�.ProfessionsGode}. -.-- . ._. :- .. ._.. . . .. . _ . - ... ��..�. �.-�� . i :: .'_., -__. . . ... :� - . . . . _ _� . . . . - � . � E C4NSTRUCIt4N 1.EDiDlCLG.AGENGY� ,., . ,...,. r..,,..�.„ ..._,..,�._. _......: ..�... ........... . ._,.... .._. - -.... : therehy:v#37rmtha(thara��cortstrus[caa3end+rigngenc�efai �- �`- =. --- �- -_ - _ _-_ -_ -- -_ .__ i _. the perfnrenance af.�he warl�focaarh�ch ihia permit tsassued- �: .: -. .:_ : -.� . � (Sec.3047.Ltv.C.�:' _ - - ` ` - - - == _ _ . _. . ,_ ,_ _ _ _ _ _ I i - - -- _ _ _ ,_ _ _ � _. ..,. _._. , _ --' -- '-- - , _ • - - _- Lender's-Name �� -. ` . .. . ._ _ ._.__ ... .. . . . _.-- ( . ._ :._ .. -. , . ._ . . _ ._ . . ` lender'sAddress -. __ �_, .:, .'- -- - - -�- - � -- �- � -. -- ___ _. . .. - i certify 6F�W t hnve reoct lhis appf�catwrz�d siate tF�acthe � - � - � � above inf�matcan ist�recL k agrsala�anth-ai€�nuoiy _ _ ...,_ . .- . _ .- -- - __ . .. � ord�nances c+r�Srate}aws�egulnling Plumhing end hare6i' :. 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