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0758A
� . WORKERS'COMPENSAFION DECLARATtQN - �pp���qTa��:�FC�P.�PlU1VtBING PE�NIIT - � '�f�t t hereby affirm tbat 1 have a certificate of consent to se4f ��bp;bplq� � - - � .t1 � - insure,ac b cerf'rficote of Workers`Compe�sation Insuronce, ,�817 jREV.10/81) . � - : _ � . . . t t i or a cert�#iec€copy ihereot(Scc.3600,lob.C} CC}LlNTY OPlQS ANGELES BU!!.Q{NG ANp SAFE?Y �y � p�o1'rey Na � � Campany . . . , . ... - . . -� . . - . - _ . ._ ._ . .. . _. . - � .. � Certifiad copy is hereby furnished. - ` . � . . � - FQR APPLICRM TO FlLL!N(PRINT OR TYPEF BU0.QING. . . .Certified copy fs f,4ed with the coaNy buiid�ng inspec- A�� . tipn deppetment.- � �Nt1MBER_ .. FIXTURE OR iTFM � F€E _ . .�. pafe �`- '� �A licaat. . "f��'� WATERCl65Ei . . . � LOCALITY . . . .. a . . PP . . NEAREST . . - .. - . EERFFFIGATE Of-EX€MPT10N-FRQM�W(3RKER5'... '�r.+'�'BATN Ne � � � .` CROSS 57. ~ . - COMPENSAFICJNtNSURANCE �H�R OWNER � � - .� �, _ - .(This section e�wd nat 6e-compbtad�tha worlc tnvoivod bp - -� . wwlL. � . . ' th�permit Ia far wre hundnd dalfan(5100}or 4ow.} uvnr�r -- nawzess � :t certety thot en the perfwmance af ihe work for which this - � . . . -. : . . --- - �permit is iswBd,k shall nat empfoy any person in any manner � SINK . � . . , � CfTY-.. � 7E�Np_ � . . . _ �so as ta become wbject:ta ihe-Workers`Gampensation Laws. . 1� DISttWASHER � � ��NTRARQR � . � - . � . . . . � . - . � _.. . f Date nTPfit€tnt CtOTtiESW.eSHE& ---- - .- � � . . t TtCE'i45 APPI:tCANT If c�#ieE mstktnglfi��etltficnis 4f -_ : _ � P;DORE55 _ _ I . � �, -- � " SWtMruun{Gg3o[aEe�i4� '..�- - --- .__ __ " -' �_.: :.-s - . .n�tion, �cw-sFiouEd�i�e subje��--�-"tfie-SFl�ufi�s �Com �sation ravrsions of ih� .. ..LtTY . . . .-_.iFt.N6. - � t pe $ e lnbarEade,you m45tlorth- � LAWNSPRINKIERSYSTEM � - � . wiFh campL�.wi�h such prawisiens ar this permit shafl be � y7p7E ��,�c� �� . deemed fevoked. - � _ , . WATER VfEASER � � - LICEN5E NO. �tJ � --� UCENSED CONTRACTC3RS DECkARAFk�N � � DISSCRICFNO. � vrsUGESSEp.gY � --- .� GAS 51'STEM QUTkETSr. . � _.._ � - 1�hereby c3ffirm�[hat#am bcensed urrder proyisians pf Chnpter 9. . ^ • . . . . - .. - � � � (mmmertcing with Sect'ran 7W0)of Orvisron 3 of tEre Bus�ness . OUitET�OVE2 - - . � - andProfessiar+sCode,andmy.k[censai�iaful(fQ�c�pr=d�#fect. .- . SVERSYSiEM � � - - .,.- ' . .. .. > �y( �, �,�,� H�ta� ,-.i4 V1ML[DA�ION � Licerise Number""� lit.Ctass� . .. . �� �-���L� `�'' � � V � � .... . _ . . . ' -. . . � , . . . ... ' -� FIN . . . . . , .�� � - CQntrucfor � [?ate ���� - . � BY � =. . - - . � � ��::.�. ❑ t am exempt ursder5ec. -- - - . . . . . . ��.�.._ . . . . . .. ..- u�t 7 - �6.8P_C.'fw this reason ..- . .. � � . . . . . . . . . a z � � Ptan check fes � _Z . � [torer � - - � � } ..- . . . � - PLE1hM19WG PERMtT ISSUIFtG(£E E .. � �ja � . . .. . -- . . � . � - Signafur - - _ � TQFAE FEE ._� � __ _ _ - � _.i _ �U7a8A �. ...- . _ .,... � � Plan check applicanf� - � . . . � . .. �� . .. . . .. � � ' I .. . � SINGlE€AMEEY - .. .. . . � . . . � #s ► s . .�j .�4 - H4ME.01NME��C111QE3DfCLARAT14t� ._. .. Name .. ._._ . � � . � _v .-_" —� "_ �it3� ._ __ F � ebyaffic�++tfuir#nmaxeinpth€zmn3heCanfxc+ctuE`iticense. -' . . �.�- _. � e a. - - '- — -- - --- --- -- - -- . luw for.ihe fclFowirrg reeson-j§ecnon 703t..�.Husirtess and Addres¢ .- . �--�— -. . . _. _ - ,r g e�aaCEJ�iV ¢ - Professions Code�r � _ � City � ..-� Tel.No. � . -� . - ❑ l,-ad owner of the�property,witi do the-work and the � : . . . - .�.. . . .. .- -- .- � . . .. . . Q�� �-�.�j . - ". strutrore is not intended or offe�ed for snie (Sedion .. . . . ... - � -. � . . .�� . . 7U44,Bvsiiress 4nd FrcrfEssioas Eode}. - . � -. � . - .. - . _ .. . . . -- . . . . - . •_ ' �CONSTRUC7K3FI CENDtNG RGENCi'- _ ..- . ._ . . _ . - _ . . - .._ . _. � � . . - I here6y aHirm that tF�ere is o consirudion Iending agenty far - - � - . . .. . � - . . . - - - - � . � the performpnce of the work�for which this permit is�ssued - . - � - � �_ _ - .. - . � � � � . _.� (Sec 3047,Civ.C.}. . - . � . . . . . . . . .. _ ' Lentfer's Nnme----. . . . . . . _ .. . - ._ _ ... � ..._ . _ . .. � _ E - .. . . . . . . � lender's Address - - � - � � � � � �� � - � I certify that I have rend this npptication and stote-fhat fhe � � � � � - - . a6ove i�ormation is corrett.k agree to comply with a4I Eoumy _ _ _ - � . . ordinances and Stote laws regulating Plumbing,ond hereby _ , . � �, . - . � � � outhorize representa�ives of ihis CouMy to eMer upon ihe � _ - �� _ - � .- . � _ � aboye-mentioned properiy for inspectivn.purpozea. - � � - � \T. [�(\�\ ( SEE REYERSE FOR EXPLANATOBY LANGUAGE � _ � { �1.��. �i2^t�"�� . . . . � . . . � .. .. . . ... . � - � . Sig a e of'Perminee ` . � pate . .. - . - � � -� . . � - � � � .+^,-,, m-� o�=o v ��c o� +b _ � c •=u a ''� o-� m-o a o ' L in N O(1�- - p.Ny O"' �... . . . . . Ls �, ds;o� o � a � ': +) °�,° �.�n c.n+;ri =��^ c N o m p o,n T"' ys ; m F° ���u>°, ;� o ,n ,n c m � p� ��"'�d.�L O..0 C�p .;� . �.� c 7i 7O Oi D C"0�.. � .. �+� " . ' �G L �� b a„ ��m-� ��� N w����G�G.d p � p.'�^ `��'� ' , U q u i c' ,� o'� y �o�� -"o u p ° �;o �.m a;`' '4r� Z m o o ° ?,',b °'u „.p ° �. o � �'i �► cp�� ��Q. 0� O.fl p { O `N �'.0'_ O L P GO .,x1C }"� E. 01 � N p,,91 N C �� ^ �„ _YS . . . . r1 p p �— w,+ � �y , Q Q,_ o`� � O a�-�p,L .�.. � - cn o ��,. � . . . 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