Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1217A
w1 /�Qp �J� p� ��/� �� WORKER5 COMPENSATKNJ DECLARATIQN - - :. � � - �P����AT�Q1�1 ��/fZ r LU/Y�B��G r�NYI�T ,.. 1 hereby affirm-lhai"I have a certifimte of consent to self 76qby�p . � . � insure,or u cerfifimte of Workers'Campenwtioo InsuranCe, �E gp(REV.-10/BI) - - . . - � � - � or a certttied copy#hereof(Sec b.C.} CpU[�fTy pp LQS ANGELES BUILQiNG AND SAFETY x` ,� � � P❑oflcy No, . - Company .:(��� � _ . . . . . .� [J� . . �f Certified copy is here6y fumished. .FOR APPLICAtJT TO flLi fN(PRINT OR ttPE)� . BUICDlN6 � : .� �.. .,..., . _ -. . . ��Certifiect copy is 4iked v✓ith the covnry building inspet-- �� - ADDRE55 ��� / - fion de art�neni. - - - NUMBER FIXFUREOR ITEM - �- � - � _--- � � ... IOCAtITY . Dote�Appli�an� . �..-- _ W2.iFq.C105E7.._ . _ l : . . _.. .� . , _ � NEAREST . � -, � �� � � CERTIFPCATE OF EX€MPTlOM FROM WORKERS' �$,/ Bn7H TUB � -`-a„ � crzoss si. _ . � �. - . .GOAhPEN5AT10N ENSURANCE� ..- OwwEa.. - . �. � SHOWER ... . WN . �4Tftfa s�ioa aesd aot ba-ceunpltt�d��Nq-work im ohed hK . �- - ' � -- t6s��rmtt Fs fw one humkod dolMrs(4t00}ur tau.} wvat6a� r���` Q �C.Gt� ��.ADDRESS _ _-4 certify that-in.the performance-of the wark for which this . �ry � � � . ..pprmit is i55ued,t sF�all noi employ anY PQnon in dny manner � � S�NK - - � 4 .� ��y- ��. -- - . . .. �. ..so as to become eab�ecf-ia ihe lMcrkers`Eromperuafian law�. DISHwRSHER � � � .. . '�,�� .Datel`*��"^� n,f, 'nn�`'lr-i.�i.'��I- � � . fONTRACTOR `�f . - : �[.� p� CLOTNES WA$HFR �.�.+� � i . .t�F '.E Tfl APPLtCAFtT: fF,ruher making'this Certititate nf _ . .. _ - AaDRE55 -'-- _ - - -_ - E( �fi�n. Ysw--.s6asufd_-beca�s-subjoe#---to�-if�r�SNorkarr� '- 5��--�-��F�b"�`mT^a : - -` �7 . Gompenaqhort provisiansof-tht kabor Code�You mus!€arth- - . Cm' TEt.t�3. • tAWN$PRtNKLFR SYSTEM ; wF�t eompky wHA such prorisians m fhis permit-shott be - STATE � �C . . dEemed r�vDked.�_. .� .. _ � . � WRTER HEATER � � �� E(CENSE NO. �q� � . . �€ _ - UCENSE6 CONTRkCT6R5[�CLRRATtON . � .. � 615TRICE N4. .. ._.. . �SSED BY � i . khereb afFamthW-tamticensedunder - p� . Ga55YS�EM -- .^,.. - . . �- . . :-.; Y proresiorts o#�Gho r 9 �. �1����. f} -- � (tommencing witEi�5ectian:3U06J of E3ivision 3 ai the Bvslness-. .. dUTI€75(}VER - . . ..... .. . `�', �. . ... . .. � �.. � ortd Pratessrvns Godee and my=ticense ts in fult{���arid effed. _ - s v€R Svsr€en . .. ..._ � 7• s -- �,� v toaTEoru . � � �`ll `q � I CicereeNumb�� Ec.-tlass .... : " - -� `� F S� - � � . . . . . � fINAL � . . . � � . .. � � .. . � i . � Cnrttracb �� _ Date � �� - . . . BY - � . � - � i Q � 4 ._4am.excmpt�nder .ec.. _ . . . ... - -- . _ . . . . - W � 8.8P.C.far this reason . . . . � . . . .H- ? . - - . �EOCi{f1EE�C�Ce- . . -� � . � . . � ��:.�s ,�:. . _ . �EMia-� . . . - � - . -. �. . - . . -...�� �-�.7-k :-.i . . .. . - - . �PLUMBtNG PEkM1T t55U1NG FE€�- . -t - � � � .. .. � � SignaFure - -� � . -- -. � . . . . - - - - #s s e c �.`G,. - . � . _ _ . . _ . . - � .. .� _ TOTAI FEE_ .Q('� .._ . . . . . � � - . . . € � � - SINGLE FAMitY . . . . .. Plart chectcapplicanf _ . - � .. �.__ -- � � ' . . . . '�-• �.(}���J�O� - r � HOME pWNER$UIl�OER DEC�AhRATfpN __._ � Name � � . . . . . . - -'��'� � .���,�r�� � t' iy a4firm rhai.l am exemptfram the toneractq�zt�canse, _- -� - _ _ _ -_ ---:..t . l��.- roe-the foffrnvFng reosnvi'(5eceto�s`TQ3F 5, Business and - �•�rea�--: ` _- _ __ - _.�. . _ _G��.� �._y"- -.:-:� ProfessfansCode):� . . . � tiiy � l'7e( No. � . . -' ❑. 1,as owner af tFe propert�t,.will do ihe�vodt and the . . . - � . . . . . � ii! -:structure is nat inter�ded or offered for wte(Section . - _-: � � � 7044,Business and Professiarts Code). � � ' � . � � - . �� � . - � .::� �.. CQNSTRUCTIOM1i LENOING AGENCY . - - . . . . . . . . �- - . - . . �- .. .. ; � � 1 hereby,af£irm thut there is a consfrucfion Iending.ogency#w- -. . � - � . - . _. - .- - � - fhe performance of the work for whith t6is permit is issued - � - . � � _ _ ., . - .� .:_. (Sec.�3097.Civ.C.}.- . � . - . . . . . � .. . - � - � � . . . . _. . _ � . � _. . . .. - � .... �Lender's Name � . . . - . . . . . . _ . . . . . . � .� �. Lender's Address ... � . . .:. . . -. � . . .� . . . - . � 4 certify tho!-t have read if�is application ond siafe thot the � . __. ' - . . .�� . . � � ,, � � � obove infwmction is mrrect.I dgree to compty with oll County � - � � � � . � - �. - � o�dinances and State taws regulahng Pfumbing;and hereby . . . _�� � . . - � � � o�thwize�repre5entafW�S�-of'fhis Counfy ta-enfer �pon the . . . . . . . ..'. . . : .. - � � abore- nt� ned prope Inspection purposes. - .. - � . - � � . _ _ SEE REVERSE FQR FXPLANATORY 1ANGt1AGE ' _ ����.Q-�.,�- -- -- - --------------------------- ---- : _ . __ ,. �1 . �8i na re of Permiuee . . pa�e . - .-. - . � � . - . : . . . «, e� o s'o � �� c tn Y' � C �.G ..... 'p m v� O -- n- ' ; -o c ° a ..-o o a . . N G:= Q 0 x'" p H ry= ..- .�-� � ' .,.. u + m � �„ N� � �s' � �V o� o °'..00 c� �c o YP.. � ,n � +� 3 � o+� ro s .,.; s o o "' s o> h ',r' . � � o�,o m a ` � m ' ,p+�v"' d s � `v o pA " . � . `oo, o � ..o '^ . ^o o w � S,� a c3 y m pn' , � �` o� 2'm °,.� °, m° o a a c �°"p�°c a'� a �p. .. � c.�-o y cn� � a - n � ,-oU o ° E �r �,m ? _ Ua'�Q � �q o � m�oo Mw m N � r.s-� m� o. . v o c5 m c.o o m '�� m � o u c � ` ,.y � � � O � — d �6'> • o ��rw� � T w „� O-G L U.. O . Z � � }a �,..... L a m m rE o L, p m m c } s o :,�f O E �•o ; � mE 4g'y� i� s�.s o s �, v r E o� '_'�-"�-. Q $, s Qo.•. o ° a s �°n �`•° `a� '- � o �ac �.� � c�YQ pc ��;a��� w; D �..w � a 4 �s d o m �x ° m o w o s�c '" �-�a v o s Q � s V �� L �v'"' m n,,.• � ;_t �o �jai ro a 30. ."a o � � °� .rn�-o �o.�a3 0 •'"- E y a ,�a �-p E °y� '-"^ �E' � ". � , � U Q V N � N�J „ S X` � ',�0�:._� O� O C'O M� . %,.,�' U d . � O 'ao" O U,Ti� N G Q +'O �Q '•Q N�m N'O � ^O M p'O O. � a , .. m "� s�°�-�� �:o .. rn����6 5�u a=c-�u o�'Q p. �p O . N. �'j o m a � :� p x t a o . . . 2 `+E°a- o c ,'A'ps��v ° .'�a o �Q�n^ =" s °c��° c -o a.o�o 0 o m ,r, o m`�n p ; ; '_ " �p':`'�a 6 � N a« ,at,. o o���.,-�'oy �a'". +`9 r c��.m m °�imn '"�'� � '1 . m � N � `�Ev �;y � �m o `�� � .. '' �, � f '�k�.: ,'` 2 � �n . ��., O � ��`'', � ,'� a � o� � � � ,..."- ,. "g ,,w . .� Y " �1 . ^. .. � w �• �, r y ' , . '.� . � . � t,."A' . .. � O �� � t " Y ,. � � � ,,.�' � , z . �.! f. . i V� wiy • n V'� i y, � , ' ..r ..'c �. . ^ ' . d . `�-'4 '~ ,,,, [� � � . � ' ^J-/- 6 ''-- , � ' Ow '. . 7O . . ,�:.; ���� O.; d 4 . . d 2 a�,+ a p 2 ` 2 � O ?S" ia . � Z r u � p s. & m � 2 Z 'i w � � y ZTi ,-�' ..,;�. Q � � �Lj O � � r� "' ��"�-'' S 1 'V s O O (' � S � � a .,-�`'. .��.