The URL can be used to link to this page

Home My WebLink About0797A WORKERS'COMPF.NSATIONDECLARATION �••��•� � qPPLICATION FOR PLUMBING PERMIT � t hereby.afflrm that I have a'eertificate nf consent to self ce ev zee � . insure,or a certiticate ot Workers'Compensation Insurance,or . ` �. � ' certifed copy there�f(Sec.3800 Lab.C.) � � - .�.�... ` . G°�'3hG^/a3 od'✓ �� COUNTY OF LUS ANGE LES • � • �� BUILDING ANO SAFETY� olic No. Company � � �/FD �s,�� ❑ � �� Cer 'ed copy is hereby furnlshed. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Cer�ified copy is filed with the county huilding i ectlo . NUMBER FIXTURE OH ITEM • FEE ADDRESS a� � Dete�de artme _o q LOCALITY �J Applicant u�� -� 1.u.t.ts� WATER CLOSET d"' � NEAREST �� BATH TUB y.� CHOSS ST. CERTIPICATE OF EXEIv7PTION FROM WORKFRS' COMPENSATIONINSURANCE SHOWER � pl.�J OWNER ° -t d' u/ . LAVATORV � �� MAIL p . / � } .(This section need not be completed if the work imrolved � � aoDAESS �/� ��0�-S�.ui .r-..+1/ a � by fhe pE(flil[ IS tOf one hundred dotlars (5100)M�e5a.) SINK � CITV�� r� TEL.NO. yr��0 � - [certify that in the performance of ehe wnrk for which thia / D�SHWaSHER p�-C� � permit is issued,[ahall not emD�oy any perwn ln any menner CONTRpCTOR �� O so as to become subject to the Wnrkera'Compensation Laws. CLOTHES WASHER �- DLlJ pDDRE55 �J'��-a ��,� U Date Appiicent gWIMMING POOL RECEPTOR W NOTICE 70 APPLICANS:It,after making thls Certiflcate ot CITV TEL.NO. �.�j � ExempHon, you should.b¢come subject to the Wnrkers' LAWNSPRINKLERSYSTEM STATE y r� p' LIC. z Compensstion provisions ot the Labor Code,you must forth- WATER HEATER / LICENSE NO. / d!O o -CLA55 with comply with such provisions or this permit shall be d�° . deemed revoked. � DISTRIC NO. PypCESSED B� / GASSYSTEM �OUTLETS � � LICENSED CONTRACTORS DECLARATION OUTLETS OVER . 1 hereby atfirm that 1 am licensed under provhions ot Chapter 5 vER SVSTEM � G�`'� 9 (commencing with Section 7000)ot Division 3 0(the Busi• � FINAL� /f� I ATION ' ness and Professions Code,and my license is in full torce and � DATE (j 27 d eftect. q ` / - � ' License Number /�/�� l.ic.Cleu ��" / � gy AL��,�,L � Contractor� Date �'v2—�J � ; � 1 sm exempt from the licensing requirements as I�m a Plan check fee licensed architect or a teeistered ptofessional engineer pLVM81NG PERMIT ISSUING FEE$ �jf � acting in my professional cape�ity (3ection 7051,Bus- ineu and Profeuions Code). TOTAL FEE p�� LiC.or Reg.No. Date Plan check applicent � � HOME OWNER-BUILDER DECLARATION Neme � � 'p 7 9.7 F aaarx: �`• • •ti •5 i hereby aff¢m ihat 1 am exemyt from the Contractor's ' � License Law for the following reason(Section 7031.5, Busi- City Tel.No. � � • ��7 a 5 p ness and Professions Code): � . � 1,as owner of the property,am exclusivety contracling � � �']3�� wilh Iicensed cnntractors to conatruct ihe projett ' � (Section 7044,6usinexs and Professions Code). . o b Q�?�2 3 CONSTRUCT[ON LENDING ACENCY 1 hereby a(firm that there is a construction lendiny agency for the performance of the work for which this permit is . issued(SeC.7097.Civ.C.). . � - . Lender's Name Lender's pddress 1 certify�that I have read tMs application and state that[he . • above informatian is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE � ordinances and State laws regulating Plumbing, and hereby � authorize representatives of this County to enter upon the ' �bo -mentJifned prop y for inspecHon purposes. p - � �/./1.2i' ��C.LL�- `Y-�'O�"��/ . . 'Tig at'f�ure of Permittee Date . G �� G� � 2 G� r � � N G � q 'n � T' C < < -c �+ 9 -�i'. r N � m �c ;, N 9 �' �O r � N � rr � � � � o ^ � G Y � . �N� � � X r, � W p rN . y?� ? �` Z vY � � �m\. � p • y �,j �'p � � \�. �, -. ' . ' ' . f ., c� !►�\�m . . ' ' ,` .. " \ p' 1 ? �� . �` ` '' .. � � � � . L � � "� � � �� m . . L� , . q O , . ' 'e. G N � m . o � • r, � _ . N ..� _ ' '\ . . � • . - . • - . . . . . �O • � • m �� ' � N . Z O � . . � � . m _ N ' � . . . . . .. , r„f'� r� . c4 � � .. . � , . �- �. Q to -..� n „ ' � . ' � N .� " �p O� � C�io n �C. O �� C �� H � 2 � `� � =' f.. eo S�+ ` . . v,'C ^ �� f'io't.-�-�H %� �' �Q d4. ^. 'f=� ' f� �'L ��^ :' v+�� ^ � C "' ^ v. � NC-. •� • N `pn �•n �.h .. .. v+ ^, 0 ^ N �^ • � � �_ � �,��'�:.c �, n;�r._ ;, ,�° d Gt • .0�p 3 ... C � ..�G'^�r' v n"y C' ..="c a C - G . � � {�. t� � �'r.� �°'� r.+'n p G,�'v �'�'�'-..•o "•" Q'�o ,�„ u " C' O ".=•p o � �"`--�, �S c�o� -o � -. c o eo r r. '� . � C% . � � � oc ; ie _..O �a� y �C �O N p^� - C C F�. �C!1 � �. H p � n n .. .fl� '�� G . . . � `" � x �i =... ='��tr � �'� C v+ p �Q c�°.�.; -p �, � �' � � .� � , t � n.• t+ ... � , ' r � � n �� C�m N�'N y ^t/i� 0�".:N y�.C� �� C O 7 t' ' � � � - ' • ^ G � ` O O"�' ;G p ,~ry..��C>� � � O G'„y� � A�' �r,�„ C� . � � . ,.a � O `'s,C p O f� p C y� O�y'�� ,�� `.. � . . . � � . . � � . � � O �L1'R.n�C`,, �'+ C.. fL 0 ey ;+ �, V ,� . � Q,•: �•-,o ° �o �..`< '_`�t,� .,, � .. s n . n. .ry, �.� �-'� o�c . ....n," o „ ,.�c��y�' r� .. � .� .a ir^ <o �a � o � � - �, �. �n,^_• .w.� �'S�, - �.�`�' . � .. � r �.r. G.p,O ��O i• e�`f O .- p,^' � �r3, ' , . ` (j� ^ •�' .. K � ..+. .n Vf.� . � . � � J' � �G. "'``° �`^ � � �'��n ^.C`° o''O O'p,-»�,�,,,C' � Q , . . .�' / .ty� O� t� �'o � f. �. v'C-p'C C t �v., n � . . � �,� �, �� :� a: • -. .�� -• f.'��."' Y ��. o,o K _ '.� � - � . - . G _�. �� _ ..= �� ..�• � o� . " . . ��. .. �. .�. • . `: _-.:,~".O ��',�% , o�.o,�=-' ^" c..,s~ ` �'c c�o .. � . . • �.G � ...C"[� " C+ � -.. O R 'C3 C^'p O� " . � • . . . - 'Q t`' O O'�y c r-� C - C � X..�,^ '�' " �a`c U'//� . .. . . . . . .�=io�O.� � . � . .� �i^��`p p n _ , ' . . � . ,� 'o tO v �v �i O �.n V p �•^G . � . . ' �„��R� -a.�O p ` " ` . . , . ' . , , - ' i � �!� N�r . � . . , , . �.r� ��!O N A � . . " . � . /' ��i