HomeMy WebLinkAbout1337A (7) w°RK�s•co^^�N�,T�o�°E��,w�Ti°N APPLICATION FOR PLUMBING PERMIT � ;
I hereby affirm tFqt I Aove o cenifimte of consarrt to self� ��y�yy�p ,
iMore,or a cMificofe of Wmkera'CompenuAion Inwrance, CF Bn(REv.1oiB1) �. . . . . � .
or a cerrified copy thereof(Sec.380p,lob.C.) COUNTY OF LOS ANGELES BUILDING AND SAPETIf �'
Policy No. ..�TGompaqy � � .. . �
❑ CerHfied copy is heroby fumished. � � �.
� . fOR APPLKlWT TO FILL M�PRIM OR iYPE) BUA��
Certified copy o fited with the couNy bu�tdirg inapec- .�
fio�dlptlPlT9n1. - . NUMBER FIMUREQRiTFM � � i{E ��`m �
� WAiERCLOSE� . i
Da�s ..--_-_-APPlir,ant � h1FARE5f �
CERTIflCA7E OF E%EMPIION FRQM WORKERY enTH 7U8 ��• -�
COMP�NSATION INSUR/W.C� ... SHOWER . �� � . � �
(Thtf�Mion nNd not M rn�nplN�d.ff fRe�woric invel��d by . . i
tha portnB is toT ono hundnd dellerr(;16tl)ae Ins.} �pyp7O�y ��
I eenify that in tFre performa�rce of tha work fbr whirh this . - ?
� permN is fuued,f shall not emptoy a�ry pm'son in any monoer� Smnc � � CIiY� iF1.NO.
so o�fo hemme subject o fhe YVuken' fonlowa. �� . �
A! . . . ORHW/ASIftR � �pp � .
Oate��J��irnnt U07ME5 W0.5MER � - � +
�� 9
NOTICE itJ APPLICANT: If, aHer matting ihis CaAiti� �e of S,w������� U j
Ezempti�n, you shor�id bacome subjaet ro the W ken . �y �, {
Competrsation proviaiqns ef the Lohvr COde,.you m�af foAh- �qWIVSPRINK1fRSYSfEM .�
�with mmpiy with sach provisiont or thia permit=MqYI be SiA7E LK. � �
deemed reroked. � - � � WAtFR HEnYE�t � � -� � ���� �g
. IiCENSED CONTRACTORS�CIARATlON . WStR�C� . 8v
IherobyaflirmMiWlamlicat�sed�rnlMAroyiiiq�ofGwp�ar9 - ���GASSYSiEM - OV1lkT5 � !?O � �`Q
(mmmenang wi�h Senion 75100)of�[�kisinn 3 of tha Business ptntEiS . . �
1
and Profesaiom{o�e.Qnd mV Ikeme is In full forte_and effecl. �R 5� .FINAL A
vau�anoN �
•` p O DAlE � �A�'�
litenae Nv r � '.Cless�� . . �� Ot
� + ���� � FINAi /-� O
Gontractw Oate . - BY C G
OvW� �
I am eaempf un ar Sec. - 4' �
B.BP.C.fm this raoson � . .. . . .. .. . � � z I
Plctn che�k fee. �
oarB: � v�uneswG a�an+�T issu�wc r�a ,�D
signotuie �
� . - TOTAIFEE q9 d � � i
.... . . Plan check appYiwn� .. . r�� �3,']A _ i
. SINGLE fAMttY � . #� � • �5 i
HOAAE OWNER-BUIlOER Ofq,ARAiION� Name - �
I • •2250 `
I hereby affirm thar I am exempt fiom�ha CoMrotfor's Ucense pd�s .
law for the 4ollowing remon(Sedion 7031.5,Busines�a� � � �2 2 5 d�
Rofessions Code}: � City �Tei.Na � - - . ? .
❑ I,m owner of the propMy,w�ll do ihe work a�the . � ► 0�n� �8 4 �
shucture is not intended w offered for wle(Sacrion � .
7044,Buainess ond Prnfessiwn Code). . . . �
�
- CONSTRUCTION LENDING AGENCV. . . . . . . �
I hereby aifirm rhar rhme is a corrsh�xtion lending agency for .
rha pedormance of ihe woric tor which rhis perma if iuued . . . � � � � - �
(Sec.3097.C'w.C.).. � . .
Lendx's Name- . . . ... . . . � . � � . . �J
Lendx's Address ' �
I ce.tify that I have reod this opplimtion and sfate fhol fhe - . �, . .
obove infprmotion is[Orced.I pgree to comply wilh all County
, ordirwnces o�Stata hws reguloting Plumbing,and hereby �
au�horixe re reaeo�a�ive• f his CouNy�o eMer�pon Ihe . � � - � ��� � �
re-m io ed proper�y r inspetlion purpoeex. . . '. . . . .
SEE REVERSE FOR EXPIANATORY LANGUAGE
� Signa Per �inee are .. . .
�
Gt � q ?
_.... v 2 Y �, G r�n
_ � ,,, � u, � � �r�e .�-a Z u� ,Ye
` y o y � �4� y '' G� G � p
,N'.�„N � O �' � � O ➢
./��I . q� � G *�` � x crn
-- � .- �� � m '�N
_ O o u+
- r
. _ . -' ,�,� i �
, ^`
�
� l � � -
. , . . . . . �,,n N .
.�� �
� ' '. � ' ' � � � � .
�� Z ' � �
� N
� c�, � �
� o �,
� � p
q N m
a 2
� �
� N
�
q
a
�
�.
`
�
J
'� ,
� �
O
�
'�, O
``
N
� �
c`
C
G � � � � �
�
p .
4 ��
P . •' � OD� �o . -
N q O tD � n C N �
�P .. ' ¢n O� � �..�..3-. q,'AO q� � 'G .
P, �? o �4', N p o s sa nQpp p
�� . £ ^ 4e a �,� fp�� ^. o ,� � � � �z
0 3 0 3� M� �Q� O '^� O'O 4
k fi. �.� q
\,, � ��'300 �� .r".JC Q� 4 �$v� q�.�G� � �� m
� ' a � � oy%' tu+i� o N �N �3 0 � f`7
� 3 . ��' � 6.� 0.N ? ONOG�Gp� �,W � O � Nm �' �
\ Q o -o X a.c � o �Q � N ,� £�,n.q � ca � N " c o � op G '
k 7 19 � 3 � ��"�"o ^ � n�.�..� o�o s�� c a-� ° '�"-n° co p
c� o .o � £ N'° 'a 3 c.a ?°. ���3 ;� � �c�'6 � °��'" O
', � � xo�a, �� � S � X c,n�� o . cD.a � n
�' � w t f4, �� °"A° o ? � o,a a `° °D�� `r
'" � w _ N m °�' a"° ye . .o 'n33 ° m � o "' A
�4 . �, � . � .. - p .N� O ?T q�7.'�6 A�^�p . �j 7 m �^ o ` v� ^ n' > > p..� . -
o N . .7 m ? �, `°-a a ��0 3 -� ,p m,a 3 0' 3=c. p
. 7 `•' � �^Ts$oo �S m Nom �o� Qqoo m� 2
• .o3m � 3a � o°-� aQti3 �3o`- '" " `� � � 7
G.0 0. �N �� � �'
. , ' ' .. . . .. . - . ' N �O �'O � O p,O.O 7 ti 7 C Q � 3 l0 v J
p , . � . . � . O,'O .0..� C t,7� '^ S � O �'2^-.7 d0 3,G w9
°j ' ° ^' 3 �° ''�`� � �''' ' '" ° p=' ' �-
. N � O 3' O S m £'� 7.� N�p 'a tA O Q� ;n � tn N
� - .. , . ' � �,D � � �"^� O C Q � lT� �' ?. � f� T
�. . _' . . . ' . . . ' �.T Q� N �-o Q x avy o N, N �.c, ��-�'
- � Cl N O i P l0 _. > N
. � � � . �O 4" 'd � 4. ,
'� . . "z> ?� � `-Ro a
� ' . " . a�-o o,z<.
�
. ��
'� � � _
�
� . '
�
,�
�
\