HomeMy WebLinkAbout1036A (5) � , "'°�ERs•�°'"�"�T'°"°Ka""T'°" APPLICATIOIrI FOR PLUMBING PERMIT � ,
��ltrre6y,offirm ihot 1 hove a certificoie of cpnseni ro seli �yqyy7A � �
insure,or o ceAificate of Worken'Compemotion�murance, CE 817�REV.1WB1) . .
oea cerrified wpy�hereof(Sx.3eoD,tab.C.) COUNTY OF LOS ANGELES �BUILDING AND SAFETY i
PCllcy No. Gampany . . . � ; . . � •�,
� Certified copy is here6y f�rnbhed.
FOR APVIICAMT TO FILL IN(PRINT OR TYPE) eU�� -7�s � I
� Certified copy is fiiad with the coun�y building inspec- �
rian department. . MlM�BER fIXTUf�OR IiF.M � fFE t���, .
WA7ER a.OSET '
DCiB.. � Appli4ant NEAI�ST � i
CERTIFICAiE OF EXEYNPTfON FROM WbRKERS' �� � BATH tuB � � CkOSS Si. � - �
COMPENSATION INSURAIVCE OWNER ,i,� ;
SHOWER �
(TFTt��cften nwd net b�eemPlN�d if f6o rro�1e lmolwd br NyU� i
fh%�ee►mtt Is fer ons hvndnd delfan(SIO�or lest.) IAVATORV qpp�$ � 0� � +
. � I�Jtify thdt in the parformence oi ihe work far which tbis . .
_ pq�it fe im�ed.I shall nofemploy person in any marmer 5MK 7�t. �.(J� �—
ao e1!b be ma 6jec��o the Work pensaiion Laws. o�SNwtS�x
. OONTRACTO - - . I
xDoi9 �� � ican ' ' CIOTHES WASHEF ApDRE55 �- T�� DI.T =
NQ'�JC�TO A ICANT: If, after mpkinq this Cartifico�e of .
EKcaprion, you shouW become wb�err ro rha Worken' �������T� /'��� '
Carltpanwran prav.isiwn of rhe labor.Code,pw mus�fonh- � UWw SPRiMciFR SVSiEiM � Cm ��+�e.l � � TEI:NO.����9 i
wit�wmply wirh svs)� provision�or �his permit sholl 6e . SfA�E . u[. , _ - ;
de�m,ed revoked. . . .. � . � � wnrEk w€a7Ea lKENSE np. qn55 �
� li�NSED GONTRACT(9R5 DEQLARATIQN. � OISTRICT NO. PROCESSED BY 3
I hel8 affirm flqf A am licerned vnder GAS SYSTFM W7LEi5 � . � ?
.1iY Prorisions of Ghopter 9 � I(/ .
(co encing with Section 7UOQ)of�ivisiqn 3 at Ihs Businass p���pVER .
essiwis Code.m4d^�X�i[en»is in 1V11 f0[ce 4Jd eHeN. �9 PER S1'S1EM fINAL �• ;
��� a�roanoN � ;
Liceryse Number „ lic.Clnas . . . '� . � �
� � fINRL � � �
Con]/qtfa Date gY . V 7
❑ 1 am axempt uadx Sat. - . � d ,
N t
6.Sv.C.for this reason. � .� �. . . � . ? �
Plan chetk#ee
Date: j
a�.uruteiroG�w,nir issuinic F�s �O �^1 C��o N =
$�n�fi�n - � T�TAIfEE fp � � r o a s s a S �
- . . - . -. . � Plan cbeck applimn� � ��:
srt�Gt�FMnav I •0 1 6 5 0 i
HOME OWNER-BWLOER QECLARA7IQN . -Nome� � ... - _ . T I
I hereyy off"vm eho�1 om exempi from the Camvoctor's licerrse . »� �.J tJ� -
� Law�or t}re following reoson(Sec�ion 70313,B�siness oMl �reu . . n � �
�,,(Q�rof�e�s';iom Coda): . ��y � �Tel.No. �0 f�c T -�6
'� G141;as ow�r of the properey,will do+ha wak and rhe .
shaic�ure is nof intended w offared for wle(Section � . - � , . ;;
70A4,Business ond Profeuione Code]. . � '
CONSiRUCT1pN LENDING AGENCY � � -� � � q
� I herGby offirm that there is m m�skuctioe landing ogency for � � ;
the perfwmance of the work fa which this permit is iuued . � � � � ..
(Sec.'�097.Civ.C). . � ,
Lendql's Name
Lend s Add�ess - � � �
I c��y thot I hove reod this opp�imrion and s�a�e riwl tha ..: . . . � . . .. �
above���ma�ion iz correct.I agree ro comply with oll Co�ney .
wdi�Qnces and Sfote laws regulating Plumbing,and haroby . � - {
authq���e resenta�' of ihia County to en�er upon fhe � �
a6ov�. en oned p per {or inspection purpoi . � ' �
� �� SEE REVERSE FOR EXPLANATORY LANGUAGE
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