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HomeMy WebLinkAbout1803A W°RKERS•�°^^�N�T�°NOF«^R^T�°N APPLICATION FOR PLUMBING PERMIT � I hereby�affirm�hat I have a certifitate of consanl 10 self 78A687A - � � � � insure,or a ceniHmte of Wwkera'Compansation Inaurance, CE B17(REV.8/88) ,. � _, . - �� � or a certified copy thereof(Set.3800,Lab.C.) .. _ '� � � O�y No 73WC0050 Nationwide COUNTY OF LOS ANGELES : DEPT. OF PUBLIC WORKS ��� Lot 26"Plan 25 ,` rrified copy is he/eby furnithed. BUit�ItaG � FORAPPtICANTTOFIIt W(PRIN70RTYPE) qppRES$ 24376 East Nan��Cou,rt �errified copy iz filed with rhe aounty boitdinq inspec- NUMBER Fixtuk¢oa ir�t � �e � � iion department. . - IOCAIITY . . . are' 9-8-87 ,yPPi;Sa„� New Plumbin� wn�a aoser D amond Bar NEAREST CERTIFICATE OF EXEMDTION FROM WORKERS' . BATN Tu9 . �S ST' . . COMPENSATIONINSURANCE - ypwER � owr�R. BramaTea:Califo'rnia lnc. - .(This��elion nNd nol M tompl�t�d tf�1h�wotk lnvolwd 6y ���. - � � � Ihs p�rmit is fo�on�hundr�d dollan(5100)er Inf.) . lAVATORV pDDRE55 3151�Aitwa Ave:�,..$te N - -�' ; I cerii(y Ihal in�he performance ot Ihe wo�k ior which this � . . - �permit is ias�ed,I sholl no�employ any person in any mannar S�NK - CiTV (`pSt3 Mesa� � TE��"1O�85D-1001 _ . - so as to become subject to the Workeri Compenwlion Laws. DISHWASHER � � . CONiRACTOR . . � r-�e ' Applicanl : , . � � ttOTNE5WA5HER . .. . Ap�� � _ �10E TO APPLICANT: If, ofier moking this�ertifico�e of SWIMMINGPDOLREfEPTOR �`e..emphon, you should becbme subject to the.Worken' ��Ty �i.pp. � � Compensotion provisioas of fhe Lobor Code,yoo mvst forfh- �qyyN SPRINKLER SYSTEM - — � wilh comply wilh such-provisiona�w this pefmit aholl be STATE �� LIC. � ' d66mBc1 rovoked. � ' - � � ' � WATER HEAiER i�Ns�n�o. 426109 CI,A$5 C-36 � �-- � LICENSED CONTRACTORS DKLARATION �� - DRTR�CT NO. PRO�SSED BY ���hereby offiFm Ilwl I am litensed under povisiona of Chapler 9 GAS SYSTEM OUTtETS � -�; (commencing wi�h Sectio�7000)of Division 3 Of thB Business pUTlET30VER � . 14 �� � a� and Professions Code,ond my license is in foll fwce and effeci. 5 PER SVSTEM FINAI V � � oare 3�z��p� VALIDATION license Number 426109 �;�.ciess C-36 p� I - . - . FINAL . �, New Plumbing 9-8-87 BY � ~ conrracror �Do�e w � � ❑ 1 am ezempt under Sec. `� 8(�3 A uj B.SP.C.for�his rooson � Z . Plan check fee , #• • • • •5 �1e' PIUMBING PERMIT ISSUING FEE S . Signature ' ' . I • � � ��� � TOTAI PEE _ • + � T �+.O O� � �-- � � Plon chack opppcont � SINGLE FAMILY . . . . .. . G 9,� 7—S 7 � l HOME OWNER-Bt1ILDER DECLARATION Name � - - - ._ .lereby oHi�m�hat I om exempt from 16e ConMactor':Ucense A��S _ _ __ _ . . . . � � � � . .. �Law ior fhe followinp reeson(Sectlon 7031.5,Business ond _ Professions Code�: - � Ciry Tel.No. " '' � ' ❑ I,as owner of the properry,will do the work and the � � . strocWre is not intendad or oHered for sale(Settion -- � . -��-�- �� - - � � ► - - � �- � � - - - � 7044,Business ond Professions CodeJ. � CONSTRUCTION LENDING AGENCY � - -� - � -- -� - - �" �- � � "- � � � - � �- �"�� � I heroby offirm that there is a tomtruction lending ogency for � the performonce of�he work for which thia permit is iaued - �� - �� � � - " � � - - �� '" ' � (Sec.3097.Civ.C.). - . . . . • .. _. . . .. _ . __ . ._ . . .. . . . . .. .. lender's Name - ' " � Lender's Addross � . . . .... .. . . .. . . . . . . I certify thot I hove rBad ihis applicotion and stale thol�he- . . . _ __ . . . . _ _ _ ► . .- . . . . - � obove i�fo�motion is carect.1 agree to mmply with oll County � � ' ordinances ond$�o�e laws regulaling Pivmbing,and hereby _ . � . . . aoihorize rop�esenia�ives ol�his County lo en�er upon the � o re- Mioned propenyforinspection porposes� � SEE REVERSE FOR EXPLANATORV IANGUAGE _ fgnawre of �mittee . Date _ . . . . . � , .. . . _ . . . , _ C C1 � 2 G� G) �o c .. � N� ' VE C -1 N N C Cl . . ��„<Ci. D K -a m `� c � _ .zmi � . . . . . r_..-_�..-..�.. .'A . n � .:�, y. + v cn �� I . , �. � � � „J� � T 7t� G1 C � ➢ i . � . . _ ,. . . I 3 .� i � I � x x � `S p ._, t"` j � , _ � D 7 O < . . . . �� i�; ! + m� `� zr D . ` i= +�7 ll i I` I :,` �,. 0 y `n I T N ' . � ' • ��! J ! t , � I r � � m f'.' I�y C ` _ I L i l"� � � �^ � �; o . I� '^ `_''� - � i � �� � .y t,�m �. " . 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