Loading...
HomeMy WebLinkAbout0502A . ! � ' "'°"KE�•�°"`�"�,T'°"°�,�"T'°" ; APPUCATION FOR PL.UMBING PERMIT I hareby affirm ihat I hove a certificab of conxn�to self ' �y�yy�p , � � _ iosure,or a cenifica�e of Workers'Compemo�ion Mluronce, � CE et7(REV.t0i81) - � � '� � - - o.a«���r�ed opy thereof L«.aeo tob.c.) G� ', COUNTY OF LOS ANGELES j BUILDING AND SAFETY ' a`""��`�°p°°°Y , Certified copy is hereby fumished. - �./� FOR ADPIIGWT TO FIU IN(7RIM OR TWEJ 8��� � � ! I7CI Certi{ied eopy is filed wi�h the county building inspec- �� � %� tiondepartment. NUMBER � flXTUREORITEM p FEE " ± 10 �� ��4�A�.l� LOGtItt � �alte Applitonl WAfER C,lfnEf .. .. NE1lRE5T , _ � CERTIFICAiE Of EXEMPRION FROM WORK BAiH TVe � �. �. j � COMVENSA710N INSURANCE . . . pyy�yER . (Thts s�Nton need eof be wrhpteNd tf tlri work ImeMd 6y SHOWER - a �tha p�rmlf Is ier on�hvndred�.dollars(St00)or la��.) -. ' �qyq�v - �� .'�(� � � �� a� 1 I cerli/y that.in the perfomance of tha wwk fOr wNith tbis ! permit is issued,I si�all not employ any peraon In cny mpnner � � . ���_ �El.NO. ( . � – ao as to bewme subject ro the Workeri Compenwtivn laws. � � � , . . . . � OISHWASHER CONIRACTOR , � . e � . � Date �pplicAnt .. . C10THES WASMER ADORE55 � �FO�I�� �.1' I NOTICE TO APRIUM: If, ahx making��his Cerrificaro of Exemp�ion, you ahould-become subjacl fo the Workers' $W���P���� i Compemation provieiom of�he labor Code,yw m�si fonh• � � m'�' � - ` �wilh compiy wieh cuch provisionc or Ihis permit shail 6e . ���NKtER SYS7EM G/ j deemed reroked. - wnmt HEn7Elt �tl�1�115E No. �O 10�– LK. �, i UCENSED CONTRACTOR$OKIARAt101V � . . ` OUSiWCi vRO�n sr !hae6y afEirm tho�I om licen�ed uRd�provisions p1 Chapter 9 � ��� �T� .. . ; (cpmmenci�with Section 70()p)pf.pivisi4n 3 qi the 9usiness q,�7tEigpVER . d � om!ProfeRions Code,and my license ia in ivll force ard S�ER�SYSiFM ��� . //�'Q�� �_ �� VAl10ATION V 3 License NumbeTl ��c.Class� - �y� �,�,p� p�` . � �� .. . OC i Contron�—�—N�t`��� �vo'e �i�a'��uJ _ . . _ . B� . V � I ❑ I am exemp�under Sec. � - .. _ . . . ��( .6�r �fL x �–"//"'�7 � y�3� � � B.SP.C.for thia reason " � _�j Plcn CheGk fee . �► �� �.-�/¢� , � � Date: p�U/ggING VERMiT�SSUWG FEE S �����'�N, i '���� TOTAL FEE _ �/r���Q'0 . j�',�o ..• "� � J��^ D'� ;r,,r � SINGLE PAMILY Plon check appliwnt � . � (,o� .9 HOME OWNER-BUIIDER DEUARATION Name � . `,(�, j��_ I he�eby affirm�hal I om exempf from the Contracror a License � - - . . • y ^ - i Law for the following reason�Sec�ion 7031.5.Business and "��0� � � � . � .�� ��,� [ –;�(� i Professions Cade): City Tel.No. - ' � � I,as owner of the proper�y,will do the work and�he � . - ; ehucfure is not intanded or offered for tpie(Secfion . . � �' � i � 7044.Busirross ard Profassions Code). . . . . . . i CONSTRUCTIpN IENDMG AGENCY - . ... .. . . � � I hxeby affirm�ha1 there is a conshuclion lendi�agenry fa � �� the parformance of tha work for whieh this permit is issued , _ . . , _ . . (Sec.3097,Civ.C..). i r Lander's Name � . ' - . . . ; I ! ! lendeis Addren � � I cehify�hat I hove read ehis opplication ond state that the . , a6ove in4amc8on is corcect.I agree to comply with all County . . . .. . . -.-- ' . . . . • � �� ordinanca and State lawa regula�ing Plumbing,and hereby j authorize r r ives of this Coumy ro enter upon tha� obove-ment ned pr �fw inspection purpm . j c � SEE REVERSE FOR EXPLANATORY LANGUAGE � � giwture rmifle 1 . . . .. . i I . ' A G ' G� � � O . G G� `�G O� �r 'a 5 u y .. „ �` v, :o � r .a . , �7 Y � "� � Y '� 4� G � O _ 9�0 r . O � m p .. � � < S Z � � , . po� Z, C '�q` -. Gl F v� . . � .o� '" O A� p ... . ..- � . . %$, N O - . .. . y . . . �.. . .. . • , - ' � " � � ✓ q � t . - , . ' . � � .. O ' . � � � Z t` � � �� 0 0 �1 � p ,`�� � • • � q 1 n, , _. G � � ` � � - . O . � - N 4 " ` �� .. . � �� . . �l . � N �` O i � �, •,` .` `� � ',� -. , . � � ` . � . 4' � . � � . �, . _ . ;1 • . - .' J. � . �. - . O W m � �' .. �;� . n +1 O O'n 3 7 O.�C� y, � •L fS.p O 7 M p y� N r '' , S N O C) S Q 4 �, . . .f' i-- Q a .�. S� O � � � , � �oqa o 'v�Tn� �cs „a �� " � . . '. �� S N n ��v � Po ��-10_TQ j m ..O O ai , Z ���4v a �'� r"'�G ..U,nK n o �M oro-e 3 o s '� . i o � anp+` O A �u � o p� � n n ^ W S A ° '?�.4 � `� ' � o ^ --o � m � G .. ',� ~�a G h < O 7 :�' m � �i q ...t9 �.�� r� • p O , -o �-��'..'yc� o �o�Nv��✓��n�OQa oc $ � o� p kY � � C� cc Q ,g - •..R 4 a i� a � 0 4 '"• Q a-H �° - S g m 7� �p -•• � 3 � A o3 o.M ' o a �3 H � 4.'� �'9� a.�"cn , O � ° G .po��a,� <'�N° � � o o x L'n 3'0 0� o.`p � - � �-O.. D 5 O c ' "�?, �r' � -�, 4 7�'o.+q .c t]- m ., � O o o a eo °�y m � . nl. . � Tn ,..� ` .W { t�� O.N U .fl�,O o Q -�p. •� ?.3`o n ,.�� o p."" p . �` .� m ,6 m �w Q �0 � .�.� j w � o `"a ~ ^_.� 3 . .�+ l . o .,.�m�w N�.�'Op N o � 3 i9 -� n m,o�o N 3 ..t in 7 O o ..-� ` Acro -ca .� o :<. °3. c ��,�� • �'° o o �, _ Z �, J� � ,��v � ��-$'� o � ° �. ° � ° o � °�O � � n o Q o �p _.��'`co � 3 0 � nO' ' a Q:� 3 �3� �•�� > > ? \ . - ._ � o � , . w °.� <p p-�£ `.�°o o --^ � d�� �� 0 3` Wo � ' ' . . ' 'O ��-t '� 7 � S < �' O^ 6.�= N a'N O � ...O •' O 0 f1 (! 3� �l� O p S � 'd iII 0 N � ' h t1� N �p . .. . ' ~� . O 3 � W � � �...� O C� � lT� '�.T� O T T" � ' . " � �.� 6 N �ro �' � Q-.0 O N'M T � O � + . v o= an ,� ro ? ¢ � :. � N . . . . �.� _' p N ^ ^ . � O.. • � .. . , . . .. � • 0.TO O ?'< �� M �. . . � -. .� ��.._` G. �t _ .,1 ,� .� r�^ _ _ t, ' -� � �' � i --�' ir' ` //�, ✓