HomeMy WebLinkAbout0812A "'°"KE"s•`°^^�"�"°"°E��,R""°" APPLICATION FOR PLUMBING PERMIT
eby affirm that I have a cartificata of consaN�o salf �b,qyy�q
b,or a cerlificafe of Workers'Compensotion Inauranc CE BV(REV.10/81) �
�e.rifiIed��c/o�p,y,rh,e�re�o,i(Sec.3800 b.c.� COUNTY OF LOS ANGELES BUIL�ING AND SAFETY
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Y IVc4iCLLd�CamDa^Y � �
�Certified copy i�heroby fu�nished. . �
fOR APPLICANT TO FIU IN(PRINT qt iYPE) BU�LUING
h . ' CeAified copy is f�led w�rh rhe covn�y boiWing in3Peo- ADDRE55
�� fion departmanf. NUMBER FI%7URE OR I7EM � FEE
..a���--/�1y6y� IOCALITY f
y--r=-t!`�'APP��Gon/ WAiERQO6ET � NEAREST
CERTIFICATE OF EXEMPf10N F OM WORKE 5' BATHiUB . CROSS ST_
COMPENSATION WSURANCE SFiOwER {riVNER �
�a saclfon need nof be completad f!ffia work tmolwd by ���.
i pormtf i�for on�Iwndr�d dollon(�100)or Ins.J i,4vqtOrtv qppp� �
�eAify that in the performanca of the work fw which this .
rmit is issued,I shall not employ any person in arry manner SINK � Crtv ' Tfi.NO.
'os fo become subjecl to the Workera'Campansation laws. D4SMWASHER ._ w U
, � CONfRACTOR ��#.Q�_
�e epplicanl � GAiHES WASHER
�TICE TO APPIKANT: If, aNer making fhin Certifiwte of SW�MMING POOL RECEVTOR �� '�
emption, you shoald betome subjecr ro the Workers'
jmpanschon pro��aions of tha labor Code,you mvet fonh- ��n �'
i�h comply wirh auch proviaions or this permit aholl be �'°'�`''�NKlER5Y5TEM - ,
STAiE 1 UC.
�Gemed revoked. � . WAiER HEATER QO ����� a — C�u
� LICENSED CON7RACTORS DECtARAfiON oisrrtia nlo. vaO�SSEo er �
herehy offirm thql I pm Iicensed�rdx prpviEiwis of Chapter 9 GAS SVSiFAt OUflETS �
:ommencing with Sec�ion 7QOp)of Division 3 of the Businesa p�7�E15 pyER . . . . :
md Prafessiom Code,a�my liceme is in fvll iprce pnd eHpci. . ......- S PER SYSRM . . .. .. . fINAI VALIDATION '
� Q DATE 7I�0 SS�
.icense Number�7�� �-ic.Gass
fINAL
'omroUor Dn�e - BY .G,..,�� . •
❑ I om aKempt undn Sec. �
� B.Bv.C.for rhis reawn
Plan ctaeck fee "'►
�re� - VLUMBING PERMIT ISSUING FEE S � �
� Signafure � .
ro,A�F� 3
' . Plan chack appliwm � �C Jy��2 A .
� SINGLE FAM�IY - -
' HOME OWNER$URDER DECUIRATION Name _ � - - , �. ._. .�•5 �
I hereby offirm tho�I om exempt from�he Conhac�or's Liceme ,q�dress .. ' �
� : Law for the Following reoeon�Section 7Q31.5.8osiness ond --. �.- . . . _.. . . . .� • •J�1�J� . .
� Professions Code): Ciry • Tel.No. - � -
� ❑ 1,os owner of the proper�y,will do�he work ond the . .• ' •�'d Jr Q a
� ahuctu�e is nm intended or offered fpr sole(SeNion � �` �
�oae,s�s��+e.:o�a r.efe:siu�:ceae). ` G!z 1 8—8 5
CONSTRUCTION IENDING AGENCY . . -
I he�eby aRirm that the�e is a eonshurlion lending ogency for - . �
the performonce of�he work for which this pnmil is issued . . ,
(Sec.3097,Civ.C.). . . . . . . I
Lender's IVome
Lender's Addrpss � �� ��
I tertify that I hove read Ihis opplicotion ond atete Ihot the ► � � i ��
above infwmaAon is correct.I agme to tomply wifb all Counly � � , � '
ordinances and Slafe lows regulati�g Plumbing,ond hereby . j
ou�horize represenrotives o(this Counry to enrer upon the � - � � � �
above-menGoned pr efty fo ' e 'on purposes. _ �
SEE REVERSE FOR EXPLANAiORY LANGUAGE �
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