HomeMy WebLinkAbout0819A (4) '"°RKERS-`°,'"`E"5"T'°"°`"ARAT'°" qppLICATION FOR PLUMBING PERMIT
I hnlehy,offirm�hat I hnve a cen�f�c��e ef censer.t to self in- �A�z,A�PN d�?7 �
suie,or a cei7fiica�e ol Workeri Com.p=nso�ion Insu�encrt,or� CE An(4EV BiPh�
certified copy therecf�Sec.3&00,Lob.C.)
Polity No.]���O�i�B,Q�yNATIONWIDE � � COUN7Y OF LOS ANGELES DEPT.OF PUBLIC WORKS �
� • 8 2 8
CerGfied ccpy�s hereby furnished.
� FC2�°'l�C�tii TO FILI'N�F41NT C4 TYPC) HU'ICIN i
Certified copy is filed wilh t�+e county b�ildin�inspeclion AC�RESS
deparlme��. hU".'ACR FIXiU;E C4 IiF!.1 (`n f:E �OCALITV
Da'e 9-1-8$ �+pp�icon�NEW PLUMBING 3 L'��+TERCLOSET(iC'!ET) 6 lg DIAMOND BAR
r:�a�esr
CEFTIFICATE OF EXE.MPTION FROM YJORKERS' Z 9ATH TUB 1 Z• caoss sT. GRAIvD AVE.
CO�MPENSATIONINSURANCE SHC1:'E2 iZl °�''"�q� SRA.*tALEA' LIMITF.D
(Thi�secFion naad nof 6o complN�d if the work involrad by „�,i , ,
th�parmif is!or on�hundrod dollert(5100)er laas.) �AVATC7Y 2 FCORE55
I certify the�in th�perfermance of tho wo�k fo�wh�ch�his pen 5�.•JK
mi�is issued,I shall not empiny ony pprson in ony monncr so Z 12. CiTv COSTA MESA 'E�.NO 850-1001
os re become subject to�hr.Wor4e•s'Co�npensa�ion Laws. 1 DiSH1V!$HER (
CONTRPCTCr��W p���Itr CONTRACTORS INC �
Da•e Applicanf 1 CLOTHFS w;tSf+ER I 61
NOTICE TO APPLICANT:If,eftwr moking rhis Certifica�e of Ez• �D�K;SS 21(yl $. DUPONT DRIVE
emption,you shouid be.coma suhjoci�o ihe Workeri Compen- 5`::I4•.•,�•NG f'OOL RFCEFTC4
sor�on provis�ons of ihe Labcr Codc,vou must forihwiih comn- I ��TY ANAHIEM r¢t.r:o 937-3972
i.,�,.:�^e��:e::�srs�::•.
ly wiih such provisions or ihis perriit sholl be,deemed revok• � c�nir �i�,
ed. 1 WnTE4 HEnTF� bl ��crNs_no.426109 Q�SS C-36
LICENSED CONTRACTORS DECLARATION �� e:5rc„T r:Q F:C{CSSiD 6Y
I hereby oifirm thnl I om lice�sed under pro�is�ons of Chop�er Gn5 SYSTE".1 6 pUTLETS �� /D
9�commencing wi�h S?Cli011]OOO)pP DIVISICfl3 O�I�1C BVS��^SS 1 CUiLETS OVE4 ��
and Prelessicns Codr.,ond my license is in Iuli forca ond ef- 5 FFR SYS7E'.t ll 5�
f��� I FINA !� i.!/' VA IDATION ''
DATE [ J�l a
Ucense Number 426109 u�.eio5: C-36 0
U
Conimctor NRW 1 FINAL �
PI� MBIZIG—Dn,e R-31-8R I 9Y p
❑ ~
I am exempt under Set. I U
W
a
B.RP.C.For�his�eason , ' y
. Plan check fee
z
Dc��� ' p�UMBING FER,'.",IT ISSUI!VG FEE S
l0i 50
s�q„���,�
51!dGLE FANILY TOTAL FEE 114 OO :'���,�;%
HO:ME OVJhER-9UILDER DECLARATION Plan cfieck cpplicnnt � _
�. . • . o -
I h�re6y alfirm Ihof I am etir.mpl irom ihe Conlrottor'S License �,;�mp �
Law icr ihe following reason(Sr.ctian 7031.5, Business and � e � � (;_�?!1
P�olesslons Code): �dd�Fss -
� I,ns ownr.r of ihr.p.operty,will do thr wark and nc� Ciiy Tel.No. ' " � � `:���:-�u
s���tture is nof in!ended or oiirrrd lor sole(Section 704d, O� , � _;;`
Bus�ness and Professiorts Code). � ► �
CCNSTRUCTICN IENC!NG�GENCY •
I hereby a(f�rm tho�there�s a cons'ruc�ion Ir.nd�ng ngency for �
I the periormance oI ihe work for which th�s permii is issued
(Sec.J(797,Civ.C.).
lender's Nome
Lender's Address
I certlfy ihot I have�ead this applica�lon o�d sra�e rhar the �
obovr,informoiion is correc�.I og•ee�o comply wi�h all Covnty . ,
ordinonces and S�a�e laws rr.g�ln�in9 Plumb�ng,ortd he�eby ,
authorize representoii�es of this County io enter upon the
ohove-menrioned property 1or inspection purposes.
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