HomeMy WebLinkAbout0818A "`"°RKERS•`°""PE"5"T'°"°E""R"T'°" APPLICATION FOR PLUMBING PERMIT
1 here6y,afiilm thai I hove a certifi:c�e o(conseni�o srll in- ���A'J!are7 �
su�e,or a ceri�fice�e of Workers'Compensalion Ins�ronce.,or a CE B17(kEV.8ie6�
certified mpy ihr,reof(Sec.3800,tab.C.)
Pol�cy No7'�WGQOSO�j�A¢b��NATIQNFIIDE COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
� Cendied copy�s he.=6y r��nished. LOT67 PLAN:25 TRACT:42578
FCR f.c?�ICa\f TO Flll I!�l(iR'tii C4 TVf�[� f!U:ID'\(i
n Cen�F�ed copy�s F�I�d wirh the caunry bu�lding inspr.ciion nec:ess 24204 EAST PEAK COURT
'-�+' deparfinen�. hUN9ER_ FIxTURE CQ ITF'.1 � (F� �CCALIiY
Daie2=]-88 aPPuco�NEW PLUMBING �"��TFR ClCSET(iC^.ET) 6 18 n,en��sr DIAMOND BAR
CERTiFICATE OF EXFMVTiON FRO.M WORKERS' Rn1�a Tuo ' 18 c�css sr. GRAND �AVE. �
COMPENSATION INSURANCE 1 <upy;rq 6 i CN"`�E� gRAMALEA L-IMITED . •
(Thi��edion n��d no�be eompl��ed if�h�wo.k involv�d b� .fA,i �
rh�p�rmif I�(or ons hundred dollars(5100)or lass.) (+ LAVAiCRY 24 I neoacss 31$1 AIRWAY AVE. SUITE N
I certify ihot in thP performoncr oi�h=wo�k fcr which ihis pnr� S�hK
rri�i�s�ssued,I sholl�ot employ ony pe.<on in o�y manner so � 12 ��iY COSTA MESA TF� "O 850-1001
os io 6ncome s�bie��io thr.Wo�kers'Compensai+o�taws. eis��wns�[e ceN:a�craj�EW PLUMBING CONTRACTORS� INC.
Do�e Applica�� 1 CLOTHFSK'ASHER 6 ACC¢E55
NOiICE TO APPLICANT:If,atrer ma4ing rh�s Cerhfica�r.c(E.- S,n,•�h•�;;'�G r00:REC[vTCa I 2141 S. DUPONT DRIVE
emplion,you shou�d 6ecome suble:t lo Ihe Workeii Campen- i CITv ifl.NO
sotion provisions ef fhe Labor Code,ycu must(orfhwi!h comp• �,.�.;�c��.;���R�y�-�;•, l�.�V�r�.L:�1:'t 937—.1972
iy wiin sucn provisions cr�his prrmit sholl L•e deemed revck� 5��'E l�C.
ed. � WATE4 HEAiFR l!CFN'E M1O CL/155 —
LICEN$ED CONTRACTORS DEClA4ATICN 6 i CiSTR�Ci np. F3pCf55:D BY
I hereyy nffirm rhvt I nm licensr.d under pravisiors oi Chapler Ga5 SYSTF'.1 CUilE75 �
9(cemmencinq wilh Seclion 7000)of Division 3 oT the Bus��ess OUtlETS OVER �
I 5(':2 SYSIE.'�t 1 50 /,` VALIDATION }
and Prclr.ssions Code,ard my li:ense is in f�ll forcr.ond ef- FINl1,
lect. I DAT� /�t �'
License Numher 4961 fl�_L�a Cl�ss C-�Fi U
� FINAL/^ _ ¢
co����r��NEW PLITMBING o:��_$�1-$$ Bv �•� O
r-
OI om e.^mpt under Sec. i W
a
B.BP.C.for this reoson Plan check fee ! i '�
Dnic: p��MgING PERMIT ISSUI:JG FEE 5 ' �
s�q��r,,,� TOTAL FEE 114 00 �"0 b L°�;
Si.'.'GlE FAMILY
hi^v.ME OVJNER�BUIICER DECLARATION Plon check opplicon� 1' � � � � �`�
I hxreby oifirm�ho�I om eKemp�from�hc Con�racfor's Licensc Name � • � � �,v i�
law lor thr,lollowi�g reoscn(S�c!�en 7031.5, Busir.ess ond
P�o+essions Cedc): . Add�ess s o � � ;•,(�!j,=
I � 1,as owner of ihe prcpe�ly, will do�he wcrk nnd the Cny Tel.(�o. �S� � —U u
I s�ruUure�s not�n�ended or offered For 5alr,(Sechon 70�e,
Business and Profess�ons CodeJ. ,
ICONSTRUCTION IENDING AGEI.'CY �
� I hrre6y af(irm th�l lhere is a cons!ruclion lending oGency{cr .
� rhe perfermonce of the wcrk tor which ihis permil is issued
(Sec.3097.Civ.C.). �
Lender's Name .
Lender's Address
I ceriiFy ihat I have reod ihis opplimtion and s!a!e Ihal thr. � ' ►
obove in(crmo�ion is corrett.I ogrr,e io comply with all County
ordinonces and 5'atr.laws regulaling Plumbing,end hereby
au'he�ize rep.esentot�ves of�his Co�nry io enter upon ihe
o ve•men�'�ned proper�y for inspection purposes. �
-Q�.Rg SEE REVERSE FOR EXPLANATORY LANGUAGE
SL.
S�gno!ure of Permiitee Dare
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