HomeMy WebLinkAbout0823A I ""°�KERS�`°"'P`"5"T'°"°E"ARA"°" APPLICATION FOR PLUMBING PERMIT
I I h,-Ye6y,offifm th�t I h�ve a reriific��e of consenl lo s�If in- ����Ae��4�fl� �
� S��e,er o cer�ificate oi Workers'Compcnsalion InsurOnte,or o CE ft17;CEV.B�FA)
certlfied copy thereof(Sec.3800,Lob.C.)
I Poi��Y No Z3�IC.��10�YNATIQN�IpE— COUNTY OP LOS ANGELES DEPT.OF PUBLIC WORKS
� LOT PLAN•25 TRACT:
�I Ce��ifled copy is hereby furn�shed. EU'�D'vG •
FCR AP�II[1NT TO FILL IN I��I^!T C7 TY'EI
I� CertifieAcopyisliledwiihthecoun�y6uil�l��gi�snecr�on ADCGESS z¢217 EAST PEAK COURT
Uil deporlmeN. � NL':'?FR FIxTU6E CR IiE'd @ fFE LOCnUTY
I � WAT:R CLCSET�TO�IET� DIAM�hp BAR
IDote9-1—R8 Applican�l .W PL1M N, 6 iH h:ARESi
. CERiIFICATE OF E%EMPTIO^!FRO'y1 WORKERS' AATH TUn 1 cacss sr. GRAND AVE
eo�MPENSATION INSURANCE 1 s�+owea 6� °`'�`R BRAMALEA LIMITED
(Thit tection n��d not 6s complN�d ii 1ha work�nrolv�d bY .•.n�:
fha permil I�lor one hundred dollan(5100)or I�sa.) LAVAfO'+'V z!+� neoccss 3151 AIRWAY AVE. SUITE N
I cerufy rhoi in ihe pe�(o�moncP of the work for wh�ch th�s pe•-
mii�s issued,I shall�or er�p�oy o�y perso���any man�e�so S�NK I C�Tv COSTA MESA rF�'��$50-1�01
as lo become subjacl to fhe Werkers'Compensotion Laws. OiSN:YnSNfR
ccNrancTcpEW PLUMBING CO[r'TRACTORS, IKC
Dafe Appli[anl 1 CLOTH,S WASHFR 6 RCCR:S$
I NO110E TO APPIICANT:If,af!r.r mo4in ihis Cerlificate of Ex- ��[[PQNT D
4 SW!M.V.'tiG PCOL RFCFPi04
er�prion,yo�sheuld became subject to ihe Worke,ri Compen- Ciiv iC�.�:O
� sa�ion provisions o(Ihe Lcbor Code,you mvs�(cr�hwi!h com�- ;�;;..;�pq�•;r,;;R�r5t::' � ANAHEIM 937-3972
ly wiih such provis�ons cr�hfs rermlt shali be deemed revck- SinlE uC.
?d. � wATFR HEnTFR !i�EhSE h0 CLP55 —
IICENSED CONTRACTORS DECLARATION I D'Si2•�T`:O. O i':'�'ESSFD 9V
I hrreby off�rm Ihet I om Iicensed under pro��sions ef Chop�cr GAS SVSTE.a� OUTIETS /
9(commencing wdh Sec�ion 7000)c(Division 3 c(tho Business CuriEiS OveR
1 5 PER SYS?E,41 1 50 VAIIDATION
and Prefessions Code,and my license Is in full fo�ce nnd ef- i FlNnflj l / �, >
fed. DATE /
License Number G76109 L�c Gess r—�� ^�—�G� �( O
I V
FINAL � p�
Con�mdo� NEW PLUMBING paie_H=�1=S$ � 3v �� � O
F-
� I am e.emp;under Sec. I w
a
B.BP.C.ior ihls reason Plan check fee ► � i
��1Q� PLU�+A81hG FER?,+.IT ISSUI�:G FEE 5
I Signa!vrr, TOTAL fEE 114 00 r�F�.�;
51\GLE FAI.+.IIY �
. . HO"T.E OVJIvER-9UIlDER DECLARATION �'�o��heck opplicani �+� . . ,. . �j
� I hnreby aifirm thnt I am e�empt(rom ihe Controclei s licensr. �;amp
law ior�hc fcllowing reason(Sec��on 7031.5,Business and � • I � t;��l7
� Professlons Cedn): Aridress
i a . � � � ..'7��.,
� I,ns owner of the p.r.pe.�y,will do ihe wo�k c�d ihe City Tr.l.Nn. �
struc�ure is no�intrnded or offe�ed for sale(Secuon 704a, O E� � —i�.7
Bus�ness nnd Proless�ons Co�fe). ,
CCNSTRUCTION IENDING AGENCY
I hereby of(irm Ihaf ihr.rr.is a tons!ruclion I�nding agency for �
�hr,performance af Ihe work fnr which ihis permit is issued
(Sec.9097,C�v.C.).
Lender's Nome
Lender's Address
I certify tha�I have read this application and stote that�he � ,
a6ove informo�ion is cerrec�.I ogree io comply with all Coun�y
crdinnnces and 5•a�e Inws regul��ing Plumbing,and hereby
au'horize repre5enlo�ive5 Of this Cou�1y 7o enter upon IF.e
obo -me�� �ed property fo�inspection purposes. ,
� � !�,�, p� SEE REVERSE FOR EXPLANATORY LANGUAGE
O
S�gno!ure of Permit�ee Da�r. .
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