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HomeMy WebLinkAbout0824A (4) WORKER$•�oMPE�SAT�oNOE«aRAT�aN � qpp��CATION FOR PLUMBING PERMIT �1 I heieby,aff�rm rbot I hnve a certi(Ico�e of consenl ro sclf in- ����5 oP:J aie7 L � 7tAhp7A � � sure,or o cerlilico�e of Werkers'Compensaiion Insurance,w a CE gv(REV.8i[i5� L� cerr�f�ed cepy thereo((Sec.3800,Lab.C.) voi��Y No.Z3bIC.QQ59�7.9966ny�ATTONWIDE COUNTY OF LOS ANGELES DEPT.Of PUBLIC WORKS � Cerl�fied tepy is here.by{urnished. BU'!D"�G • fC7 AFPIICANT TO F:��IN I,F31VT C�TYFE) 1-1 Cerlified copy is filed wiih the county builrling inspection :.CD'r;55 ����'j' Ld depar�men�. '�U•.'DE2 FIXTL'R'CR iTE!.1 � FFF LOCALITY �a+e 9-1-88 APPr�o,,,NEW PLUMBING 3 WAiFR CIOSFT ITOiLEiI 6 Lg� DIAMOND BAR r.=nc esr BATfi TL'9 ceoss si. GRAND AVE. CERTIFICATE OF EXEMr'TION FROM VVORKERS' 2 1Z COMPENSATION INSURANCE cH0'.^.'R 121 C�����4 BRAMALEA LIMITED (This saNion naed nol be complatad 11 fhe work involvsd hy ' t.��� --�� --�-"-��-�--� -�� tho pormit If for one hundred dollor�(3100)or lett.) lavnTORv aCCaFSS 1 ATRWAY AVF_ STiTTR N I cerlify fha�in fhe periarmancr.ef the work for which!his prr- S�Nr mit IS ISSUPd,I sholl noi emplay ony person in any manner so 2 12 C�fv COSTA MESA T;����`� 85�-1��1 os b becemr.sobjr.ct to the Werkers'Compenso��on Laws. 1 OISHWASNfR (I � ccvrznne, W�I:IG—C4NTRA.�S Da�e Applitont QOiHES Y/ASHER E1 ACCp'S5 NOTICE TO APPLICANT:I!,a(�er mo4ing this Cerhficafe o!E�- Z I�i 1 $. DUPONT DRIVE r.r� +ion, oo sF.ould become sub'ecl lo ihe.VJorkers'Com en- SVJI.M VING COCL FECEPiCR P Y I P C�TY iEL.h0. salion provisions of�he lober Code,yau musl fcrthwi:h comp- :,q;;,..,ceq�.�,,;;o�y�,c.q I ANAHIEM 937-3972 ly wi!h such provisions or�his permit sholl be deer�e�l ravok- Si�,iE uC. ed. V.�ATFR f1EA1ER IICFNSe 1:0 CLA55 — IICENSED CONTRACTORS DECIARATICN 6 �'S*.��CT^:o rsC:[55ED 9r I hereby o(firm iho�I am I�censed undr.r provisions oi Chap�cr GAS SvSiE!.t � CUilEiS //—� 9�commPncin�with$eciio�7000)el Division 3 r.f the Eusinesz Uu�tei50e•Ea �O — !� 1 s rcx srstt.�+ 1I SO V�ILIDATION nnd Professiors Code,ond my license is in full force and ef- FINA N fect. I DATE ./ � a Ucense Number 476109 lic.Class C—"�6 � U I FINAL ^ ¢ co��«��o� NF.W PLU*1BINC�o�iP�31-$$_ I I BY �-^,�-� o � U � I om exempi undrr Sec. I W a B.BP.C.ior this rrasan Plan check fee I ► 2 �O�'� PtUM�BING P[R.MIT ISSUI!`G FEE S 10I r)� Si�na'ure TOTAL FEE :G�2.u,. SINGlE FA!.11LY Plan check npplicon� � ' NOME OWNE2-BUILDER�YLARATICN (. • • • a e ` I hereby oifirm thot I om enempl irom Ihe Contractor's Licens� Nome lo•.v for fhn lollowing reason �Srclion 7031.5, 6usines5 a�d ��• � � :'•(,'(' Professions Code): A�idress � Cii iel.No. � ' � I �-.i,.�O ii I,as ownr.r o!ihe p�operty,will do thr.wr.ik a�d nc� Y srrucrure.is noi int=nded or of(c�ed for sale(Sec�ian 704�, `1 Business ond Profess�o�s Ccde�. G C.� � —C`.3 . . CCNSTRUCTICY LENDING AGENCY ' I h�rrby affirm Iho1 Ih�re is a to�shu[�ion lending ogency for - �he perie�mence e(ihn work for which ihis permit is issued (Set.3097,Civ.C.). lender's Neme Lender's ilddress I cartify that i have�ead ihls opplicoiion and s�a'e ihat the � above in(orma!�on is cerrect.I ogree io comply wiih all Couniy , ordinances ond S!a�e lows regulotfn�Plumb�n�,and hereby ou�herize represen!ctives of this County to enter�pon ihe above�mentioned praperly for inspection rposes. , � � �/� � SEE REVERSE FOR EXPLANATORY LANGUAGE ' Signal .c f Prrmilte Da�e � C � ' C' C n 'L -n � G' �' y �' i^ �� O �— i. �. �: �; r+, z � co .� < < r, � � s, � V C r � � �,� �i � T r �r., ti f^•N-1 C� -1 �) I?� [1 C Cf O '�'r?: � ' 2 c' ` A 7- � �' Z � � �1� C C � `� � N o " •�'` v � RI L� 0 � R . ,. :. V „ � '1.-� y ; i �: a �- � z z ��,� �- ,�c�_ N � y�� � �o n � � = r�� � O � n ..� p O U� N Z �' O D 1 -� � , i T . m Z N � n � O �� . N Z O m � . o �c, ax�� 3 ,,o, a� 'p�'wr�;,� 0'o3�>>m � Cp 7 f O�G O^C.j y v��� cp O � y�� O � O a� � ai n � ❑� N � �f�c0 n ��y �� C � � 7 c: 0y Q1�'V� y O O_ fn 07C r] � O R° � Q`�m `�� � o o "i q�a a.� �oc a x' Z Se � .��b��an� i:m`�cn ���� Q,��+ � a-..3 tR 7D W � _ c� n�^w� S1 m � " oc =m�otim� O$s.� a'`°S o3�mv+ roQ ? y n O Q c0 f` — � �,N p {p � �. 3 av�`Pia3��n.��i � �25n;ccw � 6� � � O � � � o �+Z�c�~ vi�s w� . -, .+ v�_�o_�of tim :or, � �.o� r ,� � � � 3 a 41 CJ ��`�n"� 3 w�X d O m m n"'" �� o � aA 4 �"- � �n'-� rnv»�� ��ro ��� v�?� �' � s� � ' . .tF,, m om�i°c =� o.o �0.3�3ra�� � �� � 0 • w � �p� O �r�� ���p� �� � x W� � � aG �� � C) • � g�ty Qi �0�,�y-, 4 O'O �3p �C =.'d C �• � <D . NmSc � ���^ ti3.�Cv�'Cj �� p �?� �� � �o^�m � '��nm $ =c�c�e�� a3 orrc��� �1 p+ �T� p m Su CJ ui � �,•, 0 '—,� �'O y� d cl �iti=��(1� _ � O O V�p �`Y t/� Q 1 cD � _�� O t�n�� �y � � �� 'Z yo �O�W O (D ? f F tn O � v: �� F:N=5 v� <D w � �+.��njfu'noc� � �3 �c� � m� a+�oo �i� • , =c��oc�c� c�' c,� n_ u,�>>o� m co c� o � ac, c�nv�'.o�� �Ku,m o � n �? � �' x man �o�v a. � m o�' w � a.:� c� a�� a�Kn a . �.--- �-`�s_��--.��