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HomeMy WebLinkAbout0963A \5'pRKISHS'COSIF'E1SATlOS DICCLARATIOV va�e�v � 1 herehy affirm �h,� , �,,,�� a rertifitate �<<<,�s�n< «,5,•�< <e.�„=..o, APPLICATION FOR PLUMBING PERMIT insure,ur a crrtificate of N'orkers'Compensation Insurance,or a ccrtified copl'thercof(Sec.3R00,[.ab.c.) COUNTY OF LOS ANGELES eUILDING AND SAFETY Policy No. Compans' � CeHific•J c�ry is hcreby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � NUMBER FI%TURE OR ITEM • FEE ADDRESS CcrtifieA cnpy is filyd w�ith Ihe rnunty huilding 6ttptC[inn �icFarlment. LOCALITY /) ' WATER CLOSET Du[e Applicant NEAREST![1 � BATH TUB CAO55 ST. � /� � � CFRTIFICATfi OF F,XF.MPTIOV FHOM V.'ORKIiRS' C041}+��S.4TI0\It�SUR.+.IM1CI: SHOWER I I OWNER _���„� r-. LAVATORV MAIL � • / ("fhis section need not M: cnmpleted if Ihe work im'olved � qDORESS by lhc permit is for one hu�red doliars (5100)or Icea.) >' SINK CITY ' TEL.NO. �C C I certify thnt in the perfnrmanc=of the w�ork fnr which Ihis ' -f v��n Q�- �S� O DISHWASNER U permit a ir.surJ,I shell nnt employ am• von in any manncr CONTRACTOR�_�� P r � sn oc�MJ b o� e x hiec�to Ihe ' ' mCrnsatiun Laws. CLOTHES WASHER I ADDRESS O Date'✓ i�Vr�1L'2I11 • F SWIMMING POOL RECEPTOR \OTIC i T APPLIC:\NT:If,afler making this Ce '�alr of I I I CI7Y TEL.NO. W fCzemptinn, you should hrcnm: suFject to th 'nrkerc' LAWNSPHINKIERSVSTEM �- $TGTF. LIC. 7 Cnmpensatinn prrn�isions of the Lahnr CnJe,ynu must furth� y�qTER HEATER I LICENSE NO. CLA55 Z with cnmply u�ith suth pro�'isionx or ihis prrmit shall he — JeemCJ tEcoked. / /'� DISTRICT ND. PHOCE ED BY GAS SYSTEM OUTLETS v � / [.ICf\SEDCOtiTR:1CTORSI)F:CI.AR.4TIOV ' OUTLETSOVER I /� f�C/ I harehy affirm thal I nm licenud under pm��isinnx of Chapter 5 PER S�STEM �(��'�' 9 (commencing x•i1h Section 7000)nf Dicision 3 of the Ansi- / D FINAL VALIDATION nexa and Pmfessions CoCe,and my licenxe ie in full furrr anJ *^��- � DATE effect. I FINAL I.icrnsc 9umhrr l.ia Claes gy Contractor Date � 1 am ezempt fmm the licensing requirements�s I am a Plan eheck fee licensed Archilect �H a reQistered profecsional enginner pLVMBING PEFMIT ISSUING FEE S ��f actin� in mY ProfccsiOnal capaCity(Sedion 7051, Pus. . inexs anA Professionc Cnde). TOTAL FEE � �.n. f.ic.�r Rrg.Mn. f)itc Plan check appllcan[ lin�tf ON'\1•:R�HUII.1)I'R 1)I�.C1.:1H:\'I�IUV NamQ 1 ' y, 1 herchy affinn IL:it [ ar� esempt fmm the Cnntr+ctor's Ad��ess 3�� ��� � � f 0 9 6 3 A l.icense Law frir the fnllnw�ing reason (Srction 7031.5, Busi� �;�y � Tel.No. C d'�P S �.�'"'� • ��. g. .. . :5 ne.ts and Prnfessinns Code): � • � f,ax nwner nf Ihr property,am exclusively contrecling + .. � � � • •.i 650 w�ilh licenud cnntrectnrs In cnnstmrt the projecl � (Sectinn 7044,Ausinres and Prnfessionx Cnde). •.• • iQ50d COtiSTRUCTfON LE'VDING AGFiNCY - �2 0 9�8� t liereby affirm that there is a rnnstnxtion Icnding agency for the performance of the w-ork for w�hich this prrmit is issurd(Src.7097.Civ.C.). I.ender's Name LendePs Address 1 cerlify tha[ 1 huce read this upplication and state that ihe aLurr inform��ion is corrcct.1 acrce tn comply w•i�h all Covnq• Slili RtiVIiRSI:1'OR EXPLAN.aTORY I.AyGIfAGI: mdin�nces and St:�te I�NT regulitinF 1'IumNinG, snA hereby authorize represen��ti��ex of this County to cnter upon �ha ���aPnee� ntion F�� ty f ins �o�����s�t. ���- Sipnalurc of 1'rrmitlec C" "'�rG�U� S� \!�n t �� !� �'�\f��\t�^ �\� � .Z " ..� �,� �\i 2 r 'p � ..��� f �� �^. G` �y\� C G � • �':� O ^� •Ci � V� `X �.;� O �� � U G n\t �� � a y'\ \ .� \ �O \`��i��/i� ,\ \O . � r � ! \��� \ ` `\ ` v� \� �'.�� \ �'� \n ` `'. . � \ \�� ��' �u �' ; i, � \ ' . � � ��:.�� � C: �• ',` � � � ���� � \�'� �,4' �, G, � ti .. � �. � \ O �' ';` � � '�� �� ' � \ ,\ � �� .Lt , �' \ vA� � ` �� � \ ` � � , `\ G �� \ �•. . � ti m v . �3 f� n � 0 / `„ 'o � � \ s , �\ \ \ , � \. \ � ` �\ � `� � \ \ . � � �� � �, ! � � \ \ \ ' 1 . . �; � . , , � � \ \ �, � . � \ , � � ;, , � � � \ � � � � \ ; \ \ 1 ` � \ �, , � � , \ � �, � � �� � � � �, �� ��� \ , \ � _�. , . , � , . _ - - _ � � �, � ��� , � � ; � � `�,- : _ _ _ �-:::: ;. \ \ i� � \ ',\ � :;��c;:_ _ _- _ .- _ ��.,._� .-: ` \ \ \ \ � \ ` _ ,- � � • ! � �ff• rV- ... ' � J�. % � \ ` \ \ \ \ � f. . _ _ �_'[.. V''=.� .. _ ` � ,: �� \ \ `\ ` � � r� � "s ' � ~.�'C H - f.%'• �i \ \ �.'/ :� � �/` f. �S.I_-� _ �_ . _ � � - _ :.• � `,,,,v ^•r f• �!. \ , r • -•J_' r:L'�� J- _, �• -��^µ - - _^~�'� � , % ff� ..� C . � ('. /� _ �r � .." � .. � �. �^ ��. \ ! ,� n. � ^' • � �f..!,' v^y_%� _ ` - � ~C,�'1 r=� = a_' '�` = � r=-� f 1 . � _ .� - � `^s_ �- `^y� v v �C�C,tf . . �^ - _ , c 'i��': n.`_' -. i.. ^.. � _ ^ �i: �� f C. ^. - �..r:. � 'J�J. ,� '. ,� � ' . �, rv..��. • /'� :`-� � _ f. •� . �. f'. .. r.. ' r: � . � '1 � �,'. . _ f ` _ � — � � �- L . • , �. ' � � C� �. �-w G",�: . � � 1 �� � ��.r�