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HomeMy WebLinkAbout0963A (5) \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 � `=\��.\° �. °��° `� -r. �-� ���f.�;\� '\� � ::y � ^ �'� "1,=`�?�\i' 2 r � O c�\! � � c G '-� � ��� \f �� �^`G� ' -�.��, (ti -�\ . �\ ' � f �':� \ 1 Ci V� \X % O �; � V � \ �\t ^� \ � �a �`�y,/`j� ,\ O � '� �\�,� \ ` �� � \vt \� \�'.�� \ ��,� \n � i"� � �.`.\�'�/ /' � \ \ �' �4i \ �`:.� �. C� � ,% • � i • � � �i�f\ ` \t%� �' �, G, � _ .. � \ O �' �1 � . 'r� `^ ' � \ ,\ \ 1 `' .Lt , �' \ vA� � ` �� � \ ` � � , `\ C �� \ �•. . `c� � m v . �3 f� n � 0 / `„ 'o � � � i . �\ \ � � . \ ' �\ . '� � �� � . 1 \ � � `� � \ \ � 1 . \ � � � , � � \, \ . � � � , � � ;, , � � � � � � � � : � � ; , � � �, , � \ , � \ p � � �� � , �, �, ��, \ \ � ��- , . �, , � , . _ - - _ � � �, � ��� , � � ; , � `�;- : _ _ _ ��:::: ;. \ \ i� � \ ',\ � :;��c;:_ _ _- _ .- _ ��.,._• .-: ` \ \ \ \` � \ ` _ ,_ � � • ' � �ff• rV- ... ' � J�. % � \ ` { \ \ ` � '. ' _ "�c. :! '-� .. ` r `i \ \ �\ ` �„ ✓ �— rr. '-" ' : "t �__ ' - _ i ~.�.'C H _ . : : f^'� 'i \ \ � �� � ./` f. S. _-� _ . _ � .- _ ,:. . `,,,, ^ r f• �!. \ � f - _. , _ - — �r' , Y i • �. ', Ji'_rr:J- . -� _ � _ `' '� , i. •'�� •. c_ . _ � -'� _ . ;r r � _ '_ ' _. '^ i'. \ � � ^. _ ..� _ • � �f..l.' F^s-%� -- - � - . ~C,n r=, ^ i..' ��� �- . _ 'f. 1 . ` -_ '� ' � �s_, �_ . �•`^�^ v v ' �C�C�-. . . �^ - _ , c 'i�'-': n.`_' -. i.. ^.. � _ ^ (`. �, . f. � C. ^. - �..r:. � 'J�J. ,� '. ,� � ' . �, rv..��. • /'� :`-� � _ f. '� . � �. f'. " � r: � . - ~ C'. . _ f ` _ � — � �- L�. • , �. ' � � C� �. �-w G"',�: . � � 1 �ti '--`�