Loading...
HomeMy WebLinkAbout1349A l_ a..mrc�n.4i�U1 UECLAR.4TION v���aw 1 herehy affirm�that I hare a cer[ificale nf consen[1�5�« <E.,��=..o, APPLICATION FOR PLUMBING PERMIT � inwre,or a certifiulc ol Workers'Compensation lnsurencc,or a certified c py thereoF(Set.)800,Lab.C.) �� ,� Z Ili� COUNTV OF LOS ANGELES BUI4DiNG AND SAFETY o¢v � Q C�n^pany � �� � Cerii�eJrNpy�lfcreh}•(urnished. FOR AVPL�CAN7T0 FILL IN(PRINT OH TVPE) BUILDING ��� y�/a / � ADDFESS �� CertiFeJ cnpy is fiied with the c�unfy I�uilding Inspec[i�n NUMBER FIXIURE ON ITEM � FEE LOCAL�TY •lepar m WATER CLOSET Dete �� Applicant �•�,T NEAREST BATH TUB CROSS ST. CERT11�fCATE OF F,%EMYTIO!:FROM N'ORK}:RS' COAIPFNS.4TION INSUlt.4NCti SHOWER I OWNER (This eectian need no[be compleied if the work involved LAVATORY q�ORE55 1 s}. by the permit is [or one hundred dollara (f100)or less.) SINK , C1TY I TEL.NO. 1 ccrfify that in thc prrformance�f the work(�r which this DISHWASHER � permit is issueJ.I shall nM employ any person in any manner CONTRACTOR � so a6 tn hecome subjttt to Ihe Wnrkers'Compensa��on Laws. CLOTHES WASHER ADDRESS � U I)ete Applicant SWIMMING POOI RECEPTOR I I a VOTICE TO APPI.IC.aVT:if,after makin¢this Certificate of CITv TEL.NO N F:xcmD���^. 5'�u should bec��mr subject lo [he Wnrkers' LAWNSPRINK�ERSVS7EM I I STATE J.. LIG. ` Cnmpenwtinn provixions of the Ul+or Code,pnu muFt forth• yyATER HEATER UCENSE NO. ✓Q CI.ASS with :omp15' w�ith such provipione or Ihis permit shall be D1STqICT NO. P ,OCESSFO BY deemed revuked. G/1S SYSTEM OUTLETS LICEhSEDCONTR.4CTORS I)ECLARATION OUTLETS OVER I I /U • ���'�� � I hereb>•affirm Ihat 1 am Iicensrd under prm•iaions of Chaptrr 5 PEH VSTEM 9 (c�immencing w�ith Sr.c[ir>n 7000)of ni��ision J of the Rusi- � FINAL VALIDATION � nest anJ Yrnfessions C<ide,and my licence is in fuli lorce anA I� DATE'3—�—�Z � effecL � O�� � ��^ / FIN L Licenst Numher�J�uv� f.ic.Clecs ��O BV '' i u-8a Cnntractnr� Date � 1 am eKempt /rom the licensing reyuirementx as I am a Plan check fee . licenud architect or a reRistered profecsional enginerr pLUMBING PERMIT ISSUING FEE S � �J aclinR in my profe5cional capa[itY (Reclion 7051, 8us• n ine<s and Rofesunns Code). TOTAI FEE ��C � LIC,or Iteg.Nn. natc Plan Chetk lPPliCbnt ' IfOME ON'NF.R�B111LDGH DFC1..412A710N Neme '1349A I hereby affirm that I nm ezempt from lhe Conlractor's Addra�s rt'. Licenu I.aw for Ihe follnwinR reason(Section^031.5,Husi- City Te1,Na. � � � �S r.ess and Professiona C��de): � I,as nr�ner ot the Oroperly,am exclusivcly contractinp � • �� 2'S� with licensed contractnrs ro canslruct the project • 1 Z 5 6 u (Section 7044,Business and Yrofesxinns CoJr). � � COVSTRUCTIOV I.ICNDING AGEWCY 0�.2 7`a z 1 hereby affirm ihat [here ix a construction lending agenq• for the performancc of the w�ork for whith this prrmit is issucd(Sec.3097,Civ.C.). Lender's Name LenJer's AJdress 1 certify that 1 hace read Ihis applicatinn and slate thut thr ahove informatinn is mrrect.f agree ro mmplY�'ith aq County SEF,R}V F NSF.FOR F,%PI.A4ATORY LANGUAGE ordinances and Sta1e laws regulafing Plumbing, and hrrrby authorize repre ntatices of t ' Counly to en[er upon thr abo�•e- tio ropertY f in ec�lon purpoces. � G� ature of Y minee Ua�e —�c'�i`:I_ �� . .,, :.�- 1.�1e -� ` ' �7,' Irli' ,, ,�� � ���" '.. , r ��,�.��c.�'� `��`?1, � �. .-C I`^,1�;i,'� a I C � �< . �=,+,��:/�; t, '�;1 �{'.`� ..r" .'Y`,�C' 't'. T' ' � i ��r'i �r�•� �� '�'� 1=;��� _'* . �� , •��a /1 1�.�_.� . . . i• ='' -' -- �. G ij.1 ' �!(� ��/�, 1 I^',1 �i'•`��Y � , ' ' - r 'f,! 1y '� �.�~l � •� .. I• r • ,�Y ,� 1 J , • .1' , ' •�� � , . ' "�� ' � �.��� r � ,1• ♦� `1 �i � . . ,1 11� �1 �1 '1 11 I'!,�'l_ ,',I, 11 i�', . � �t . � _ =� ,;': �� ' _1� '—��� �.'� �1 ,r . • � ,.y_ .%�. •: i; '�'. , � ,' 1 1 �' � `' M1�-. , 1 ,11 '.—',_�,. ...,, �J 1,,� I i, ... c=. ./ ,�� ;i� �'� � ri � '1 � '`C ' ' � 1. . ,I �' 1�1� �t�� 1 1 Jr - y I ,� 'I�: � 'i 1 !� � �I ' � '�'�' . �. =t_•; �.i . 1 `. !. ;" �,t 'I '� � ' •° , �' •`,! �.~' �e� ,� � �' I ,'� ' c �- .� !: �i '; , 1 �� � ';; ' ' °' � . � �:'� �. ' j-1�.�..."" . • e , �,,,,��.._ , , ` � 1�,_ � i . ti� ..... � � 1 � i 1 ; , � 1 �� i � � � : . , �� . � � . � �� o . � . � �: ., � � . � � v � i ��. � � � . ., ' ....r �,,, c��--% _ " c'"�c'� " � =��.t'� �. G � �' N.^O�^� :G~v � �'i�'�..t. C: i��t% /. 1 .=� � = . �`- � � � =v^' [': ^C .L',_�'-^^ � ' ' _ =CY :` . � _v w `�C� '. •. ' ^' r;, �,.v •- I-' � ,,, f F `-+r C� �'�'� ��^ Cr � t% .�. C V r 1. ��' r..r tn� .�t�~ f,, �" �''_ �,. G � . � � ,��-.5- ;- -. �,}��c � C :.-� ?�«- p,�.; c.^ ^' n� �' C ` � t,,�' � `.. __ _ c_ - . `' oL` _- 'n" 5.. ' y° _ " ,r.5 t :.' ..� ,� + ` r.L ...�N_fi. �.. � 'vi� O�.• ia =b �.:'v G� N � G ' � ai.� .. � �^ n . S . f;��.f v ' , .'� � ; : i r ��:. C•• ...,..� ., c: O ; �: „n � � _ �^.. ... _ v� c v� '„� « ,y.., ri: _ C? J� � C C �G�^ , n �Gv' � C , Y� 1 f. '1 �'--f ^• ~• ^y^• �C1 f"'�� � � � �,•� � � V1 :: .4�^C - " � � � c ., �: n� � �,';. i,. f. � =��. ,� � � � - v, i � ., CJ f7 �-i ^ , , ry. �. %^,'.' v' "`' �""' � ''+ V''`�. � it � ..- �, r. �_ �: = ;r�,��C`•r,_':.� -.e' _ n��' � ` Y c ",G � �;', .� �_ `c._� ;, .�r, �•c ..C.��: r. � _ =- - « ° f 'I. 1 . � _.[; _.`^~ryc.C_��� ��' - 4.`ySa~ C we^ , 1� �'.._ ,C''C r� :. ^�o - �.:." C y�� C tn u. ` .; r• f C` �. ?� L ,. _�-," ,�r- a�' -v . _J`� • �-w v' = ='� � :• °'' �e r '��•_ . � �� C � C� '` . C'��: "`"'� —_ . I � �I! i � . . . ���—