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HomeMy WebLinkAbout1349A (7) 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 ��:i��� �'�-',. ,�,��1� ;�1��:; '-1 `J (.��'tIt„`��1C- �� � ,.-,i I7,' i�i�-,. -��,� _�;..�� � s '��� • t- i; c�� . �u,'�:f��� , ��,�'�i1��1���;�I.�.1;C' �< z;; � ! Y: �r: _ ' "•1�';I r. r'' � , ,�'i ,',.'I;.'�,/'� 1„,o� • ' . . . :` "r! � C% 'C. a /� 'I"�1�.� '�✓ li� I i,' 11 ��.,�i^ � � I�'�, . ' i� �� �i, r ,��.� �6• i '�, .. �! f; ,�1;,''1i= ', -1 I'^,•��-�`1:_ ��i.•It� � ' ' �:� � i j � 1' �1 l';-1 � +t •f . . .. � � �u . � 1:Ir/� .: 1 'I'. i �e ,j� � 1 ! ''i� � �. 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