HomeMy WebLinkAbout1565A (9) WORKfR3'COMPENSATIONDKIARATtON APPLICATION FOR PLUMBING PERMIT 338/A � �.
I here6y a11�rm thai I hore a certificate oi consent�o self �y�q607q
inryre,or o cen�f�co�e oS Waken'Lompe�sa�ion��suronca, Cl 87�(RFV.1pi01)
. o,(Y certif�ed copy�hereo4(Sec.3800,lab.C.) COUNTY OF LOS ANGELES BUILDING AfVD SAFETY �
P�i[�iHFi1771� 7 �o,,,�„y Fi ranm�'c H1mri
QCeaified copy is hero6Y fu�niahed. �
� FOR APPLICANT TO Fla M�PItINt OR TYPf) e��1 3 Porto Gr -
Can�{ied coPY�s fited wi�h the couny bu�lding mspeo H�FQ p�xiURE OR i�EM O PEE
- +ion department. lOG}tTY •
2/6/84 RCR bY�T/.Cf WAlERC1aSET 08 ` r+ewaEsr
pq� n��c�n� � eRo555►Di�Nxld Bar B1vdIGY3rid AVe.
CERTIPICATE OF EXEMPTION FROM WORKERS' y e�n�Tua -
tornafNsr.sroN�nsuRnNce S�R 3 �R 1?resley of $Q. Calif.
(Thi���d�on nNd nof b�eomplrTad it Ihiwerk lnvolv�d b� µqK
fRs p�nn�f li ter ano h�ndnd de0art(SlaO)ee Isss.) tavarOxr — qppRES3�16�� �Y'j.V2
1 fan�fy�ha�in�he perfamarnro o{�he wvrk for wh�ch�hia �N� G ,_ C�tv iF1.NR �
(feimii ia iswed,1 shall npi ompiq ony persan in mry monner � .
!ry os�o beeome wbiecr�o�he Wakers'Gompe�aOtlO�Laws. �Wpy�ER ��' �
Car]fw�CroR R.Cs.R. Pll�1b� Ii1C.
Qpfe -APP�'mnl UO�i�w"�"E° ^��12 85 Lia A
i �1CF TO Ai+PLICAPR: If. oher mck�nq�his Cfmt�cate of ������� ' '
ion, you :hould beco+*e �ubjec� ro !he wlwkeo' ciiv fFl.Nq.
&qmos^aouon Prov�varo of�he 4aba Code.Nu I^vsr forth- �nnwtv Sv�tu�nclEa xvctEN. • -
with caodr '+h syc�h Vrw:r�o�c or tb:s p4rmi�ihaii � ��No. 336428 �UA59 - 6
�Oemed raroked. wAhR H�.ohp •
LICENSED GONiRACTORS PK��T�RH qSTRICI NO U BY
hhereby alfmm Rq�1 am limmed urder prorisi0m o/GboWa 9 Gni svs�rtn ourrETs
�ommenurg witA Settion 70pp)oi Ocr;siQn 7 of�ha�ness OU1Lfl50VER � y
OId AofaRiOnS f.00B.CnA my I1Cenis is in fiA{fOrc9 qnd ENlCI. S�FR 6YSIFM �
Fwru �s/ VALIDATION a .
336428 uc.C�m� 'S.�- �].�_ °�`� ��r��, v .
m
Uceme Numbe� FINAL � O .
[o�nocrorR�P� T^ ino Tn��e 2/6/84 e� � .
� I am eaempt undm Sec. � N '
�
8.8D.C.for�hn.eoao� P(qn Gbeck#ee `► r �
Date:�— PIUFh$iMG PERMIT 155iJING FEE S Q . I ��'.::r�
Signonneti TOTAL FEE �� �: • . • s .j
Plyi ched apPlicunt i s c..�.'�`r.:;v
S�NGIE iAMRY �� .
HOME OWNER$ULL�ER OEGARATION �9�+� R.C.R. P1+I�MBIlVG INC• '� :;,�
�eby affKm�hot I am sxamp�from tfie Conhpctp's lice�ne ��� �278t�M�n.,0�2$AV2. . .• •;:.. ,.�'.)_
ior H+e follow�ng.eaxon(Sec��on 7p:f1.5,Business and �f�"
Profms�ons Codel: Gq Tel.No. G C-1�-s�l ,
❑ I,as owne�of rhe propeny,w�ll do�he work and iM �
anunure��s no����ended w offered for wle(Section ►
7Q4�,Busineas ond Rofessions Code).
CONSiRUCT10N LENDING AGENCV
I hereby alfirm tFql ths�e�s a consnuciion lend�ng ogancr fo�
�he perfmmance of rhe ww►tor which�hi�permit is issued �
(5ec.3097,Civ.C.). :
te�de.'s Nome Securi.ty Paci_fic Bank
le�er':Address N�-^Y"�� B��r �
1 cornhy�ha�1 hnre�ead ehi�oppl�ca��on and��vte���he ►
above infamo�an Is cwrec� I ognee to comply w��h oll Coun�y
ordinvnce�and Sta�e lows regu�ati�g Pl�mb�ng,ond he�eby �
ainhorize�epresen�o���as of�hn Coumy ro emer upon fhe
abo.e�r�e���oned pope.�y for�ropept��on p�u.'posee. SEE REYERSE fOR EXPIANATORY LANGUAGE
RGR bv .�..14✓�" 2/6/84
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