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HomeMy WebLinkAbout0842A ��'ORKGRS'COti1PEtiSATiO'd D};CLARATl0�1 veesnw ^ � �,e«hY nffirm �h�� 1 haee a'tertificate ,>����5�„�,�z��< <e.�,«..o, APPLICATION FOR PLUMBING PERMIT �i insure,or a certificate of�Abrkers'Compensaiion Insurance,or ' ' �� a certified c�{�y there�f(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY U PolicY No. Company ' � Cettifird cnpy is hcrrhy furnisLed. FOR APPLICANT TO FILL IN IPRINT OR T�'PE) BUILDING n ,�" � � NUMBER FIXTURE OR ITEM � FEE '�'DORESS SQ� �' /"/PVl .!C/-v/IJ Cer�ifieJ copy is filed k•ith�he enunty Uuilding inspectinn � /� �Ic�ariment. LOCALITY �//��CvoG Ia2 I1atc .\pplican[ WATER CLOSET NEAREST BATH TUB CfiOSS ST. S!J^����r' C��Polf���✓ " � CERTIFIC.ATF OF EXFNI'TIOV FRON N'ORKERS' C0�1PEN5.\TIOti I�SUR.4NCl; SHOWER OWNER �3�(� (�/'yJ/�/r./ LAVATORY MAIL } (This sectian nced not he completed if the work invoived aooRe55 -S�/�+E a by rhe permit is tor one hundred dollars(;100)or Ieat.) SINK I S9SG�2 O CITY TEL.NO. U I crrtity lhst in thc perfnrmnnr_D�IIIP u'O!I(�Uf ti��ICII II1I5 DISHWASHER � pennit ic issued,I shall nqt empipy any persnn in any manner I CONTRACTOR Q(JN� � sn at�o becqme cubjeCt to Ihe N'orkets'Compensation Lnws. CLOTHF.S WASHER � Il AODRESS U �ate —1�Ap�licant�(,�E�'Yln.� SWIMMING POOL RECEPTOR I a \OTICii TO:�PPLICANT:If,afcer making Ihis Certificxtc nf CITY TEL.NO. tA Exemption, you shoulA hernmc suhject tn the N'nrkrrs' �A�NN SPRINKLER SYSTEM I STA7E V.C. z Cm:ipensnUou pro�isionx�.f liir Lai�or Cndc,you mus[ior[h- UCENSE NO, CLASS w�i�h comply u�ith such provisinnx nr ihic pr.rmit shall be WATER HEATER I Jeemr�rc��af:ed. GAS SYSTEM OUTLETS I� v DISTRICT NO. PROCESSED BY LICLti51iDCOVTRACTORSDI:CI.ARAT10'v OUTLETSOVER ffl <��ttJ�Li 1 hereby nffirm ihat 1 am licensed under prnvixionx of Chaptrr 5 PER SYSTEM 9(commcncing u�ith Scction 7000)of Dieision J nf the Pusi- /��� � FINAL (� nrss and I'rofescions CoJe,and my lirense is in full fnrce and � '�L� �L� �ATE �����''{L VALIDATION cffrct. I FINAL � Licence Number l.ic.Ciasx Ay ��j f��(,(��� Contractor Dale � 1 sm exempt from the liccnsing reyuirrments ax I am a Plan cheek fee tiCensed architrct or a registered p�ofecxional enpineer pLUMBING PERMIT ISSUING FEE$ ��j arting in my pmfeceinnal caparil3'(Reclion '051.Rus• '1 iness anA Professions Codc). TOTAL FEE �� �v l.ic.or krg.Nn. Da1e Plan check aPPlicant 110.'dti0'd'NICWEUII.DERDF.CLARATIO\ Nnr�e 1 hereby af(irm thit I am cxempt frnm thr Contnctar's ntldress I.icense Law fur Ihr follou�ing reason(Settion 7031.5, Husi� City Tel,No. nes5 an�Prnfessi�ns C�de): ::C�',(,•r rI� � 1,as owner of ihe propertY•am exclusively euntracting' . � with licensed coniracturs to eonstruct the project � e • e • � (Section 70a4,Ruainess and f'rofrssinns Code). � � �x�� COySTRUCTIOV I.I:NDItiC.�1GI;�1CY 1 hereh)• affirm Ihal thrre is a canstruclion lending nRency ' ° ' � �'�(;" for the performance of the w•mk for a�hich this permit is iccued(Sec.J097,Civ.C.)• � �,�;.�^,,—Fj� Lender's Yame Lendcr'c Address I certify Ihat I hare rr;id Ihis npF�ication and stare that the sboce intormatinn ic correct.I apree to cumpiy«�ith all County S�r RFVi;RSti FOR IiRYLAVATORY LAVGUAGTi �rJin�nces �nd State Isu•5 reRuistinq I'IumbinR, and here6y , nulhori:c representalirrs of this County to enter upon !hc �boce.mrntioned property inr insprctian O��rposes. � ��'iG?�� 1/-3� - p/ Sienature of Prnniuee Date G . �, 5 1 ' G..`,\\C.��\T��\��\C' �,t :1 �'` \� ; �'���'`\t"` '`\` �c�' U � �\ a n�Y� �'�.Z Z r �\G •aC `\ti, C� �-� �\�`��� C ! �\r ' �\p y, ',\ \� ��1�, C rf . , O �\r •\ `,C �` U � ° � \ � '� ` � �; O �`` •i-'���;� O. \ � �. �\� � �` ` � � � � �r` �, \;�,�.�� 3 ,. �r \ "\ \j��� ti'.•. - ' \� i.-��+ \ `� � .. � �� �.��� . � \,� O1 .� o , w• �(� ' � � .r \,\`� ;�•.\ \ V`1 . � y� - o .. � � '\ c N \ \ f. . " ` � \ � ' N � ' .e tG, (� n� C 1 7. c� � a ' � \ ` . \ ` `\• � \ \ , `� \; \ \ `� " � \ , \\ `�i \ ; , \ \ \ \ �\ \ \ i `� \ `t \� `\ \ \ ' � i` \, \ �� � , \ � ,\ ._.. . �. . :. _ c _ � � � � � ` _ _ � - . ... -. ""_. : � "1• \ \ _ � t• � ! \ \ ` . ; - := `'_ ; c�" : _� - � -- _- ; � \ � \ `� \ � «_ „_ . . . �' ` �_ r. _ _ _ ; ✓ � \ e \i � - - �-� - _ _ � - ' r. _ � � � ; '.` 1 � ��__ " .r. � _ t_`'f• = � �„-�~• - � . Yi� I � \ , , ' ,f. _ � •l^ ., � ' r ` ` u/ I� •f " i.__' �,_= �� � •f• _'� _ _'�." --�� - __. / r. �r � �� .� 't:" !/' ��.J �!. �/'� � 'l�" � - f, r J - i'. � . � -'1�• � � � � r �C _ V�^Y• .� �' " �. � ��� _ _ ��� f . \ �. :r f ._= ,^'.��. __ �(^` ``�+c ..t^� • — ='�` _,�f '/, � .� \ � f'• • -• ` _ ��.� _ -•(/% 4 i- :•i'�r� � � . � ��. '!. \ / � � � ^•C'� '�t'! `�'` . \ _ ` ^ :J . � . � ^ C � C f - = = - -�f. % .. � i: _ �'• `s. _ ' ' - u � Y _ r'�' - _ . � - C �� � ��w ' • ' i 'C�- f-�' ' �� ' � ''"' -, .. L� �. f� � = - .^ `.. � � � � ,V -� � ~ � - .r lr' -. _ _��'i ,, �^��.i • ', // . �✓�