Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0912A
w'ORKt:RS'COMYF.'vSATIOVpE:CLARATIOh �••••�• qpPLICATION FOR PLUMBING PERMIT I hereby affirm that I hace a'certificete of mnsent to seif ce�n(z-eo) � inwre,ur a certificate of Workers'Compenutinn lnxurance,or a certified copy ihereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Yolicy No. Company � Certified copy is herehy furnished. FOR AGPLICANT TO FILL IN(PRINT OR TVPE) BUILDING �} ❑ ADDRE$S � J ~11 U\(y,� Certified copy is filed wi�h the coun�y building insDectinn NUMBER FIXTURE OR 17EM • FEE �lepartment. LOCALITV 0. WATER CLOSET h✓� Datr Applicant NEAREST BATNTUB CROS35T � CF.RTIFIC.4TE OF F.Xf:MPTION FNOM WONKERS' COMPE!�S.4TION IKSURAVCE SHOWER OWNER �'+y.Q MAIL ' (ThIS 6eCtlOn nced not Ile Compleled if the wD�k invOlvld LAVATORY I ADORESS ��� • R : � ,�r. by the permit is fo� one hundrcd dotlus (5100)ur lesa) SINK � I CITV w N TEL.NO.�� (� � 1 cerlity that in the perf�rme e f the x�ork fnr which this DISHWASHER ( • C ! permit is i+sued,1 ahall nM em y person in any manner COroTAACTOR K ;0�1 V• L Q so as ec e subject to thr ompens ion Lawc. CLOTHE5 WASNEF F— /� ADDfiESS `�pC`�) a�y U I)afe 'O�Appiicant gWIMMING POOL RECEPTOR � v a !JOTIC T APYI.IC,i*IT:If, '�8 this 'rtificate of CITV Q y�,� p.r� 7EL.NO.Q�'��"� y F.remptinn, you shoul� be me suhjccf lo th Wnrkers' IAWN SPRINKLER SVSTEM —I 0 STATE. LIC. n� � Cumyeu.wli�m yru�i.�iunx uf e i.aiior Code.Yu ue[furtn- -- "" i— UCENSE NO. ��5�6� CL SS —/�• W�i1h comO�Y w'ith such pror ' s or th- rmit xhall he WATER HEATER deemed revnked. GAS SVSTEM OUTLETS I DISTRICT NO. P CESSED BV I.ICk:\SEDCONTR.�CTOR511F:CLARATION OUT�ET50VER � .CLGs.sLr� f herchy atf'vm that 1 am licensed under prnvisions otChapter 5 PER SVS7EM � 9 (commencing u•ith Seclinn;000)�t Divisiun 3 of the Busi� iINAL �. i VALIDATION ness anJ Yrofessions Code,and my licrnse ix in full force and OATE �, ���� � effect. LicenneVumher^�'"��� I,ic.Clasx �_�� F�NAL � BY �J µc ,.��- y "1 �� c��i�a�m � � I am exempt from Ihe s�ng reyuirements as S am a Plan check fee licenxed architect or � registered Dr�fersionat enRineer pLVM81NG PERMIT ISSUING FEE S � scting in my Profesxionat cepacitY(Section 705�, �uc- . iness and Profescionx Cnde). � s� '�''^ � �" TOTAL FEE [' • •,• . c Lic.o�ReR.N�. n�te Plan chack appliceni }IOME O�l'\ER•BUII.DF.R DF.CL.4RATION Nama �' � �1���>G AddrYac � ' � � ^.��J'J 1 hereby affirm that 1 am exempt (rom the CnntracMr'.r License I.aw for ihe fotlow�ing reason (Section 707L5,Busi• Citv Tel.No. �.�.'i^�j nexs and Yrofnssions CoJc): � f,ax ow•ner ot�he property,am ezclusively c�nlractinp with licensed c��ntractors to conslruct �he prnject (Sectiun 70as,Busineas and profeccionx Code). . CONSTHUCTIOY L1iNDISG AGIiNCY 1 hereby atfirm Ihet there is a conxtruction lending agency for the performance of [he w•ork for u•hich this permit is issucd(Sec.3097,Civ.C.). [.endePs Name " Lender'x AJdrrss 1 cer'fy Ihat 1 hare read this applintion and state that the � abov 'nfmmation ix correct.I agree tu comply.vi�h atl County g�_r K�VF RSC FOR EXPLAYATORY I.ANGUAGF. nrdi� ces and 5totc lau•s regulatinR Plumhin¢,and hereby auth representatire this Counry• cnrer upon the � abuv lione eriy fur insFrction pu pus . Si re a erm� ee te ' ' �'� !!��o\�: �..�TY�,`�, c;��;\'s�4,\�,y'.:. ;1\ \J•.c• •��,:\�',� t\�.\c•�^` 7 0� .`'' � `�'C .�'.�'� ='"`L�,�,G'.G��\G ;�.'. . � '�,^. .t\�. ' .,. :�� � a � -�` �. �\ �' � `- t ;x1 c. ,1�•C . 1;j\� . �'',, ' �'i"�� \ '.C�i 7 �� �,� �r `� _\ ' C. i • \ �i';• �' \ j ���•�� ` . y, �. .\C"�; \' . ;,������ � �.' . � : \��i��', . , . �' . � • '•�. � �� \, � '� . . . ' '', \�M\. \• � ��` ,. ���- .,�' \�; . . ,� , � � �:: \ - . � .�� ,,`�;���!�'��� . `�,. '� � .� \ . ` \ ; \ \ t' , p e,\ \��, .\ �\ � � G \ ,' _ i ; t �'` \ \�1 \ \ ; , • � ` ;,` \ ��. � ` ,G � � �. \ i .\ �' \ \ ` 4, ` \�,�:�s, � \ �� . \ •\ \ \�.../� � � O \ � \�. \ �� . _ \ \ \ � , �....-��" , � \ �i \ O . , c� � O a ` � . \ t' \ ` .,,r � c-, _ �� ' �''� - ^.��,��?,, G .. �. =�� _ V _' •. ;< <. _; : _ -�.. _•.�,�'^ � f. .. f c: C,s;,l n r� _ ,� ' � % �'. �l � �C^ �, • �. ���� _'��,�n y�i ,•z^v.~ •�•� � . .. L ' '`�~� ,�t. .... � t `�^ i�-.,rn "� �i �i \ "� � r. y�_�^:: C�' . � -�. f t._= 'I.(:,. _ �'" e: �� ' r� p.�� <' �,. ` �` :r: �v •-i. r. C t.. :-' �' �y 'r" � � ' =, •r^ _ c �7"�"' :.i:, �� :. ;7, ^^r,~'�r^ c G�V. G/.'� � _C _ ^% -"r- .. a,� � � j. � . f r �i: - � .-. � � ��• ; � _ '�'•=„ ... ' � ,,. r N G � . �. ' � � ' �' y C. .. (^ f. ^ r � . / � � i� _► .' �_ � ..�� `��.• c'v .. ��.% �.�/ ` ( . � f;' � � ..���. ^ �.V.���v. � ''r' . ^1 „ . f- /� ' J ^ �'' .�.. �� �'. � r N�^ 'r � ^ C��rj: �l�/ � ' v r' + � i -�i~'G,''�C. .`,, /: G^•y�^ �iy�.l1 � . Y.~ l � � n �f� �� � � �!.�v .C �C ^V ' ~ r' � �� . . C 'C� G+ � v, �n ...� �. ^�: i . :�' � � =t -� - ,:' �.c a �.—o:.. : -•�? - : ., � :i c'" � _ .. r,;, n c �. i- ^ � �- —� ; , ' - r � � ^�' '�' +^!'.^~ i�.:l. L�^h'. =..-n �.� .,.�r f, ^ C: O • � �� �' °`� � _ � � v'=.. �, - ° r"~ ��' I ' � � '' �.� ' � ,o��.~Y ".f.�. � � � V • . . ^`� Y�'� ? 4 vl�i � � w �� f: � �t. � - _ +,^L ' � .�' C - �. r. v � C+ . . y _- �. '.t � w,,,.,� � �.,,, C v�. « S^� .. , �: � ,[t d' C C' � -� �' � Gi �-w C - i� � � � ' f n C r �.� C ... Rn y ' . �,r `� � ` . G � Yt �'. :v, •.• i � -'F�,'�'� _ ~ � = n1 C� r. �' C ' Ga . • ,�c'�� ^ _^, c' ` � . . �` - � �" �+ � Y�;G f^' ` � _ / .!'� /�i ��i i��''/ .,'. �,� ' //'��//