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HomeMy WebLinkAbout0877A (4) -•�F�f'�SATIONDECLARATIOV �e4a��w APPLICATION FOR PLUMBING PERMIT {� have a certificate of cmiseart to uii ce n��z-eo� �1 f N'orkers'Com��nsatinn InsurarKe,or �� ,�(.Sp��00,LaF.C.) (^ ,��r` ��'(,1 1�-- COUNTV OF LOS ANGELES BUILDING AND SAPETY 1ri�•. -Compan, r���'1-��'I ;q�� n , _ �n.����'f is herehy furnisited. FOR APPLICANT TO FILL IPI IPRINT OR TYPEJ BUILDING ���/`: f������� '_ \ �r/��.��.' ADDRESS v ��;�( (..LJ 'r.•��,� (� �s fileS with t e cii t h IJinR ins�ecli�n NUMBER FIXTURE OR ITEM • FEE LOCALITVt ' , � T� f�c ' 1/, WATER CLOSET w��'�v' �� � .a�plicanl NEAREST r/�r I��`�� :.4Tf:01�f:Ct:�tYT10Y I�ROM WOR ' S' BATH 7U8 CROSS S7. � �f r��^ COMPF.tiSAT10\INSUR.�NCE SHOWEF OWNER�Ay�� � MAIL "��!r a nccd not bc com lelwl if the wuric imoived LAVATORY I `�J `�� ,�J } D ADDRESS � r� d '!'+i� mit is for one hund�ed dollers (5100)ur lesa.) O ��,, SINK CITV 1 I 1I�1 I .) ' TEL.NO. U .nat in the pertnrmance nf the u•nrk inr u�hich ihis DISHWASHER I I I vv��v � ��;�,� sxved,1 shall not empl�y any pe�snn in any nlanner CONTRACTOR \ �ecmne sub'ad to�he u'IIfACfb�Com cnsntion Law•s. I I A�DRES ��� � �� O 1 P CLOTHESWASHER �'r. :1PVlicant � �, W ,f SWIMMING POOL RECEPTOR I p, TO.4PPLICANT=ff,nfter making this Cenificate nf CI7v �� _ 7EL.N , tn �r � nn, ynu shoulJ be[nmc xubject to �hC l4brker5' LAWNSPRINKLERS�'STEM Z setiuu rorisiuu�uf liir Lai,ur CoJr. — -------- STATE 'llvf cX // LIC. — p yuu must fnrlin WATER HEA7ER LICENSE NO, d CLASS � .mply with such prorisions or thix permit shall he � J revnAed. DISTRICT NO. PROCESSED BY + GAS SYSTEM OUTLETS �/ [.1CFSSLnCOtiTR:1CTORSDF.CI.AR.�TlOU OUT�ETSOVEa I I I � � //e�f :rehy affirm thst 1 am licensed unJrr provisions nf Chaptcr 5 PER SYSTEM � � . �commencing��ith Sec�ion 7000)of Ui�ision 7 ot t��e Busb ` . � FINAL ����'j VALIDATION 'ess and k'rofessiocs Code,and mY���rnse ic in full force and .� �ATE O effrct. / I Lieensclumbr��` �C`� `£1aClass�� I FINA� r 6Y Contrect� �-�� ��Date S?-�1-��� � I a�n exBrt7pt from�he licensing reyuiremems as I am a Plan check fee • r�•,'?��� licensed architrct or a regixtered profexxiunal engineer ' � . . .�n �i �ctenF in my rr�fec<i�nal capacity(Stelinn 7051, Nux- PLUMBING PERMIT ISSUING FEE S [:l � � inecs anA Pmfecsinns Code). TOTAL FEE ��O SCJ �..� ± <.��+ � I.ic.or Req.No. Date Plnn chnck applicant • � a i , ;�' - � Ii0111:ON'NI:R•BI71L1)f:R I)I�:Ci.ARAT10\ Name ' n� _��. . .:1 ,. � � 1 hereFy �ffirm that I am exempt fmm the Contracror's AAAreas ' �� T.icenar Law fur ihe(ullmsinR reason (Secli�m 703i.5,Ausi• City Tel.Na. ness and I'rofessions Cnde): I � I,as ow�ner of fhe property,am exciusively contracting wilh licensed mniraclors to construct U�e project (Sectinn 70a4,Hucinesc and Profesxionx Code). CONSTRUCTfON LI[tipINC.ACFNCY I hereby affirm Ihat there is a constniction IenJing agency for the per(nrmance nf thr work fur x�hich �his permit is iseucd(Sec.3097,Q�.C.). I.ender's 4am• Lendcr's AJdrccs 1 certify ihat I havr rr;id this apC�ication anil st�ie that �he abnve infnr 'on is rrect.1 agree to comply aith all County Sfili R1iVIiRSiC PUR fiXPLAN.aTORY LAYGUAGF. orAin�nce and Stalc laws reFulating Plumbing, and hercUy authrni�e pre tali es of this County to eMer upon the above�mci ��d .rty for inspeclion purpo5e5. �/ � �� 1 ��r� Sipnalurc of YrrmiHec 1 Date _, c` . �, ���� i�\�`O �,:, :c� � � �,^ ``' c � � ,: a ����. � c .t z ..'; . �=.Z� \� �� ^'�:` ''=+ ��i �` ���o a�� � �� � a ��, ? '�\c c c < , . r°'+� \ ,Q +c� '� �� T,;��� � �?. x� � \ \2 �t r . ��i a c'\�, �c �` � t 'f''!S .\� G � � \� �� , � . `. \ ' \��`,° . ; n • � �\ c7�. \, . . � \ \ ` \`��`J , `' � ` `%�'�, ` �� . .,h � � . ---'�, . � � .� , � o � � . '� �,,, ` ,\ \ ; \ ` �, a � - � \ , ` 1; o , � \ � � . � � �. `�oo • . . ` `' r N U: f'� C% J C r C^ ` s V1 � 4• . \ ` ` � � , \ \" � � ', � \ , `� .� � �` � �, � � . \ �, ._ ;` � � 1 � \ � � � ' �, � ` � �... , � � � � �. _ �, , � , ` ` � � � _ _ _� - - :. 1 \ `` � �`-- V_ -- ^ "_ _ _ J,_ _ 1. \ � ` _ ' .._� :.- ,�f `J•� =•C'_ :., •-� _ � � « • N \ \ ' ' _ '. ' , ` ! 4^%�•^,^y C'' ~ ... � � ll:. - vi � . � ' 'C _ _ .�� `�� � _ ' �^�. � � _ e. ; _ r (. C„^.': r� I t': \ I � �'� � � _ � �' ^r - � „ �J", ✓ � �' r. — .. �.= 'r ; " . 'r-; i: — — ' ._. �� C — ' v r� Y _-_ _ ' �"=�� �[x M'�� — y�' i f. � _. • . -- � . .. f' ^ � ./� ' ' ^ _ _ -_C n- C—.�`��,� C. = = = _,�" ! , •� r� " �' � ' _. ••^�r• � C. � _ " I I�. f' � . '. ' ''` _C ± „C C�i ,�,J�� .� - -. .- r. . .:_ . �^^" '. _ C/ ' G. ^ '� G'i ,.,,'%''' ;��' �'.. ..�. ' �'= _ 'r .~t`ri. _ '. .- � wj�� - •. , • � ��''� C ' - %i �- f� ? � C S, ~ �f