HomeMy WebLinkAbout1220A (6) w�oKxe�es•co+teevswrtovnrct.,�Knrio;v "•���, , APPLICATION FOR PLUMBING PERMIT �
1 hrreby affirm that 1 hare a'certi(icate of consr�t tu sclf ce m�z-�o
insure,ar a certificate ot Workers'Comprnsalinn Inxunnce,or
a certified t�py there�f(Sec.7800,Lab.C.) COUNTY OF LOS ANGEIES BUILDING AND SAFETY
Ynlicy vyG;A((LLZ"nmpanyJLl/�/1 —��Q�
� CrnifirJ cnpy is hercby furnixhe�. FOR APPLICANT TO FILL IN(PRINT OR TYPE1 BUILDING
�ry ADDRE55 3� ��JL�
�y� Certified copy is filed u•ith 1 e county uiiding i rction NUMeER FIXTURE OR ITEM • FEE �
r�
bate ��e Applicant �NATER CLOSET �oCALITY G,��� �D S
NEAREST
BATH TUB CROSS ST.
CLRTIFICATF OI'I[KGS1f'TION TRq31 k'O t 1?RS' 1
C041PGNS.4TfON I\SUR.I�CF SHOWER I OWNER
(This seclion need not fie compleled if the work im•olr•ed
LAVATORY ADDRESS d
6y the permit is for one hundred dollars(f100)or Iess.) SiNK I
O
CITY TEL.NO. U
1 cerlity that in ihe perfmmance of the N'OfR�O�R'M1ICN(IIIS OISHWASHER �
permit ix iss�md,1 shall not empiny any persnn in arty manner CONTRACTOR ' �
so as tn hrcome subject to the N'nrkers'Comprnsaliun Lews. CLOTHES WASHER AODRESS �L[[]��'D/ /'�//� /A1���(��� O
Date ?,p�liCant SWIMMING POOL RECEPTOR —"-"""�'–"= W
tiOTICIi TO:1PYLIC,\'�T:If,afler making thix Certilicala of CITY - 'l�l TEL.N �
lxemptinn, }•nu xhouii! hecome subject to the N'nrkers' LAWNSPRINKLERSYSTEM � I�'e f�• �_�G �
Co::ipc:Sation pro.isirn;of llia i.ahor Cudr.Y����must furlh. STATE LIC, 1 —
u�ith comply w�ilh such prm�isions or this permit shall be
WATER HEATER I I LICENSE NO. CLASS G—.!
ilrcmcd re�•oked. I I DISTRICT NO. PqOCESSED BY
fiAS SYSTEM OUTLET5
LICE\S[tD CO\TRACTORS DIiCI.ARATiON pUTLETS OVEq I �� ��C
1 hereby affirm that[am Iicensed under prneisions of Chapter 5 PER SVSTEM
9(cummencing�rilh Srcfion 7000)n(biaision 3 of the Rusi� FINAL
I nrss and Professinns Cndr,nnA my license is in full fnrce and DA7E VALIDATION
� effect. I
1 Licenxe Vnmher�►L/.�� I.ia L'laxs �r� B1NAL.
! n.
Contractor�vn� J/�� Datc����
� ..1
� f am ezempt frmn the liccnsinq rcquitemcnts as I am a Plan check fee
licensed archihct or a tepistered profeuional rngineer PLUM9ING PERMIT ISSUING FEE S �
acting in my r.orr«�o��i eapacit}' (Section�ns�. n�s. Q
ineis and 1'rnfecsinne C�de). TOTAL FEE
I.ic.or Reg,No. Date Plan ehack opP��cant
FI0�1C OR'NIiR-OUILDfR DICCI,AR.aT10Y Namn . .� �'^,i,;
f herel,y n((irm thnt 1 nm erem�t fr�>m ihe L'ontrector's '4`�`�`�6 � • '�' • • `
ILiccnsa Law for the follow�in rracon Srction 7071.5,Rusi-
ness and Pmfessions Code): F ( C�t� Tel.No. � .+ '1 �,'\'
� � l,as nu�ner uf Ihe property,am exclusivcly contractinq � � � L
u•ith licensed contr�ctnrs to cnnstruct the pmject -
� (Srction 7044,Pusinrts and Yrnfessions Cadc). f ,
� � f: t /� _^ �
I CO�STRUCTIDY I.ISYDINC ACI:NCY
' 1 hereby �ffirm thnt therc is a construction lending agency
� fqr the perfmmnncr of the w�ork for M�hich this permit is
I icsued(Sec.3097,Civ.C.).
� Lendzr's Nam•
jLcndcr'S Addrcss
I I certify thst 1 hare read this application and state th;it the
aboer information is rnrrecl.I sqrre to romply�vith nll County Slil.REVF.RSG FOR IiXPLANATORY I.ANGIfAGP.
� mAinanres and St�te lau•c regulaling Plumbing, ond herchy
anihur' c represenlali.�es af!h'c County to enter upon the
abore- entio�peC;y for .ection purpotes.—
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