HomeMy WebLinkAbout1148A (7) WORKERS'.COMP£NSATION DECLARAT[OP3 �� »�os�w ��-ji
I hereby ef��m tha� , he�e a certificate otconsent to self � cE..,,._so, APPLICATtON FOR PLUMBlNG PERMIT �
insure,or e certiflcafe ot Workers'Compensation Insurance,ar .
a certified copy thereof(Sec.3800,Lab.C.) � � �
�n�np�dC FREMONT INDEMNITY COUNTY OF LOS ANGELES BUiLDING ANDSAFETV i
PolicY No..G3Li][.YYHMnpanY �, .
�
� � Certified ropy is hereby fumished. FOR APPLICANT TO FI lL W(PRiNT OR TYPE)- BUILDfNG � � � �
�Cer[ified cop ia filed with th ,County bu' !ng i pection NUMBER FIXTURE OR ITEM • FEE AOOFiESS
depart e t. / ; WATER CLOSET LOCALI7Y
Dstc ' �Applican't ' NEAREST
9ATH TUB CROSS ST. � ��'K' I
CER IF1�ATE OC EXE 1PTlON FAOM WORK£RS' -
COMPENSAT[ON INSURANCE � � SHOWER OWNER
LAVATORV MAIL 'tZ1�L7 RIMFIRE �
(This section need not be compieted if the wo�k involved AODReSs d
by tlie permit is foc ane hundred Jo{lazs (5100)or tess.) S�NK
. dTY DIAMOND BAR TE�."0.594-862 V
I certify that in the performance oP the work for which this DISHWASHER � � �
perrtit ic issued,t shaF}nat employ anY person in any manner CON7RACTOR �
so xs to become subject to ihe Wbrke[s'Compensatiors Laws. CLOTHES WASNEIa F
aooaesQ145U GOLDEN SPRINGS c� I
Date Appticant � SWIMMING POOL RECEPTOR a �
NOTICE TO pPPLlCnNT:[f,after making ihis Certificxte of CITY w��Ur� TEL.NUS,gS-7547 N
Ezemption, you should become subject to the Workers' LAWN 5PRINKLER SYSTEM STqTE LIC. �
Compensation provisiuns of the Ln6or Code,you mutt forfh- LICENSE NO. CLASS �j3 �
with comply with such provisions or this permit shalt be WATER HEqTER
deemed revoked. GAS SYSTEM OVTLETS DISTRICT NO. PROCE93E0 BY
oa �
LICENSEDCONI'RACTORSDECLARATION OUTLETSOVER ��/ �
1 here6y affirm that[am licenced nnder provisions of Chapttr 5 PE R SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- ��Np� VALIDATION �
ness and Professions Code,artd my ticense is in full force and f" P�N� DATE � � 8� �
eLfec[. �O f �� , `v _ Q� �
FINAL
License Number - Lia Class � 'S BY
Contractoc � lDate Y �
� I am exempt from the lieensing reyuirements�s I am a Plan check fee � .
licensed architect or a regis[ered prafeasioaal engineer pLUMBING PERMIT 13SUING FEE$ �l� s
aciing in my professioaat capacity(Seetion'i051, Bus- � �
iness and Professions Cude). TOTAL FEE (p l0 �
J
5
Lic.or Reg.No. Bate alan check applicant €
HOME OWNER�BUILDER DECLARATION Name ��UT POOLS
Addresc 2145d GOLDEN SPRILdGS � �> > �$A �
t here6y af£am thxt I am exempt Prom the Contractor's .
License Law for the followi�g reason (Section 7031.5,Busi- City T Tet.Na. � #• • • • • 'rJ �
ness and Rofessions Code)= �
� t,as uwner of the property,am exclusively contcacting � • •1 b 5 0 �
with licensed coniractors to construct the project = `
(Section 7044,Business and Professians Code). . • ��� �5�� �
CONSTRUCTION LENUING AGENCY ��L 2 9�$.� �
I hereby affirm that there is a construction lending agency
for the pertotmance of the work for which thia permit is
issued(Sec.3097,Civ.C.). �
Lender's Namo +
LendePs Address
I certiPy that 1 have read this appiication and state that the
above information is correct.I agree to comply with all County , SEE REVERSE FOR EXPLANATORY LANGUAGE
otdinanc and State laws regulating Ylumbing, and hereby .
auth�ry�represen veS of this County to enter upon the
�b�fnentioned opert for inspection purposes.
�'� f�]. — _ ? —� ! I
�� ignature ermittee Date � i
"h �> � °y�'_ e.�' �� � oon �ro�r I � 1 I ..
•���.. 3 � 'r` o+ i "" _�;.! a .,.. `�' V a'V c' i ?� � I 9 1' i
F o � C��`'�� 0.O K = C i w y " ' � a, ��o,� � 3 E
^ " � ^ o sM °so.00 0 3'� a �• �
,'� o � o� ' `' �` ��Q o F 3 �-' ° = ° 3 v u, ?;
O u° �� .. e o�� .,.,.. ^ ,; . ets ao o� o
►" a>. c, w a°',�' � � 3'�•,-� c�, _ � ^,%a c ��-= d Q
Q �..�� " ° o�.y.�•� Q n"S tl o �� o ° z-z.`'?;z n•�
' L Q� y Qs'e= V ° �' �-'� a
� C �� �l'� y� � y O a v O b `�3 '.�. : C y `'�. 3,� � _
v
r., h = � � AC v � G "' � fn,a�3�
W £'����o � �u�0�c°, e s� �o v � ��,p o y a
G �•c'� " ��°` '^�'ew >,•� o0 0� o�ro y'ro �
a','' C° o � = o �° . 'a'� •. � �, a v ' e u
C� o '" cyae �o�-' c • o.v o �'ti �', .'�� vi v
A �o = .. h �.t �° =y,� oa �c o'� a °o°' �:� c �
,.:... o � >,:: • o N o "�� Y a c � 'ts
� " a� y V 6 C,= C�I '_" ,p� ���.. C y � �n � �'' 3� � r
� .y�'�4 i�v CJ M'�� � ` � � � o�V��O oo .. ^ � .�.�
� �•�� tl on',� v� 3� " �4 c c � � z-�o,�i�C �,'��„ n�; 0' p _
Z ia ��Q o a-a °� d n o,z a ro ���v 3 i,.�C� o � �� �� V � � .
O T� 5 �S•Q.N r � � L` ��� U C_�n ^11� GO y.. y c � � �
•�;v"', o�,�-i'� i,p N � d,,��,.Q � s��� y v z ��� ► O �4y °Y+ ec 3
L �y� £ o = ocq '�`a� _ a: � tin'u �•.. � �G � OQ " . A O
`r�.:1 W 3�a'.?o C`��.'� b�','� �`�.�. 4� 'v.c c�,o c�i. .
1 '
W • � �. � , I
� . � I � �
� ! I
z _ l �
� , �
o � ��,� I ' !
w ' � �
a i ; �i .
Z � : �
� : I ; �' �� �
� I '
I j � ; I � � � I
� � � i � '�� , � ' � I
� , i
i �
� I I . { ��= I ; I � �
� ' ` II � � I �
� I
, I I � � i I .
. ,�.�.�.�., .
W I
� ;�
�
Q ��
�I �.-- . I
Z . � . ,
. � ��..,
N '� ' � I�' ,: I .
o I �I ' -�� �1 _ _� I
�I. � 1 '� �{�. �, C y i �
W; � W ;
�: � ! � �j.` ' � i
�; i I � I � �.• ,.:; ��_; o I �
- i �c._ �-S'�;--, '�- � � I � � ' ;
Qa� ' �."�;,_'�, '}�.I�� . I � � . i ;
wl ' \ : I o ' � i
Q. :�`I . � '�`{' 1i.`�!. ' � f ` � I
p �, \ � i �'I i . w � � .
+—�\ � � � � � I
-�—'--r��i i�o.. • z. � �
Y I l O I � . I � :
Q I c7; a� cn.. w �C,� : . . .� I i I j
:w.
�,.o z W;�; � a ,_
Q i m'g �w X I o' I ; ` I �° { ;� . .! I �
�i��� �i ,2:LL I2', ; i,:7 �Q�d ' _ . `
.� ��ip.� 2lZ{Fu,- �; uF-l��l ! ..-��:[LQ.� ! I
a �,=;,a..wi¢Im; �;Y' . ' J , - I �W� ,.. � (�i. �:,,� 1
I Q W:C7 I S..''7 j S I S 1 I f_1 Q ' i�F' 1
� ❑:�I C� ln:' fn:J . i�4�� .
i Z' O Q Q I Q I�� Q'H. ? { zC :
����C7 C7% W.���',.�.�. ...�' tiw... — ' !
�.w.e„�.,�.Y..�.���... d. ...�..