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Home My WebLink About0864A (4) �ian:��u�l�U4.1'LARATIOY �eRtuw J7 affinn`that � ��e ��r«.f.��e �,�cnnsep[ ��u�� E.�„=-.a, APPLICATIO.J FOR�i�LUMBING PERMIT ��i a cer[ificale of H'arkers'Cnmprnsatinn Insurnnce,nr i u .i copy thereof(Src.1aoo,Lob C) COUNTY OF LOS ANGELES BUILDING AND SAFETY. r'� n(�� Jo. Company d'� �' :rnifieJ rapy i.a hercAy furnished. FOR APFLICANT TO FILL IN fPRINT OR TYVE1 BUILDING� �� Cerlificd cn NUMeER FIX7URE OR ITEM � F[E ADDRESS � _ � py u filrJ w�ith t nty 'Idi inxpccti��n . �de m t. � LOCALITY • WATER CLOSET ��'�� le/�'/�`��i pPPlicant NEAREST 11 BATH TUR CROSS ST. (y4 /^ �y�;'iQ� � CIiRTIFICATIi OP EXENPTfON FROM�V'ORKISRS' COMFL�5.4TfON IISURANCIi SHOWER I OWNER �( � LAVATORV MAII (This section necd not be compieted if the work incolved � qooREss �� .7� 1— by the permit is for one hundred dollars (5100)ur Iess.) >' SINK CITV� �Q TEL.NO. � O 1 cerlify�hit in the performant:of the wnrk for w�hich this OISHWASHER I f� C.1 permil is ixsucd,1 xhall nnt emplo y•a�y person in any rnanner CONTRACTOR�Q�. su as�o h com subject to theyyp nr"�� r �m nxalion law5. [LOTHES WASHER I ADDRESS � /�O +�� Q I)atc��:lpp�icant_t!�.,� � f-� $WIMMING POOL RECEFTOR � I �� _�� W NOTICI:TO:1Vt'I.IC:IVT:If,afte aAing ttiis CertiPcatc nf CI7V�^ TEL.NO. � IiMemplinn, ynu shnnld hernme suhjttt tA tlie,R'nrkcrs' LAWN SPRINK�ER SVSTEM I I �� d STATE /?!1p on LIC. V> Compensalion pm��isions nf thc Labr�r CoJe,ynu musf fnrth- "' LICENSE NO. 'pLI I6 IL� C�ASS� � ,vit!: tc:r.�.ly u�i;h such pru��isiuns or [his Fermi[ 5ha11 he WATER HEATER I I ` _ deemedre��oAe�. GASSYSTEM OUTLETS I I DISTRICTNO. PROCESS�DBV I,fCfti51�:DCO\TRACTORSDf(CLAR:ITION OUTLE76OVER W ��r ��1/��. 1 hercby affirm fhat 1 am licensed under provisions of Chapter 5 VER SVSTEM 9 (rnmmencing a�ith Sectian 7000)of Di�•ixion 3 of tl:c Rusi• FINAL �/A IDATION ness�nJ Yrnfes�inns C�Je,anJ my licrnu ic in(ull force and I DATE � a, —�._� rfftct. t Liccnxr.lumbcr v Lic.Class �n4� gy AL �c� l ' Contracror Date 7 d�� ` � 1 am exempt f m the licrnsing rcyuircmm�ls as I am a Plan check fee � lirensed architect or a te@isttlred professional enginerr � pLUMBING PERMIT ISSUING FEE$ � actinF in my pmipsional capeNty(Secti�ln 7051,8�:3� ' � inc:s an<I I'rntr.c.sions Cnde). ` TOTAL FEE ! � . � � I.ic,or Rr!C.��• Date Plan chack npolicxnt ' � H0.`diS O'd'\ER•HUI[.UEH DGCL:INATIOV �1ame � 1 herehy affirm thet 1 �m eeempt from the Cnntrxctnr's AdAress ; • l.icense Law fnr Ihe fallou�ing re�son(Section '031.5,8usi- ��ry Tel.No. I� � nrss s^.d ProfcSsinns CoJe): , � 1.ax nwner of Ihe pmperty,am exdusively roninttiny , , �:` � �ri1h licensed cnntratturs ta construct ILe pruject I ' (Section 70a4,Businecs ond Professinns Codr). , � � �� 'f�Ge�l. CO•r'STNUCTfUti L[NUIV(i AG1iVCY , �'• . • e .I�• i hrreby affirm Iha[ �here is a rnnstruction Icnding agenCy ' fnr Ihe per(onnm�re of Ihe�cork for ahich t6is ptnnit is � • • � C�li isxuc:l(Sea 3097,Civ.C.). � V Lendcr's Nsme . � " 1 . � " � l.:...� \I.endcr's:\ddrasx � t�.� _�� 11 cef�ify�hat 1 haee read thic apPlication anJ sfate Ihal the ' �•hm�e informaiion is rorrec�.1 aprr ro romply u�ith all County S1iG RLVLRSG FOR IiXi'LAIM1ATORY LANGUAG}: � �rdinances and State 1��5 regulatinq 1'lumbin,r„ .�nd hereby unhoriic reprrsentsfirrs of this County In rnter upon the �l�ho`�e.yiff3lone p�p tY for inspeclion p'vCnses. .. v 1� _,)J� //�7�� ESiKnai otYermittec Uate ' 1 , �� n C C ��' I n � �.�1 �r �� ,��;1�,1�,I��Y . L � I�`�, ��I,�'�; r' � • ��` J .a I C: .;�R' i t�— �..,. -�.. � lr �1�'14z�a ` � }:.� �' _ . � ... • � r..�I ,I 1�U l� Cr. ��II��r I r r C 3':%i I_ F < .. ' �I�.I 1 �U �X yi �I� 4 _ �/ ... O! 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