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HomeMy WebLinkAbout1824A w'oexees�coWvit�s,�no�orct.,�R:�r�ov ��••��• � qPPLICATION FQR PLUMBING PERMIT I here6q affirm thai 1 hare a certificate nf consent to scif ce��r�z-eo � insure,ur a urtificete nf Wnrkerx'Cnmpensa�ion Insunnce,or � a certified c y thereot(Sec.JROO,Lah.C.) Nolicy No���l3US/��mpany-�(�//1�rli n � COUNTY OF LOS ANGELES BUILDING AND SAFETY f'C�r / j'S l d� � CertifieJ c�py is hrreFry furni5hed. FOR APPLICANT TO FI�L IN(PRINT OA TYPE) BUILDING r � CertiCed t� R• p ADDpESS � J (+ f[' �N�� py is filed with the cnu�ty huildin �nx ectinn NUMBEq FIXTLIRE OH ITEM • FEE department. /^� �A��< / �OCALITV I)ate�,$,Z,pppiicant,rdj�p���� WATER CLOSET G � NEARES CERTIFICATE OF EXF.MVTIpN FHOM WORKF.RS' BATH TUe CROSS SL � ! COMPFNSA710N IKSURANCIi SHOWER � t) OWNER ���� ILAVATORV � MAII } (This section need wl be completed if the wnrk invoWed ' O G qDDqE9S Q � by the peimit is trn one hundnd doiiars (f100)ur I!!6,) � SINK L�OC� Ci7v �'•6 3[�V � I � TEL.NO. 1 certify that in the performence nt tfie w�ork fnr which this � i DISHWASHER � 6 � petmit k issued,1 chall nnt empiny any pere�n in any manner CONTRACTOR O sn as tn becqme subject to the N'nrkers'Compensati�>n Laa•s. CLO7HE5 WASHER ADDRESS D�lc App�icanl I �. U ISWIMMlNG POOL RECEPTOR I �" a *%O T I C F:T O A P Y I.I C A'.V T:I f,a f ter ma king t his Certi ticatc�( ��TY/�N FUiAI f Q TEL.NO. N F.Yrmptinn, ynu shnulJ become whjecf fo fhe Wmkers' LAWN SVRINKLER SYS7EM �N � Compensatiun prn.�icinns n(Ihe Lahor CnJe,you musl fnrih- $TATE ��C, ? wilh [omply w•ith such pru��isions nr Ihis yermit shail 6e wATER HEATER •��� LICENSE NO. �� C1A55 L'�� deemedre��oked. GASSVS7EM OUTLETS I DIS7RICTNp, r 11 pROCES9ED�B�V^ LICFI�Sk:I>CO�TItACTORSDtCLARA710'a OUTLETSOVEH l�� _�'J— ��y 1 herehy afPirm Ihat 1 am licensed unJer provisions of Chaptcr 5 PER SYSTEM 9(rnmmmcing witb Srction 7000)nf Uicixlon J nt Ihc Busi- FINAL � ness and Rokxxinns CoJe,and my license is in full force and DA7E �G/[r /�C',.7 �ALIDATION ef(rcL i.icense'�umber_�4�� I,ic.Clyxx ���b PINALr�'� /,° ' � �.���Ce�I�� BY � .L']�'4K:.<.� Cnnttactn � � I am exem0� M�m the liceniing rrquirrments as�am a Plan check fee licensai architect or a regislereJ pr��fessional engineer pLUMBING PERMIT ISSUING FEE S acfiny in my pro(rsxional capacity(Secfion 7651, Bus- � inecs and Prnfessions Code). TOTqL FEE '1 �) l.ic.or ReR.No. [)ate Plan ch�ek aoplicent I i��oHr o•a•vt;rt-auti.�rK o�s�.�x,�r�o:. r•1e^�a F 1 8 2 4 A 1 hereby af(am that t sm exempt frnm �he Cnntnc[oPs AdAresa �,� � � � �j � I.irenu [.aw f�>r[he fnllnu�ing re�son (Settiqn',037.5,Rusi. CitY Te1.No. nea and Rofessionx CnJe): � • •C O O 6 � T,+s nwner of the pmperty,�m ezclucively c�rntrecting • Q�O u wilh licansrd cnntractors to cnnaltu,^t thc Crolect �l� --�-� • • ^2 (Sec[ion7044,BusinrssandProfessionsCode). , ' K-��.C={�t�,7((�-� ��� ��r�.{Z�I ' 1�j D�11 -II2 COYSTRUCTIOY LI�:NDI!JG AGI�:NCY . �.���T�CJ � �('(��d��'C�,•.",�� I here6y affirm thal [here is a consfruc[inn Iending aRenc}• �,�-���,�M1, for thr perform�ntc of Ihr �+rork fnr uliich this permi[ is ' .���i ixweA(Sec.J097.Civ.C.)• • (��_I] �/��f�j� Lcnder's Name S t�� f� � I.enJer's Addrexx � 1 certify lhat f hai•e rcad this application anJ state that thr above informa�ion is enrrect.1 agrer ro comO�Y a'ith ylt C��wity ardinances and State laws reguluing Ylumbing, and I�ereby SFF KFV}HSF.FOR EXP[.ANATORY I,ANGUAGE • outhoriv.r reDre Rntatices nf this County tn enter upon tho �b ' Rynion property for inspec[ion purposes. . / ,� . 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