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HomeMy WebLinkAbout1824A (11) �4'ORKERS�coWv�:�s,��no�or�i.,�R:�rioy ��••��• � qPPLICATION FQR PLUMBING PERMIT I here6y affirm thai 1 hare a certificate nf consent to scif ce nr�z-eo � insure,ur a certifieete nl Wnrkerx'Cnmpensation Insunnce,or � a certified cj�D y thereot(Sec.JROO,Lah.C.) Nolicy Nol]_AlX,2LCompany-�(�//1�rli � COUNTY OF LOS ANGELES BUILDING AND SAFETY �r / j5 l d� � CertifeJ c�py is hrreFry furnished. FOR APPLICANT TO FI�L IN(PRINT Oq TYPE) BUILDING r � CerliCed m R� p AD�pESS � J P f[' �N�� py is filed with the rnu�ty huildin mx ectinn M1�UMBEq FI%Tl1RE OH ITEM • FEE department. �w��< / IOCALITV ��0��'7_II-47 ApP�K.a����n�. I//,� WATERCLOSET G � NEAREST J'-'s�.a� ;Flh BATH TUe CROSS ST. � � CEkTIFiCATE OF EXF.MVTIpN FHOM WORKF.RS' CnMPF/�SA710N 1!�SURANCI: SHOWER � t) OWNER ���� LAVATORV � MAIL } (This section need noi be completed if the wnrk invoWed ' C1 G qDDqE9S a � by the peimit is trn one hundnd dOiiHts (f100)ur lex,) � SINK [�pv CITY �'•6�[�V � I � TEL.NO. 1 certify that in the performence nt tfie w�ork fnr which this � i DISHWASHER � 6 � petmit n issued,1 chall nnt empiny any pereon in any manner CONTRACTOR O sn as tn becqme subject to the N'nrkers'Compensati�>n Laa•s. CLO7HE5 WASHER ADDRESS D�Ie AppiFcan/ I �. U ISWIMMlNG POOL RECEPTOR I a D:O T I C F,T O A P Y I.I C A',Y T:I(,a f ter ma king tliis Certi ticatc n( CITY� Fu�.�f� TEL.NO. N F.Yrmplinn, you shnulJ become whjecf fn fhe Workers' LAWN SPRINKLER SVS7EM $TATE ���, Z � Compensatiun prn.�icinns nf Ihe I,ahor CnJe,you musl fnrih- wilh [omply w•ith such pru��isions nr Ihis permit shail 6r wATER HEATER •��� LICENSE NO. 6� ClAS5 L'�� deamedre��oked. GASSVS7EM OUTLETS I DIS7RICTNp, r 11 pROCES9ED�B�V^ LICF.NSk:UCO�TR.4CTORSDECLARATION OUTLETSOVEH l�l _�'J— ��y 1 herehy afPirm�hat 1 am licensed�mJer provisions of Chaptcr 5 PEa SYSTEM 9(rnmmmcing witb Srcti�>n 7000)nf bicixlon 7 nt Ihc Busi- FINAL � ness and Rokxxinns CoJe,and my license is in full force and DA7E �G/[r /�C',.7 �AUOATION ef(ecL . i.ieense!�umber_�4�� I,icClyxx ���b PINALr�'` /,° " � �.���Ce�I�� BY � .L']�'4K:.<.� Cnnttactn � � I am exem0� M�m the liceniing rrquirrments as�am a Plan check fee licensai architect or a regiFlereJ pr��fessional engineer pLUMBING PERMIT ISSUING FEE S actiny in my pro(rsxional eapacity($eclion 7051, Bus- . inesg and Prnfession3 Code). TOTAL FEE '1 �) l.ic.or ReR.No. 6ate Plan ch�ek aoplicent I iaoHr o•a•vt;rt-auti.�rK or.c�.�x,�r�o:. r•1e^�a F 1 8 2.4 A 1 hereby affirm that t sm exert;pt frnm Ihe Cnntnc[or's Aderesa �:� � � � �j � I.irenu I.aw f�>r[he fMlnu�ing re�son (Settiqn',037.5,RusL Citv Te1.No. nea and Rofessions CnJe): � • •C O a 6 � T,u nwnnr of the pmperty,�m ezclucively c�rntracting /� • Q n O u wilh licansrd cnnfractors to cnnaltu,^t thc Crolect /`���f --}�—�� •• •2 (Sec[ion 7044,Businrss and Professions Code). , ' n-�l�t•C=r�Gt�.7((�-� I�� -j�(�r�{Z�I ' 1�j 0�1 1 —F32 C4YSTRUCTIOY LI�:NDI!JG AGI:NCY . �.���T�CJ � �('(��d��'C�,•.",��J I here6y affirm thot there is a consfmclinn Iending aRency 'T'7'("'�C����'r � for thr perform�ntc of Ihr �+rork fnr wliich thit permi[ is �— ' .�-�i isaued(Sec.J097.Civ.C.). • (��_I 1 ^/)��j�� Lcnder's Name S j�1 �� � I.enJer's Addrexx � 1 certif5'Ihat f haee read this applica�i<m anJ siate that thr above informa�ion is enrrect.1 agrer ro comO�Y a'ith ylt C��wity ordinances and Shte laws regulating Ylumbing, and hereby SFF KFV}HSF.FOR EXP[.ANATOI2Y I,ANGUAGE • outhoriv.r reDre Rntatices nf this County tn enter upon the �b ' Rynion property for inspec[inn purposes. / _� . 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