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HomeMy WebLinkAbout0861A y � ��. ,� ' ��^� W � �.r s��s�a�as' ' - � ' f ��� ,�,���z:':.. IYI� �''_�...„ I hereby affirm that I have a cert�ibafe o`�� rION ]6A06]A A P P L i C AT i C��N F 4 R P L U M B I.N � a cert f e d copytt filereo f(Sec r�9 0 0,�L 6 C,�at�on�ent to selt ce e�o(z ao) . , . , ,�� , � WORR£RS �O'dPENSATIOh DECLAR .. ..e..,p .,. Insurance,aY�.�.._...�..�. ..�.. _..., .. ..�., ,M......... .. ,.a r..,�. ..,,�. - ... � F' > C O U N T V O F I.O S A N G E L E S BUILDiNG AND SAFETY. } .. . , _� Polic No. , Compan➢ � ..;:. _,......,-, . :�:...,;� .t, .�.,-. ... , , _ .,_ ,:�� << .:.��:. ... . . ..,.. . ,,,. �.w, . . ._ .,. � '�'l�E� »:..-.... BUILDING,. . �::: �. .,..,,.-5„�a.�.�.-.�.,c,e��. . � � Certified copy ts hereby furnished. ,�, NUMBER R APPLF XTURE OR ITEMN4�P���� ADDRESS �r.� � , FEE • � Certi£ied-copy rs filed wrth 4he,c,ourtfy buiiding inspection LOCALITY department. � � ... � . �. �.. � WATER CLOSET, . ._,,.. NEAR�ST . ...�..�,. .A�A Dxte- " "� App��cant � ' - � ' " ` ����"� CROSSST. � . . , .. . . . . . � .+. '" BATH TUB . .. .._ e„ '' CERTSFIC4TF�FFXEMPTION�Fk20MWORK�RS, -- �� " � -� "" I � OWNER . � COtifPENSAT107S��YNSURANCE . . .. sHOWEF . ... . ... ... .. . _ . _ . . . .. � ' , _ ., .... ... . ,��,. • MAIL� � '' � �. " ",. � � � LAVATORY ADDRESS � (Th�s�section_need pot�b_e ompleted �P the work mvolved. � . _ „ .,,„,.,,., � � �^v^-^�-W�������^"�°^�"°�"^�"'""'���'^.��^ O by tfie pexmit is for::one hundied,dollats ($100)oi less.) SINK i � CITY TEL.NO - U I certiSy�that in the�performance„oP�the work Yor which thjs_ DISHWASHER � � CONTRACTOR Q - .<..... . F- qermit is issued,I shali not emplo5 any person�n any maiine4""`� � � . � � � �- -� .'»^".".""".."".,", � � -- CLDTHES W.a.SHER ADDRESS � � o as to beeome suhject to the Workers'�Compe a.t.�on Laws... . . . ; : .,Z� �" U .. . ._ „ ., . .. . .. .. ._ � . ....____..a�...W... ..-.,,.�,....�.... �/ 2 )ate„�2_i—YO AppLcent . SWIMMING PODL RECEPTOR � ��TY P TEL. _ . �,:� . �rv_... NO (� fOTICE TO APYLICaNT If�aftei ing this Certificate of � ' � ' . - -� '��' LAWNSPNINK�ERSYSTEM STATE � xemption, you shourd��become",sub�ect to She Workers' . _�_;,,_ � LICENSE NO. — ' e�� ' �'G"`�' LLA WATER HEATEF i SS CompensaYion provisions�f the Labor Code you must forth- � � ���-�--• pR �ESSEp 8V ��� ��" witfi comp7y��w'ith such provisibns or[�(iis��permit shall,be. . -..�...:--:.x � DISTRICT�NO � deemedrevqked- � GASSYSTEM OUTLETS j � �u��/ , .. LICEnrSED CONTRACT6RS�DECLAR.4TION�� , y W " OUTLETS OV ER' � '"' �"��""� ....,.,.,,„...„,..,.., � � -' ��� " � w �'"�T`+�"h't+� 5 PER SVSTEM I hereb} affirin that I am licensed under provis�ons o�hapter��� . . FINAL VALIDATION 9 (commencing�vith Section 7000)of Division 3,of the,Busi,. �f'�� �� ��,i ���C'r'G DATE - --- �� � � �ness an,d_Yrofessionsy_Code,and my license vs m full force and.,.. . . �. ��� ,... ..,.,.,.,,,.; . : . ..:r..,,-h..._..�-:-�..,..,,.._..� ...,..:.,.... effect. F 1 N AL , _.. ...,....�,..�.... BV License Numb,er„_, � �Lic.Cla�,.w�,a,. . � � � �. _.....r.,.,....-:.�-.-.k.......��_..�...v__......__� ...__...._.._ . .,.-.....,. :,xa.aw.» �����&?'6"�""�:�r".�r4ti: .................... . .. Contractor -- '� ' Date � „ ...... ,,,,.,..,„,wvw �` " """ """"V"�` Plan check fee ❑ .< .. I am exempt from the l�censing requirements as I am a;,,, �„ , ._. ��.�,�� „�w,., � licensed architect oc a rzgistered professional engineer pLUMBING PERMIT ISSUING FEE� t��� . .�..,.....,._. , .... . acting in m} prOfess�ortal c`zpacitp(Section 7051, Bus- . -..... � ,�� � iness and.Professions Code). TOTAL FEE �,L-�G ,..,... . ., , .. . . . ... . ......,.y_..<...M�,.�._.:.�tw<.�:.»�u-c,e�.a�.�:a�wr� 3 G�o.� Q� Lia or Reg.No. .� , �. Date ... � . . .. Plan check epPiicant � ,. .....� .._.u�. ...._ �.,�........,,,.,,:���:�...��:,�:�« � e a e 5 ...,_ ., . , .�:� :� . . Name e o HO1v1E O�INER-8i7IC DER DECLAR.�T'�TaON_�,..y,.M,xrr q� . .... ,.,,.�,.,,,.,. ,..r„„e,,.x,,,•. . . e� �'� Address ? � ° � 2.�C .�. I hereby affirm tha[�I am,�eaeSnOt from the Contr�ctor s , . . �. .. . . �: ��� ;,p, „p�.;y� I f 7el�o License Law�for tfie-folloumg reason (Sectson,7031 5,Bus�- City c, M .»,....._ .....,..«.. � ..., ._ ..._ . ,x.n....v.HaW4LLwv.nsaeEkFena$Y2.�e'rF+utiw:....<'�'.Y/a'-:atzvas.aakX."�'.tFwe::�2.SG .�..+n�.vF�.tri,t✓.'�R'S-. .rm'vn+J:wX��x» G. ness and Professions G7od� . .... .." .�...`."."".» °"""" , .. - .. � 1,as o�vner of�the property,ain exctusively contracting � � � � � � � � � � � � � f C�'i �R� ? � �with licensed,contractors to construct the project ._ . . . _. ... .. ..,. ... .... . . .... . (Sec[ion 4044,Business and Professions�Code). � _ � ' � ' ' �' � CO'YSTRUCTION LENUIIvG AGENCY � . . ...�.. ..... . _... ..... .. .. .. . � , ,, .�. .. . . , .. .._.. _ .. . . .- . � . .�.. . ... . . . .. :.... .. „_,.. . ... ... . . .._. I hereby uffirm that there �s-a cons'��uct on lending agertc�' � � :� for the perforrtance of [he woik�for whic�t�is Permit,ls . ......,..,_M.:, _..... ' _ . - „_... ,�.. .-.-,.. ..,.... ,.,....,, _....,. ,._.. , , . . . . ._ .... ....... .. _... ...,.:...,. ... ...,,._.. ....�,..:._._. .....;... ,_., . . issued(Seq 3097,Civ.C.)• � � 'Lender's Name .,..,-....,. .....w.,»a.«,.»..�.;.»ma��e�n�..�:r;..�:w�.c�a�„s.....,":k��-,�w.�:kat�w.y:.".w� � �.�s,:,'-+«��a,�s;�:.,r;ns��;wL�.w:�:d.�taun+�e.-.,�w��++tµar .�>;�,s;e«�,,,�..., Lender'sAddress � .,.,.,y,..,�.,, .�„w.w+�: r.n.��»:.W;a:x. ..�„,,:.�.�w,mA'�.*:.., � � � . �� . .�. w ... . ... `;.a x,.:�',...�mawa�...w5,��'�'���a'.st�"x�:� ak7#�s? �°"� +�,�'� ...- .rv+��'", I certify that 1 hx e read this appiicat on�and,��s[ate thut the ,._���, . ,., ,', ,� , above informatmn�s,correat,�egree ro comply with ul]County SFG REVERSE FOR FXPLA'VATOAY LANGUAGF , , , ._.., . �...:.,. �.., .,a,:;,w�,-..,..n�.;w-,.�,.�..., .,,.».:M. ..... .........aA ....w.�...va,,.....,w�.:M,....�W;..,.,�.,,..�. .�..:,-, �..,. :� ordinances and S�'ate 1�'ws egula[ng Plumbing, and hereby �"" . . . . ..w. ..., .. authorize_;epresentat�ves �f'this Coun"1'y'fo�,enter.upon the . . .,.. ....� . . . .. , .. . .. . :,.. above-mentioned pr erty for inspection purposes.' � - �- "� � � � � � ' � � ���'� �' � � - � ' � , � >z � �� . . ,.. . �C/1�6�--�ate,. . ,�._... .....,.�_ ...:.. . :,:.._ ...�:...... . ......y- . . ..,..��, . w . . ,.,. ,a ........_.,. . .., . ..,._... _., Signat of Permittee_._..,. ........... . ,.. .. .. . _... . . .. _. ,..... _._, . .,.. _ .. _ , �.,.: += . .. R - 4u d%�f�`a,�.,3..l.�;5i .�� . � .. I,.,�...�:. 'r� . .. .., K ,..� .,, .a . . �._ n .a.� v. .i. .� ,.. y�' �,._��3,. ...'...:�::� M. �:._ ..,,-.�,. .. APFR�VALS DATE INSaECTOR5 (GNATUFE � lt�SNtCTOR'S PJOI Ec .. .. . � .:Gy�r�t��-$UILI�E�Ij��;�{��$�'�'jO[�,i � � .. ....,-�. , . . . „ UNDeR SL!S WORK �� ""-� � ..... , . :t".._.i����r- _ . . � . . ..;:':,� - .r... ,.,., . .. � „ . OUGH PLUMBING � �-�-. . . .... .. �. , . . � ..��. .-.' . .� �. . . . � � �� �-�������• ��� ��- � t here�y d¢l,n;tiiai I am exenpf fram tiie Contactor's GAS PIPING� ��- •. . ....�....... .. .. .. .. r ... .;�; ..;:. � ': .� .� .,_.,._.. ..:.;.. _ ..icense Lsn• or,fi.� fel: wi�g r..ason(Secriar. 70.f1.3. GA5'yetvT � � . . w . .` ; . .��� __.� ..•-.'"�. .� . Bte:lnsss�andfFrajessione Code/:�idny ceey cr _^ounty HOTWATERH�A`ER �,^ �"' -^ " � � , � _.� •'.. .�... ._.. . .._... .:':: '- ' - ._,_,. . ..:�: ..����_. wh:cY, reauires a perrri: ;o rons vc� al er ina roo . .. „..�,. �p . ��unnau.�c:-ix-r�aEs._ . .. . . . , . .... . . . . , . . er,-7olrsh �r repalr or,y st-ucbsre,prior to its ic4��ance GAa'7'e5 i .. �` ..�=`_�....., . ... �'-_-_--.,._,,., � ... _ ... . . - e o�ptica�:t for such perm.it ta ffle a � � '':..... ,:_-. also eeguzros th �*- �� ��� ' srgned sta:eme•r.t rnr,t.he is Ticensed pu:suanr ta the _ . . . �.,:. -�.. � � . ..: . . . .._ .._.,. . UTItI7YCO,NOTIFiED . ' � �--��-� --� � � .._ .,� � " ' �'„�� � � � � provosiolFs of ehe CortraBtOrs l.icens2 Law/^hppte>9 `� `..�.'. � � - .`. .. ""^'"""'.""' ' '.'""""°.�`*�(�omttaenc€�� rvith Seetion'7000J oJ IDivrsiore 3 of the - _ ._ .. . . .. . . . -�" � � A/as"nes rtn6 Professior.s�Code/ or rh.et he is exern t . .,., < : � . _ .. . ..-- FIfVAL. , _ .. . , . . • . .. .._... . ... -,v.r_ ..�s.+,...r �..:.:a:: ..: �7 . -v. �'rr.�..x �.is''��.,�" ; the e�rom�ra he basis jor tfre adleged exemprior..dny �, - -� .s�. . . �-- . . � -- -- � . �. �,... � ..,.. ._, . � �_....... . ' - . . ..��......�. . ..,,_. . ..,. . Y .. P rc�t,for a narsart � ''"`.' "�.':'': . pfQant�oaSc�rlpena�yfajnotmorethan a rdseon of cec — - - . - . .. -'iubjects,ne cg _ , . IUDUSTRiA .' � - ,:.'. : � . - �., WASTE F.P?RO.A.l.- � � �. . . .. _._ . .._..._.. .. .� .._ , . ._. .........:.. . ....... , ...... , . , .,...,.., ed dollar /S 00J. .. _.. y . : ...� . . . . . . 5 ON'i0i O.k C '' ' �1 . , ,.. ,. . mpe�� ad do _ee or<,ar. � - .: �.�- -..: ,, � _',_-. . - �� :.__ ' .. __ ct�ie:s n�esinier,c�etl oe offered1fox sale.,L C7 I • the sixu , .. , � . . .. ', - ..�.�..,• �.� S c.�7044 63usine,s and arojesaians Code: T6='Co . : �-.. -... ...-,. � '� .._. . . - .µ, x��"!,`=�k w c?nse..a doesln ,apr y t on owner ..... . ....... ,,., a .:,^ e ::�:_.- �:. - �„�.:., n.._ � .:� � - . . _ . ..� . . .such ��rkhhi��fs p�o���d othar surkcimpra e��r.. . . . :.. :� ..:�:.; �„ .. .. .._- . � - � � .:..� ,...,�... .-.�-.;...sw.::s::�+4are nof fnter.ded or�ffQ�ed for se7e. !J� however. 7h. _ � � ' ' "� � - L,�i7c,l,ng ar %mnroverner�i is soid withirr oree year o� '-_ � _ ._.-._.. _._. --_..._ ...._; ' . ���.�. ,.,....,. � ��`•" "' ��'�dmpl�tion, ihe �wner-buelder will have th� hurde.n ._.. . .. . ._ . . . . .. . . . ��. � [�. � . .. .. -. ,. , . .. �.. '„. �.. cf�rovin.g Yr.r.f,h2 tlyd,nnt build�r imp:o��fo-v the .., ,_. . ; - . . . . . , ,. :w.pur,�7ose of.scle.) ' . ... _ ... _ / ,. . . ..._ . . .. � :. . . _ , ;2m exempt under Se:. "` �. ... .._..., .., .....,,._.. , �,<,,:<-�: •,;,: ;,r:B.R P for this.rgason . ., . _ _ . .. 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