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HomeMy WebLinkAbout1268A . _ , . , _. � _. . ,;;, . � ��. �,�,� ,.::...�, ���� � ���:�a.���,�� , ' WORKERS COMPEryNSATIbN:DECLAR.47:ION ; �sass�a " � � �7 hereby affirm that I tiade a certificate o�consent io self ceai�(zao( APPLIC�4TION FO� PLUIVIB;ING .PERMIT _ insure,or a cert�fi�ate of Workers Compensation�nsurance;o�� ' ' ""`.`.'. . "-:�` „"'.-.``. .'-�'"„" ""'"� '"°"�"" "�"".�"" """�.' "°'' ' ...' . a certified copy thereof(Sec isoo;tiab.CJ " � � � ' " ' � � ' " � �BUI LDtNG AND_SAFETY I� �, COUNTYOF,LOSAlVGEL.ES . . . ._ .. .. _r. _ _ . � � ^✓+'t�+.�'f�OY.ZPPCom an� ����d.t,'.!9 . .,., , . . . ..... ._ _ . , Policy No. . ... . P 1 . _. . ..... ... _.... . _:.. ..�.... . .. � ❑ . .� ' � � . . � . . �.. : . ... , . ._ ,�. , .,w�� . .. , �,s I . . ......_.,_t...........�.,..�..-«...,.>.� Certified copy is hereBy furnished. FOR APPLICANT TO_PILL IN(PRI�7 b�t Y`V�E) , BUILDING (��+��7oe� �?p _-. aooR�ss �3?`/%� •ti < r ' � :_ . , . . ... . ..._,,,... i FEE . .. �� ' - � �� '� �- ' ' -��� ' � � NUMBER FIXTURE OR ITEM "�-' � Cer!ified copy is filed mth the cqunty building inspection , . __ ..,. LOCALITV ��+����1��,�� �'N� y � � 2epartme t. �_„i,�y+�� WATER CLOSET tJEAREST�� ' �� � � � � � ' D�a'te�APPlicant %�a96Y� . � . ...._..,.:. � �"��'�`- BATH TUB� CROSS ST. 1 wm SHOWER .___�..« ' ... _:.. _.. ... � CERTIFICATF Of FX�b'[PTiON FROM WORKERS i OWNER ����'c(�U/L� ��/l/If°S . CO'NpENS.SY7"ONYI�P�URANCE ' � � � -� ---����,- � -^������ (This sect�on�need not,6e completed iF[he�ivork mvolveA ~ t-Av�aroRv � qooftESS�3� " ST����� a by the permit �s t"or.oriehund�e3 dollaxs (S1�0)oi less.j SiNK �' ci'rv .�j„��p,�,� TE .No.,i91P�'Q`/� Q . .. ..' .� . _,.. ., .»....� L ,.•,.�m��a�,a.. __ T�cer[fy that in Che�performanc o,f the uork fot whtch 4h�s DISHWASHER „ - CONTRACTOR_S�yy�,� ��f�� /y�L � � permit is issued I shall not zmploY'any persor.in artv*nan0ei"�"" . ,..._... ...,.. ,,,�.�... „„q_;,..,,„,,,,,.„m„ ,«. so as to become sub�ect to the Rorkers Com ensation La�vs. CLGTHES WASHE,R � qDDRESS '� � � y v '..,..n , `v i0O S.�i�,�',�'/V � w Dute f� Appiicant � ���� ,,,,,_ ......._ SWIMMING POOL RECEPTOR� � � ��� n . ..._.« ,...w�..�..«...- .. .:�..;- ._ '� CITY �O.✓�°i/7'IFIZi/�1i TEL NO/�.%.�I G7 AOTfCE SO APPLILAI�T, If� tfeer�makmg this Certifcate,of �qy�N SPRINKLER SYSTEM �-" --"""'"""""' •���"",`."`""'"'° v tl�. � Exemptton, you s{�ould�becnme xub�ect to�the Workers'. STATE �f6+�.�a� CLASS SCyy f.omqensatiov pro isions of[he Labor Code.,you must forth- yyqTER HEATE i ' - ......� �- � ���i LICENSE NO. / with compt} w th such pro isions or th�s permit'shal[be �� ... r .. ...._._.".� ,�� i DISTRICTNO ,� PROb SSE��.BY,- deemed re�'oked � , � GAS SYSTEM �UTLETS I � LICENSEDCO'+�7R4CTORSDECLAR:CTION � � - OUTLETSOVER � -'"�--� � � I�C� �CY.�.t-e:(.•C.,J . ..< <.. �s-,+.....i . �._._e.,._:. 5 PER SYSTEM . . ,....._.._... � .._.. I hereby affirm tnat l�am hcensed under provisionsof Chapter .. ..,_....__. FINAL 9 (commencing v.�ith Sectibn 7000)of D��sion 3 of the Bu;i-. oATE � VALI�ATION ness and Profess�ons Code,and my license u in_full force,.ind„, . �-`�b�Z � � ����-��� - � � � � . . _... ...w�� effect�.,. �.� . :�� .. � .. -�.� C�. .� �. '. FINAL � I,icense Number f�d�,�� L�c Class s���#�r�g.r.� ...,--. ... � BY � Contracfi�c Sdp������ Date ��'��� . . .,„ ._,. .,,, ,�.,,,,,u...;,,,. � I am exempt from the I�censing requirements as I am��a���M P�an ChOCk f00 1, . ,.4YM . itcensed architect or a rzg�stered professional engineer pLUMBING aERMIT ISSUING FEE$ � ��7 �� ac4ing in m} p`rofes'sional,cspaciq� (Section.7051, Bus- _ , ' ' �: -. iness and A'ofessions Code). TOTAL FEE '� „;j(� .... ..�-. .... .. ... � .. ,... .... . . . .. ...._.......:. . ...._ , ka Lic,or Reg.N�ci_� � ' ' Dute � � Plan check applicant � H01�tE 0�1�NER-BVILDFR,DECLARATIO�` � _, Name , M „wt��,^ p� . . � . ., ... .. ......., . „_ .:-�- Atldress . . I hereb�� affirm that�I�am exempt from the Contractor's . „..,.,,. ..,,,,,,;...�r. ..,.�,,.,,,�;„.,a,. License Law for the_follo�qmg teason (Sectwn;7031 5 flusi-_ City Tel No . .. _ . ........ .... .. ��.�.. ness and Profess�ons Code)s: . .. .,... .... �....,..,_,.:_....,,�...�......,,w,..,.,»�.»: �a...,.�.:...�,:,t.:e..-,�b..,.:....�.�.�:�k...--...,..�..�._�.,�.,.w..,�:-..,.ma.R..w.._..<_. � I,as owner of the property, um exclu5ively��conYracting � � ' � ' ' � ` �� ��8�` - � with licensed,contractors t� conytruct., the projeci . . . . � . ' . . . .. .. , ., . ., , .. . . ... ... .. .............._..,........ �! O 6 O 9� (Section�7044,�BU5mess anP,.Professions Co�e).����r � .. .CONSTRUCTIO'Q LENDING AGLNCY, . . � .�._.... .. ...... ...... ..... ..... _. .,. .._.. ..... ._. . . . . �..ericy. .. . ..._ _.. ... ... . . .... . .. . ... ... I • • 1250 �I here6y affism that there is a construct�on�ending g .'for�the performance of the work for c�h�c'�whis permit is , � ,� , . ' � ,� ` • .._ .,..� ..... , aomi250� _.. .. � . issued�,(Szc,3097,Ci��.CJ. Lender'slVame... . . . . � �x«p,n�rtx.,+z�w,a8+<..:ax..� � r;ar�u'�.x...�a�os:.,..+�a�......s�>x.m...:�.��c,.�:x.,w�a... .. . . �1 � �d�'�'l2 , . ...-y,� m«�.w.enw�.n,.. .c+a-n�»�.�mi,;e,:,,µ]1Hv.a.�.c y ;.v..aa� µ �5?'S�W<i.kWi;�.�i!!G<rik'<�'<a+sk%BY^3a'e.r+.'5L.�;iNJ:?b"��s.-n.�...:+tea�.. Lender's.Address �'� . . .-.ti �,. „-.,.,».exw.w� .�,i✓«.,.;..:n.sv� �...�w.«:.; a...>a-... .p , . .:aa.::.a�.:nu;�a::« ..,,�..c.-...ox?Ya '. . - � ,H.,,�u:.�,+'s,.,.x�.w.:. . .n.,r.�+�.�+axc..a�,�.*.:.....,�-' ...:�xwr:.._:.::;.:. . .- . .:. . .,�:..., N. . ] certify that C have read this xpplicat�on and�state that.jhe _�. , .,. ,,,. , , ,_, � � __ _,_ . LL � x6o e�informatmn is,corre�t I sy�ree to comp 7 wiih all County � SEE REVF,RSL FOR ERPLAV 4TORY LANCL AGE �"� � , �ordinances �and State-,lat}�s�regulafing Plumbing, and herebY � �� - `- ""'°" �. ,".`"`""'',`""'""•""."""":"".�'.""�"ker"' "'"a.�"`r'�.';a:.'`""^"we,�"a°:a�"ms""r°�c"u�a'.W.*�':.'°"s'�".��,s°"».. authtiri�e�representatives of this'County to enter upon the y�e �� ahove-mentioned property for inspection gurposes. ::�!/ :.. . ..� � . ' � . �-c 4 t��. � .. v..�,� .rw wr es .. � uw> ��u, �+ .yw,ao �r m , /Y�.rt�2 . —� Abate � �...s „ W .. .. .,�..a., » .., . , , . .,,. ... _„ . _. . . , , . Signx.ure of Perm;ttee.... ........ .�.,.....�._., ... ..:.. ,.. , . ,._.. - .. .,.., .,_.._. . _. .. _.. ._... ...,...._ ,...., . ., _......,. .:�•: ;..�.......�,��x,.,_ ,_ :�...,���.�w_� _: __ , . . .. ...,:w .. . . '�'°�'°�""""�"'°'�"�`� :PJSFEC i7;i'SPC tS APPROVALS DATE INSF'eCYGR551GNATURE . .. .. . . ..�. ............ • ....` . . .�,....�.,,:"QW�'���-&Z'''I�Ec�D��L.�l:ATI�'1� . __. ......................:...�«.,,,.�...:.,..,.. . ...�.. --.... UNDERSLABWORK � � stou�tt P�unneinlc � - . . �.����1.I�eFeby affiim,that'an�exzmpc f;om eh,eG�ncrac,or's ,.., .... . ...,... ,..�� , iu:a:t,=,e I.aw far the ?'ollowirg eeaxoa(Set.ion 709i.5. c.nsPiPine � � ;. . .._. ....... ....._,._,...._. ...,. - vusiness ar,d f'rofessioru CodeJr �ny cir�� or rounty: GAS�vEN7 " � ' � � � � � � whi[tir reGuires e p^rmir ?o ccrisnx:ri, aT82r, irreprove, . - . .:.. , � . � -, , . _ . . . ..... ...___ ...�. demc�Fi�:.,or �c'pa�:r�r.y srnacture,orior te its z+s::ar.ce. HOT WATER HEATER... .. . ---^'— . . .. .. . "�....:s...� _ . ... .... . . . .:. rtt,ro requu'e.s ihe aDDlicanr jar�such pzr.r.lr so f'le d PLUIUSING FIXTURES � � ` � � � -� --� sigreer:�^r��e�+Pn��theq he-is ticeuted�urs�eafrF ro tha _ ... ,. .. , .., ,,. � GASTEST previslons v;the Cont:uctor's Lrcens•e t.aw/Cha�rer 9 , UTiLiTV CO.fVCTIFIED . . . . �. ... ..x �� -�.~.�. ..,... , . . , . . ....._.... _ _ � ��minence�tg wrtk�Sect�or. ?PnOJ�Of j}lL�S20R B Oj tire . . . . � . � . ?ltzrir:es; r•nd Pro,Te.Ssreees x:od'f er ih.a' he is ex2i:P,at � ���+��� tharejram an�tke baaer for*h�aiteg2d exernpticn.kny =INaL ��ir �y„ �«yaq� ` vrolatfor:,ofL�eceir.n?03}.Sbydnyap�lie.r?tjrrraper..rt . .. . . ..:.,�__ _�..,....... . - . . . _ � . .. ..:...:�... . :._._,.. _. ;uojerrs?Ne apPiiraiie ra'a c:ie�p�r:;;if3'o.f n�r more�than ..... _...n._..�_. _..... �:_._.,� .,�.�...,,::.::..... � ,Pivel�undred do?lars«50fJ/.: INOUSTRIAL . �. � . . . . ... .. .....�.. . � ;4h^�ptnperty wili eo the work.anu WASTE APPRovqL �� � . •:U I.aa o��nec pr . . . . . . . , u�s�s:rucium�es not_n?enlcd az offercd tor sale. � ....... .......... ....,._.��:..� , . `� �: � ��. - . — _ . _..... . ..� „. � �,:.�:-s.�..:.o �.�_...._.:_fSec. 70d4. Burirees,-and P.-afessiuns t'ode: TY,e Con- . . . . . . . ' _ . � �- � rract�r's !�i^e�se Low dues nor arary m ar, u:strrr of �.� , . . . . . . -, . . .� . . - - . . . . . . _.� . ,.,.:.:: :,.,_...__,:•:��.propeny.whv hu??ers or intproves rh2reort,rtnG w:ho does � . � � - . . �- � such wurk H.em.self p;evided tlraf s✓c.�r imFrrovememr.s� � . . _ . .. . , .. ' � .. �....• arc not rnc�nde�"vr t�,ifered for sc..e. If, howerer. tne ... . . . .� � builqrng or irz�rave.m.c-nf is s.o;d wi:,irc o>¢e 1'znr' o; � � ,_„_,_ �� _�_ �_ com�iz?io�, ihe owire�-h�ild2r �vill have the Gurd�r. . .. . . .. � . � � � .. uf Nro�,ing xhqt t:e,did nor bu%fd or iinp,rove�ur the .:. .:.�:,..3.:.:.,,.::W.�..,...,.�,.:.,nurpose oj sale.J . ` ;m., . , ,,.I a}r exempY.e;nder Sec. _ :___, . .:...�........ . v_,.�w��4,fUr,thr.reasc�i _ ..._.. �.,,_...,,....,_,:. .. ,� �=s. -k:.�.._,_...__w.�r��.�:.�.,w... ,._, _.:.....,�,�. �..._.w,..... �r� .. . .., ;,:.. -- -- _ _. �.53<:de ' , , ,. ,- . _ .�.:. . .. ..,..... .,..,,,,.. .,.. ,_,,, , >.,,: ..r� . .�, _ < �« .�.. <. 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