HomeMy WebLinkAbout1301A (7) � �3 F� ��:..:.t �,,..�.:�.�'. � �,�.-.�� � �':.�.�.-- s��s�fr� �g . e�. :���,b.!sh�.w, ����C. �d �:�C5,�'"`��.a�.:� �5,.� ;�"'�rr ;- �k��;:� � �� -:�.:
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�.y�,�..�WORKERS�COMPENSATIOIJ�DECLARAiION, r `��,�� x�"��,��q'a ;�,�R�Lt�A I�I��,�.1'"ORR.���."P�LUM�BING�P�ER�M�IT �+ x $
"��'alV� `.�'��° i_� � � f` y � . > .4;:�
���.I:hereby'Jaffirm that I have a certificate of mnsent3to seif��,��bq667q,�"•`.� ,��ik� � � 2� Iti` t ' . . 5 ��7 '� .*y rt"^
� �y�,., nsure,or a certifimfe of Workers'Compensatiqq�InSu ance�,�� CE Sv(REVatOf9[}��� . �; �� � � , ; � ' , r� g ���,M;.�,�� �,
r,or U certified copy ihereof($ec 3800,Lab.C.) � �'`g�` '� � F
� �Polic No.T30507528&om an Farmers Ai���`' w,��`w''�' COUNTI�;OF LOS;ANGEL`ES �; . BUICDING�AND SAPETY � i�;�z�s ,x s��,��d�� i
t'� Y P Y , rSs� � � . • �a �
�- Certified copy is hereby furqished. �";.'
x ��� �"• FOR APPLICANT TO FILL W�PRINT OR TYPE) BUIL�ING
� Certified co s filed with 1he count buildin ns ec ADDRE55 1401 S. Stonecrest-Place n
'❑ r.�. �' -.y,•
�'day: tion deparlment. Y 9 P �''�f� NUM6ER FIXTUREOR ITEM �1a FEE
� ,�f,�� iocnuTv Diamond Bar { '? :
'r5�� ��re 7/2/85 APPlicani P.R.O. PllllltUlri2 �'-��� WATERCLOSET � � � P;
�;��, NEAREST
� �rm.�`� i:�' CROSS ST.
a,,��"�J'�' � CERTIFICATE OF EXEMPTION FROM WORKERS ,:,� `� BATH 7U8 r� CJ't� � �'��
t+�: COMPENSATION INSURANCE o5��.,� 't ' �
� s.� � ��:� SHOWER owNER Bramalea Limited � �:'
a��;.(This secfion need not be aomplefed if 1he work involvad by� •� � •
��ihe permif is ior one hundrod dollarc(S10Q)or less.) �q�, �qvnroev IJI� ADDRESS 31$1 AlYwa AVe, S te�. N �
e�?
� ����I'cerhfy thot in the performance af ihe work for wh ch ihis ��-� �
� � � e�mii is issued,I SNall no1 em lo an eYson in pm m�n er��' SINK � (� CITY (;08t.a Me53 TEL.NO.$50-],00� +- :r�
�.P P Y YP Y 'X„. :4,>
'� -.,so as to become subjeU to the Workers'CompensaFon Laws.!��
^+�{�, j'-�' f DISHWASHER I� CONTRACTOR � '?�
� P.R.O. Plumbing =
,����Date Applicant ,e� CLOTHES WASHER Lj 'r]� ,a �f��
rr s"x'NhTICE TO APPLICANT: If, ofter making ihis Cerhficate of���a ��, ADDRESS �,r,�:
4418 E. Cha man k
SWIMMING POOL RECEPTOR
F " �nption, you should bemme subjecl to Ihe Workers}�` ' CI7Y g TE�.No.630-8441 �"�
Oran e
�'�. �pensahon provisions af fhe la6or Code,you,musf{o th .y� �qWN SPRINKLER SYSTEM x�
'i'w*� with comply wiih such provisfons or this permii shall beF�,�' STATE LIC.
'��., cleemedrevoked. y:�.f, wnTErtHEArErt ,.� uceNsen,o. 443774 ctass C-36
LICENSED CONTRACTORS DECLARATION •��" '�� oiSTRiCi n�q. PROCESSED BY
�'��� �I hereby affirm fhoi I om�licensed under provisions of Chapter 9��� GAS SYSTFM OUTLETS /d �.
��'�^� -�commencing with Section 7000)of Division 3 oi ihe Business•�� OUTLE750VER t . � '�'�'�
and Professions Code,ond my license is in full force and effect�LL?� 5 PER SYSTEM PINAL /� V IDATION �" '
�n-��. � ,�. . DATE /:�"� //y '� .
�,�� `lice�se N�mber 443774 Lic Class '7§ /0" � �•'���.
� C3�� 4.
�.. � Fy,�"� FINAI � ��^,'�
`y3�`-CoMractor Date �,�� BY �: ��'�
I r ��.:
' 'h'�'i� i om exempt under Sec. s�y�y
(f�� �, . �,,' 'd1`;,_
B.&P.C.for this reason � ► e"��.
a n�;�*' Plan check fee
�x�; - Date: y� �
*� > �;����a� PLUMBING FERMIT ISSUING PEE$ ,j �;
( :� Signoture .r� R
�'�.�`r'�� TOTAL FEE 'r � �ll.�E P
i �µ�,
� � '� � v
,;�Sr Plar check applicani �T P .
5lNG!E PAhhILY �'�
i i� � HOME OWNER-BUILDfR DECLARATION ?�,<:„�''Name ' i e. 9 j.�;�
�eby affirm fhot I pm exempt from the Controclor s l tense"�y�}r
i .lh „�ar.,a,� Address r.
:� iior .� • � i�iy icaaon(Se��ivn 7v3i G, ova ��g. o .� i`.....i.
� .a�Professions Code) ��^� City Tel.No. , ,
� Y� I,os owner of the property,will do the work and Ihe�"`'.`-��� �" �' � G~�`y s -
$ y'❑ strud�re �s not intended or offered for sale (Secnon,'�.,�,�,�"
a r "f 7044,B�siness and Professions Code). oy;� ,
� CONSTRUCTION LENDING AGENCY �„;� �t
I hereby affirm lhat Ihere is a tonsiruction lending ogency 4or rf�
fhe performance of the work for which Ihis permit�s ssuedi��Yt"
� . �(Sec.3097,Civ.C.). . , '��d:'
�N:;."'
( �,-:��lender'sName �� �
xr �
f }�����yn
+��Lender's Address
9 ;�,I cert fy thot I have read this applimtion and state thot the�y��
�� above informat on a mrrect I agree to comply with oll Counry�
.:ordmanres and State laws reguloting Plumbing,and hereby f� ► , �`
: auihorize�epreseniotives of this County to'enter upan the?..�^�3• ,��
�� above-mentioned,p�operty for inspeUion purp ses. '�f'
, �� SEE REVERSE POR EXPLANATORY LANGUAGE
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