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HomeMy WebLinkAbout1301A (7) � �3 F� ��:..:.t �,,..�.:�.�'. � �,�.-.�� � �':.�.�.-- s��s�fr� �g . e�. :���,b.!sh�.w, ����C. �d �:�C5,�'"`��.a�.:� �5,.� ;�"'�rr ;- �k��;:� � �� -:�.: � ��k '�� p�� � r ��:.� } y , , . �� � . . �.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 �� �� ��s' ignafure of Cermittee ate b����� � ...., � �j37i� .,. . . ,. _ .. ; `... :.' , ; , . .. , . . _ _ -.,..,..�..... .. . - . .. �� ' � � : . : : . ,. .�,� . ' � � .. � ' ' � . .. ' ' . . (Di�C y ~ cCDl,iC'� �3� � Cp . .I i I � I .. . . _ ., m y j rn � `t, < 'O � � i i DJO� n �'Z -Di z � -fl �'�D ' � Ar � �� 7O ~��!` a�o�ro � i � ( z " � � � � c;n �i`o <' T �A rn � A�� . I � _ . � IN�SI � N ` i , I � { . : � ; ' �� , (4J c , , . � � � m: S �� �.. ' ! 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