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HomeMy WebLinkAbout1300A �rrt���.,�" r ,��,; nr'.y?.�.:,i4 � }>;Ri.� .,:;���»1;, '�`-f 4t+��'1;�,e'���`�.'3�h�`r�,2:'��`r.'�.'�,.�:s'S��;h qwa.'%�?�;s`� �'a ..;; T.q.G, ,�.J„'�i ,.�.�i'y�.�..,,:,q�,is;�*,1� x " ;..4";Ss`: F j!��'��� �WORKERS?COMPENSATIONkDEClARA710 k����,;,�;� 54'��' i>� � � $ � �'^� � �' � =z,; � ��< �,�����������4P;P�L��°AT10� '��0� PLU.MB�NG��PERMIT� �. � ��� 3� �� „�_��herebyt.affirm ihat I have a cerriNcate of consent�ro sel{`',w76.n667n���� }�- p �.� ��; g4 a a. ' ns�e or a ce���ficate of Workers'Compensq7ion Insu�ance� � iCE 817(REV 10�8L) �f . • ; }� t p � � �' � � t ° � ��or a certified co thereof Sec.380Q Lab.G i .�. ' (� � � � � ' � �"�"fr�'k"ki�d�l�t ""��' ! � py ( � : y , �s�F CbUNTY'OF LOS;ANGECE55 , � BUILDING I1ND'SAFETY �eo�y,rLt�.`�,���a a ,` t z •`�;; � ��Y N�/N0507528�onipony Farmers =� , � �, � Cenified co is hereb furnished. �� t,y�; �� �'❑ PY Y ��+�� FORAPPIICANTTOFILLIN(PRINTORTYPE) /�ODRESS 1405 S. Stonecrest P a r�� ���' y Certified copy is filed with ihe county building nspec 7; ,? � �ion de arlmenf. NUMBER FIXTURE OR ITEM (t� fEE S�� g ,s p •�. . LOCALITY � ��'� � WATERCLOSET � � Diamond Bar y "#y 1 �i ;oare 7/2/SS Applicant P:�.O_ Pl ,mh,ng_,:� NenResr � �n a CERTIfICATE OF EXEMPTION FROM WORKERS � BATHTUB �� � CROS55T. � � ��, �'� �� . COMPENSATION INSURANCE F= �/ SHOWER OWNER gramalea Limited "-�� -'�� � _.(This section�need not be complefed ff fha work involved by;' MAIL t��' ��' � -:the permit is for one hundred dollars(5100)or less) �¢�+ LAVATORY � �qDDRE55 3151 Airwa � Ave. Ste, N * q� 7j 'I certify that in the performance of tHe work for which this - �+ SINK CITY iEl.NO. } ..permit is issoed,I sholl not employ dny person in any manner�� W Co.sta Mesa 8Jr0—1��1 ��so as fo become subjeU to the Workers'Compensat on La 5 2�'».� � � 4� � DISHWASHF.R k �.Y ",� �� en'7 COMRACTOR P,R.O. Plumbing ��' ^,.i. !l �':Dote Applicqnf r CLOTHES�YASHER � '�v qD�RE55 4418 �'', Chapman r j', i x ?.NnTICE TO APPLICANT: �f, ofler making this Certrfcate of j'',�' F ' �'� SWIMMINGGOOLRECEPTOR s "t.np�ion, you should�:become subject to the Wo ke s '�` CiTv TEL ta0. r � 5 ,a, -iipensqfion provisions.-of the Lobor Coc1e;you musl forih 5,,�� �AWNSPRINKLERSVSTEM Orange . 630-8441 � �}with comply �h such provisions or ihis permit shall be, x�!" STATE LIC. � �;deemed�e�oked. , �'� WATER HEATER � uceNse n,o. 443774 anss C-36 � `� � LICENSED CONTRACTORS DECIARATION .�^ � oiSieiCi NO. PeOCesseo eV ���: � � xl hereby affirm Ihat I am licensed under provisions of Chapter 9��Vx GAS SYS7EM OUTtE7S � --: ' �4�e+ �.(commencing,wifh$ection 7000)of Division 3 of ihe B�smess' '4 OUTIETS OVER G . g.�;`� � '�'mand Professions Code,and my Iicense is in full force and effect �a�' S vER SYSiEM PINAL V IDATION �""','s ( ��{ DATE /S'�D/d'� C�,t. �' .�License Number 443774 Lic.G`(ass r—�F+ � �?' i � � ��� � ��� FINAL � �..`.: I 'ContradorP_R_n_ Plnmhino Date�_?T�$� �,r�� BY '�'`��v �� � �-. ' �f�'❑ I am exempt under Sec. �7x? �g..�.'; � � k ti.�'��, rii;. � � B.&P.C.for this reason �""�; P�an check fee � + ��� I _� ' Dafe: ��'y�'. PWMBING PERMIT ISSUING fEE$ � ,�(% 'r� �'� � Signature � �'�� .�,, �y�a' TOTAI FEE tS� .� 3 Lr r a ' X u�.�� Plan check opplicont ;y a � ��� S!MGLE FRNILY �j � HOME OWNER-BUIIDER DECLARATION '^�:lName � j � , C�q f:(� ���� '� ' 'ieby affirm that I am exempt from the Contr�ctor s Lice se��'�� � yior ine ioiiuwir�iy reason(Sec iun i�o��, us .;��'���Address @ 4y ^� v i;� �; � ,�f P�fessions Codep ^^ o �� , City Tel.No. . � 7 I,a s o w n e r o t t h e p r o p e r t y,w i l i d o t h e w o r k a n d t h e�, � � !, I C'�:5 � �'�.'�11� structure is not intended ar affered far sale(Secl�on�t���' � � ' i�`d �7044,Business ond Professions Code). ?aj'�,"t�f€��;� � , �a�� CONSTRUCTION LENDING AGENCY ��:5°�.� t �'k��' �. �'I hereby affirm that fhere is a mnslruttion lending agancy for'�:�,; , ' � �"�� r .;�.�the performance of the work for whic6 ihis permir is issued';,�,�� � � � �,�(Sec.3097,Civ.C.):� " '�.; . - y e . �;�.; : �ti Lender's Name ,���'' :t � t t:i ��s: � -� Lender s Address .�.! � �I certify ihai I have read this application ond stote ihot the��:+�.- ► i � .:!above informotion is correcl.I agree ro comply with all Couniy.3'�� � -,' ^'�ardinances and Stale laws regulating Plumbing,ond he eby,,�> � , ��� I s 1Eaothorize represenratives of ihis County to enter po ihea�; . - � �above�memioned property for'nspect on purposes. 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