HomeMy WebLinkAbout1298A r�s,�. ''��"a„ ,�.::�+..w t�4.�.;v�', ��t,�.�,..:;� .-k"��'.' „qw'a �..S�c" :a,"s �;�r:�'p S,�'.,+�.�:".�. wr'��SF;'-�.``x .."�!'Y.�.:�.st�'s`�`'5.�.,z;� $� s;' �ue.�r.<�.+;::;k .� �.
�'uN , ' . ' F, .. �`;,�y �q�� ����wS n'� '°t s� p� 9 ih �, �:� � . w��+�, , �?':� ;� {.� 1x :..
��� ����WORKERS'�'COMPENSATION�DECL'ARATIONn ���'��,�' `�'=A t���.¢ ��'v,����.P'.r��L1���AT�O: �,'FQ�'RL�MB�1�4V'��P�'R�M'I 1 .p +:i �h,1��;�..} �
herebyciaffirm ihat I hove a certificate of conseni fo self�,� 76A'667A�''}��'^�'���.,u�'y'�� ' ' � � �, . � � � �,s � a�'_�+
>, �.insure,or o cerhfica�e of Workers'Compensation Insurance;�s�b�tCE B77(REV�IOIBI)3�x•g�+�. . � � .'� �,N, � ,. .A. T.�� :y�, �k, - � g'
',or a cerhf�ed copy ihereof(Sec.3800,Lab.C.) $:�:', . " ' � � - }�y, =�G,�at,:�.y� ��'��'�
�,,�z. � COUNTY OF LOS ANGELES BUILDING AND�SAFE7Y � �" x
n. ,.e
:�P❑ol cy NoNO5O7SZHHCompany Fa Itt c �„'�i�.e t �f�"a� �; . . , .. ��`i � �1't`�k� .
<.;��, ��!5-�: P�r...v.� „,.,��' ��
Certified copy is hereby f�rmshed. f�'
�h.�y FOR APPL�CANT TO FILL M�PRINT OR TYPE) BUILDWG
�,?❑ Certified copy is tiled with t6e county building mspec }'{�'� ADDQeSS 1415 S 2 �'�;
G .� tion de oriment. ' � L,��: NUMBER FIXTURE OR ITEM �i�i FEE � �`k'
P . ' � .' �, LOCALITY �
� WATERCLOSET ' D1r7IllOt2Cl B3T �
.iDate 7/2/SS APPlicantP_R_!1_ Plnmh � �� NEAREST n �Q�
�_;, CERTIFICATE Of EXEMPTION FROM WORKERS �'��� `,,,7.r BAiHiUa � CROSS ST. �
COMPENSATION INSURANCE �{$;?`�; SHOWER OWNER Bramalea Li.mited ��
s�
' �°(This secfioa need noi be wmplefed if the work involved by-,'� MAiL �� �
p�t -�the permii is for one handred dollars(SI00)or leas) -"� invaroRr � � nooaess 3151 Airwa AVe. 5 te, N `�
� �'•I ceriify that in the performence of ihe work for which thrs �,
,„� � .,permit is issoed,I sholl not employ any person in any manner�q�� SINK � (� ciiv Costa Mesa 7EL.NO.$SO-ZOOZ ��
t�' � sa as to become subjeci to the Workers'Compensat on Laws S"',� °�
a � DISHWASHER y
,� � /� Ut� CONTRACTOR p,R,p, plumbing +
,,�< , ��c.
� "Dafe A IiCanf � CLOTHES WASHER � '�
� PP �+� ADDRESS 4418 E. Chapman 5
�^'�710E TO APPLICANT. If, after making this Certfcate of� SWIMMINGPOOtRECEPTOR - "�
1 �"l'�� �P}ion, you should become subject to fhe Workers F�j�+a CITY TEL NO.
'�"�..,,,mpensotion p�ovisions ef the Lcbor Code,you m�st fo th M� Orange 530-8441
� - �+,; LAWNSPRINKL[R3YSTEM ,�
J�te�,with comply with such provisivns or this permit shali be'�.�;; - STATE LIC.
� ��deemed revoked. , . �^ -� WATER HEATER � LICENSE NO. �FG�377�F CLA55 C-36 �.t'
� �k�� ' . LICENSED CONTRACTORS DECLARATION ������'• � DISTRICT NO. PROCESSED BY � y:,
�N GAS SYSTEM OUTLETS C� �?�
y . I hereby affirm thot I am licensed under provisions of Chapte 9 ' � � � ��,
� (mmmencing wiih Section 7000)af Division 3 of the Buvness OUTLETSOVFR � , �
� and Professions Code,and my license is in full force and effect �,� 5 PER SVSTEM FINAL ����
z; VA!DATION � �,
`T'��kr�.,License Number 443774 Lic Class C. .� `'"��� DATE � �y��%,,("� � � ,y
�rc�ja�_ �rP�: FINAL � R•.��.
� 3`�s5' Gonrracror P.R.O. PlumbinQ'Date 7/9/$5 r�,i`"�'s BY ry{4yr.,i,�. �g���
�,� �" Gj.'�.
k I am exempt under Sec ri'�' �.,$�
"�y - .f� I �, rJs �.
,B.&P.C.tor ihis reason a� Plan check tee °� '
� �"� �s ;
�'r Dafe: �..
"�,�,�,� ��r''� �PLUMBING PERMiT ISSUING FEE$ V ..�� � � w'�?
,.�,'� �Signature p: Ct
��?,��, �� TOTAL FEE ,�'-v -' ; ''G E:A `,
'�n
� �� {�; Plon check opplicant " , �r,< u y o�j '!
� a ��; SIiVGiE F.viNiLY u;�� , �+
� ',i F HOME OWNER-BUILDER DECLARATION �;.�,{� Name-..' . . .. � ti , :y.
'f� �eby afflrm ihal I om exempt from the Contrnctor s l ce ise,�.},�; � � � ��v t
.i for fhe follawing reason(Section 7031.5, Business and �'"� � �y : {� '`�� a , �
,�b�s:�Prpofessions Code): � +��?'� C ty c, 7e1.No. � �'
{ i,as owner of the property,will do ihe worK and the'�'�` ��7, � c. '�`y'- '��:;
� �a"�7 8
,.,� sir4�ture is not intended or�.offered for sale (Sedion�Y�;,Lk! ► ��i
�Y,�.�� 7044,Business and Professions Cadej. �"�'�+' �'�'1
' .,',�y' 9 :�'
CONSTRUCTION LEN.DWG AGENCY ��;�;:
� t�I hereby affirm ihat there is a construction lending agency forl��.�+q� . ��
- the performqnce of ihe work for which this permit s ssued;'"' ��'
�.�(Sec 3097,Civ.C.). �
`�:t
$y �.
� '� �
��+Lender's Name ���4�'z�
' Sd,k}a . .'.;i
�LendersAddress �:�. . � ..�,��
y'9 I ceriify ihat.l hore rend ihis npplication and siate�hat the°-1��,` . � ,,;
-%obove information is correct I agree to comply with oll Co�nty�y�;%= ► ' �g'
- ordinances and State lows regulating Plumbing,and he eby»"�'.�.', �'�
�
.�authorize representofives of ihis County lo eNer upon the�,•�,� � �,. ,�}
��y above-mentioned prop rty for inspecfion.purposes. ��
_ , '� ': SEE REVERSE FOR EXPLANATORY LANGUAGE
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