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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 r:;�: �.� � i, a' .� �� sd ign ure o Per i ee D te ��:� � �,�� �`�.[ :� .. .� ➢.;,•N.a,i.; . . ��IY . - : .: �, � , �� _ � _ _... 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