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HomeMy WebLinkAbout1288A �,;y�r, `� �;;�.,. .:���.. � ;'::z� '��.. ;.-..,�.� r:���+��t���� z�`x�<+��C'ia�����,.y,��y� �, ��;:.:�. 4 -��';:. 4 �.�vha a� : S,�-6.t a��.,�.. e �¢����`jrs� � � �.��� �`�WORKERS"-COMPENSATION'DECLARATIO��'� '•` e�''`� <�` 5� '�� � � u,: � '� �,�� � ��►RPLICATt�IV��OR�PEI�IVtBtN�P�RMIT'`a���s��;� , � ��f��hereb�'affvm Ihat I have a certiFicate of.consenNX.lo sel 3';�,;76A567A 4�e�y � �" � �"' ,�.n)I'"i ' - inwre,�or a certificate of Workers'Compensation Insurance�+n!�r^CE e17(REV 10/Bt1�'�,�� � �' � y �, � ��s� � �},�,�t�'� ���:�: o�a certified copy thereof(Sec 3800,Lab.C) s�7yw r, ���"� COUNTY�OF LOS�ANGELES � BUILDING AND SAFETY $+°�'a�p �� ^"7 '�"'F° '+ pY. . �i.??` �#;' , )5S�'k�;'a�a�i' kYi�V. i '.'�:� �cy No.NoS07528�ompany Farmers a�,�' r ,,���,�; � � ,' �µa�� �` � Certified copy is here6y fumished. �:`�� - � . ��� '� y�� ,��.yh� FORAPPLI�ANTTOfILLW�PRINTORTVPE) qDDRE55 1419 S. Stonecrest Place s + C.erpfied mpy is filed wdh the county buJding inspec s sj;�, fiondepariment. - , �^' NUMBER fIXTUREORITEM rz FEE � �i' ,�;� � LOCAUTY Dj�amond Bar. �" 7/2/85 e�. �5 wareaaoseT � � irDare Applicant P.R.O. P12imh�ncu�;r,�' �/ NEAREST �- :"�.i �f� CERTIFICATE OF EXEMPTION FROM WORKERS y�.�` U.p � CROSS ST. sb� . �. BATHTUB �� .�t, �'.; ' COMPENSATION�INSURANCE '��•y�>+� SHOWER / � �WNER Bramalea j,ltrilteCl','- ,�, '�'�, �'�(Thfs cedion need not be complated it tho work involved by�,�";�. ,� MAIL = ��.` xiry��fhe parmif h for one hundred dollars(5100)or less.) '�^):.�i�= IqVATORY � /j'� ADDRESS 3151 Ai a Ave. $'CE. � k�. '�,� `�b�.l certify ihqt in ihe performanw of fhe work for wh ch ih s�.�� SINK CITY TEL NO. X� M�;�perm�r is issued,I shail not employ ony person in any manne���,{., � Cos ta Mesa 850-1001 ' �at`� so as�to become subjecf ro the Workers'Compensat�on Laws � DISHWA5HER x�w N �� G� CONTRAQOR p,g,0. Plumbing u�u�. .�9�Do�e Applicanf ����? CLOTHES WASHER ADDRE55 � a�r�,. 4418 E. Chapman � �r ICE TO APPLICANT: If, after making Ihis Certificate of.,,�, '; k�l" � �,¢d SWIMMING I'OOL RKEPTOR � � 3r�ption, you should become su6ject ro rhe wo ke s,�.,..,„� ��TY Orange TE`."o.630-8441 � 2 . �wil'Ipensation provisions of Ihe Labor Code,you must forih`� ?� LAWN SPRINKLER SYSTEM ,��r S � �. '��with comply with such.provisions or this permit shall 6e.�i.x STATE LIC. deemed revoked. GM,�: / WATER HEATER /' (�� uceNse n,o. 443774 CLA55 C-36 �4!���'� LICENSE�CONTRACTORS DECLARAiION -;���, --l-�— r' DISTRICT NO. PROCESSED BY � �; �'��� i hereby�affirm thai I pm licensed under provisions of Chapfer 9 ��� GAS SYSTEM „� OUTLETS (,r� �' '�. �� (commencing with Section 70D0)of Division 3 of.ihe Business��, OUTLETSOVER � U �^y '..:. . � r ��and Professions Code,and m license is in full for<e and effect '�` 5 PER SYSTEM � �.. �� v ,� FiNa� VALI ATION �n; � ��• 443774 �; DATE /�'�o��f �..: R�,License Num6er Lic.Class C 36 ""�F� r �A � FINAL J �': +s°�' Comractor P•R.O. Plumbiri�ate 7/ZJRS ��: BY /�-d�8'�"� �£! �a ❑ �i" �� I am exempt under Sec. ��,�' ����, :� �� �f� e.sP.c.for rhts reason is'mr plan check fee ' � �'`{ �; '�w� a 9 �, Date: �t��'�j` pLUMBING PERMIT ISSUING FEE$ �U �R7 a "'?; 3 � � p '� , Signature '��4, �., �'! TOTAL FEE �UU S� �kr� _ � ' �, ,�� Plan check appl�cant . , '��R i� ! M SINGLE FAMILY �a'p f.� � HOME OWNER-BUILDER DECLARATION x:�. Name �`m ° � m J � . .�`,�� ',eby affirm thm I am exemu�from the ContraUor s License�tr;,. , . � �fo�the following reason(Sedion 7031.5.Business andy'���s'_ I '�° 1 l;U.�lr - � �;��Professions Code): �?r�. Ciry" Tel.No. a , r. ` 'i �3�:❑ I,as owner of ihe property,wili do the work and Ihe�j � � l�Q„L c y,.�, structure is not in�ended or offered for sale (Sechon,,��',��g� ► j�� � ?-��tJ �:. � .,�" 7044,Business and Professions Code). , ty N �:� , f ;�> � .���� CONSTRUCT70N LE DING AGENCY �' I hereby affirm that ihere is a consirutlion�lending agency for�,k{w;; ��� "Ihe performance of the work for which-this permit is issued+c y { ��(Sec 3097,Cb.C.). X�; �'' .,��*�. , �� , i � �;,.: �'..�. �h Lender s Name �"���' � i � r' ��, �; Lender s Address u:�ai"; 'rl s�� I certify fhat I have read ihis application and stale that Ihe�44�, , V$ � above information is correcr.I agree to comply with all Countyr� ; ?^.ordinances and State lows regulating Plumbing,and herebyY� V` .puthonze represenlatives of this County lo enter upon ihe� h `''�. abov entioned properf�for inspeUion purposes. �- � �'�� r �� SEE REVERSE FOR EXPLANATORY LANGUAGE �,<f` i � ��= �•s�` . I �igna�ure of Permittee D e ��' � i^c.,>r'. .,., . . ,. .. ... ....�..._.. . ...;., . : ...: .:' ,.` :: :. - . _ - _ - . . . _ ��� �o� � z C�Ds�c � D�D �;z�.. „ !� . � � . . . . . .. .., , . . � � . ,. . .. . . ,. . m�� i y _ cn'3 -� cnlco c;aj � �� -� ��p � �n � � �I ,. 1 �m. � � ! . , . �.. i D�� rlI-�^i�Z -�-i ZI-O v ��ro � I �D � � ,�.,�A ~ �i� � v I w A ' � � I I �OI �c Di t� O�� � � m I � m D I I..._�IT �� AI '� G� � . O � [ .� � �� I . . 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