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HomeMy WebLinkAbout1297A s ; , :'.. •, i`��' .'y_�v<5 ,v. .z. ����'��� �.%� s A�r�}K�2���1.. * 4.�.�� f��lt y�.;�. '��� ,�,y,'i a. > .����J` W ,�.t�,R 3 -� �� r3'�� r �, `y ,i� �;�� -- `,WORKERS•COMPENSATION:DECLARATION ���j�"'•t��•�n s� ���� x � � N � � '' � � �. �. _« ' �r,�/�PPGIC�ATION�FORJ`PLUMBING�P.E�RNCI7` � < F , �� I:'`hereby�affvm ihat I have o certificate of wnsenY to self�$ �"76A667AZ�'M' f�� °'�' ' � � .' ' g��"'����y�'�L'���' ��'`� � �:� �.,msure,or o cerfifimfe of Workers'Compensation Insurance{;�a�uCE 8n(REY �088L�,'� -, �� 7 � � . � �- �� S;: �; i � �, , % �,t°� .;,"��i� ���,'��+h�"K ..::or a cenified copy Ihereof(Sec.3800,Lab.C.) "�� ' 3�°9 � -, � ' ���"'°'�� �� F�r� a,�LR�:��} S��°< x . � COUNTY OF LOS ANGELES BUILDING AND SAFETY ��x��`,,�� �n `,� L. !,� Ocy NoN05075288 compa�y Farmers �� ; ��' ; ���otf 34��"„�'��. `{� ''�k ,..:� ' Certified wpy is hareby fum,ished �;y�• �, Y❑ ��� �}� FORAPPLICAN7TOFILLW(PRINTORTYPE) BUILDING � Certified copy�is filed wirh ihe county building mspec �°�y�.�� ADoee55 1423 S. Seoneerest Plaee � tion depar}ment. ��'fis'm� NUMBER FIXTURE OR ITEM �id FEE �,�. � � LOCALITY Diamond Sar �sx >� �;;Date �I2IR5 APPlicanf P_R_(a„ Pl�rmh ��F WATERCLOSET �� � � s� _ ---o���.y�. NEAREST � _ . �.. CERTI�ICATE OF EXEMPTION FROM WORKERS ��'�. aqiH iUs �y � CRO55 Si. . ��; �� y�. " COMPENSATION WSURANCE y�'�� OWNER "� �^� f" .(This aeCfion need no}be complefed ff fhe work involved by� '� SHOWER Brama lea Limited � { �.}he permi}ie for one hundred dollnrs(SI00)or less) � � LqVATOev Z � MniL '. �.' y� ?I certify that in ihe performance of ihe work fon c�h th s� rP' ADDRE55 3151 Airwa Ave. Ste, j� � ;M- � ,n.permd is ssued,I shall nm employ anyperson in ariy mnnne� v; � S�NK Cy (j7� ��T� COSC1 M0S2 TE� "og50-1001 � � „so as to 6ecome su6jeci to ihe Workers'Compensahon Lows�{�i�i<� � DISHWASHER 6 . ��, tY, coNreacroap,g,0, Plumbin '�a . �: r ��Dote ,4ppu�a�f - �� � aoTHeswnsHea 4418 E. Chapman '`" j�'�'1 ICE TO APPLICANT: If, after making this Ceriificate of �+p ADDRE55 � . � �nption, you sho�ld�become subject ta the Workers� SWIMMINGPOOLRECEPTOR . � ' ��:�� Ndf.�o'rrmpensatian promsions�of the Labor Code,yoo must forfh-:��'� CITY TEL NO �4' Oran e 630-&44�1 ti � LAVJNSFRINKLERSYSfEM g .� : �l. with romply wi�h svch provisions or this permit shall be4% �� StATe uC. r�; 'deemedrevoked. �'^iu WA7ERHEATER � LICENSENO. �i�F3]]�M CLA55 C-36 �,� � F� LICENSE�CONTRACTORS�ECIARAT!ON $, 5 — DISTRICT NO. PROCESSED BY � t y �hereby affirm that I am licensed under provisrons of Chapter 9 P�`'�' GASSYSTEM OUTLE75 • � T�" (commencing with Section 7000)of Division 3 of ihe Bu5 nessy'��: OUTLETSOVER �� ty�,� �,,;�� �,, and Professions Cade,and my license is in full force and effecf.��'„ 5 PER SYSTEM �//� DATION F k y, FINAL � �:�' r'� � ?� �ATE �j"� / s ` �. � License Number 443774 i��.ciass C 36 /d��'S� � L.T'!� '�'�•' fINAL �i y y'��,.ContractorP•R•�. Plumbin Dote 7�2�R5 x'�'�'�� BY ,���yya•� f �,.�' � '.❑ I am exempt under Sec. �� � � w�a,x'�.' fi. ��"h�r �e�. � a.�P.c.fo�this reason :. � Plan check fee ��' � '�' ��_-- Dnte: ����� — p � . �'} ;� � ' Signalure n,;",cq'w� PLUMBING PERMIT�SSUING PEE$ LU S� �: x, � I � ��. ���;� TOTAL fEE S ::":� t�`.': I F1 �:� ,�i �x'. A`A, • '�.i � k`. . �,yd, Plan check applimni �;n � q » ..�� �. SIYGiE FAPoiILY � a�' FIOME OWNER-BUILDER DECLARATION �.�''� Name �' � � , �� r � � „ m q l� F O t`- ��� �=6y affirm fhot I om exempl fram tbe Conlracto s License 'Sk, � � - r . .I ior the foilowing reason (Section 70.37.5, 8us ness and�� �. + �� �1ProfessionsCode)� `�. s � � s � `''�����"-� `�� � . Crty G Tei.Na. �� I �"�. �', � , g� �t ` . � �n❑ I,as owner of fhe property,will,do the work and ihe �M, ' x�, � � +�� structure,is not intended or offered for sale (Secirort �� f�„ 704G,Business and Professions Code). .��"fr� � � � r � ✓;,. CONSTRUCTION LENDING AGENCY �;,;�r� x ��I hereby atfirm thot there is a consiruction lending agency for�,�;, £ ti �,�,�� `the performance of ihe work for which ihis permil is issued � � '�,(Sec.3097,Civ.C.). � �a � * -���. C..2.: 7: S �4� � rr�. �>lender's Name p�'�; k+��� i�.Y ��.�' '� lender's Address �, _' }, I cerhfy thal I have read this application and state ihof the�..� i� � . � �a6ove informolion is correct.I agree to comply wifh all Co nty � �'�ordinances and State lows regulaling Plumbing,and hereby� �: t�- % �`.authorize representatives of this County to emer upon they��i; � � �+`ah -mentioned pro er�y for inspedion purposes. �� ��' � - . , :.�: SEE REVERSE FOR EXPLANATORY LANGUAGE yi; � � � �:�; � , ignolure of Per i afe ���: .�'. ,;.,� _ o ,� .._.�... � g�c . Z� . g z � r.,N � o`� ��_ �' � ~......:. ... : . . . .... . . - ..� . � ,, '. . . �. . a q � ' �� � � �.... - �.�... �.;. , ' . . . . ' Gl �`� GZ7t�-�w �G � Dr { m�W_ ��y ; �.. �;:�. . ., ,� � . ...,:�. 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