HomeMy WebLinkAbout1296A .:;�� Y�i� -.���:: '�� aY',�,�.;.i:": r�c�..i,�x7 ���[7`S°.��� `.;�� n ,�k�a" � �k 5��� '� x M:.:ie E ��:,k.i,if --t"�;" ,'•e*,�'�'4 ,�.:i, .�Gti�.�, xy ..V�yw�,z�',��'.-i �s¢r�., ( Y��,n � ,�'�
��'� ^��<WORKERS'•'COMPENSA7IOIV�'DEC�aRAT�t�N'�� r�°����:';i� *�+�xs�...���° � . ¢ .Y :� '+� � � � k �� �W�`� � .��=�
� �'`� �:�F, ���APPLf�ioccTlf�N��OR�PLCJ'MBII�G��P�RMIT� �� � �� ��
4 .I�h`ere6y�.affirm ihat I have a certificate of consen fo selF}�y;�,�.76tqy67AC�.x .$."sb, - / �'' ��, � z,�`'� ,'����'����
-insure or a cert��cate of Workers'Compensa)ion Insurance�"�lynveCE 8�7(REV 10�/81)���. ��- . � �-. � �,� - `^��,� . �. ! a;, ; ! � ��.�a��� :�_ :,�,� ��x�
.,�;;oracertif'ed�co thereot Sec.3800,Lab.C. f��< �
k� � '� COUNTY OF LOS,ANGELES � - BUILD�NG AND�SAFETY ,� �
�.Policy'No N0507528$omPa„y Farmers :;��s , ���, ; . � . � � � ��'`�.;?��Lot�.36 �.�� ��-���.
� ❑ Certified mpy is hereby fumished. �'"���R
!'�,' F O R A P P L I C A N T T O F I L L I N(P R I N T O R T Y P E) bUILDING � � :i,�:
};� no�aEss 1431 S. Stonecrest P r�y
Certified mpy is filed with tHe county building inspec �� �. :,5
�.^ lion deporfinenf. � z� NUMBER FIXTURE OR ITEM r@ FEE �pCALITY $k �
y ' ��, � Diamond Bar � ry�;
� � oore 7�2�85 h' WATERCLOSET q
Applicant P.R.O.Plumbine s�,r,� NenResr > �
CERTIFICATE OF EXEMPTION FROM WORKERS ki y` '�..- BATH TUB ��„ � CRO55 ST. S >�;
� �' � COMPENSATION INSURANCE �� stiowEa OWNER Bramalea I,lmited
�;(This section need nof 6e complefed if the work involved by'�s��,'
� MAII ++ .,i I
r `fhe permit is for one hundred dollars(5100)or less) "��:�� ( LAVA70RY �'
�zi I cerfify ihui in the performance of iHe work for wh ch thisi"'>�; AD�RESS 1 ' 0 �,' i
"�k�Tpermin is issued,I shall not employ any person in any ma ner'C'�., SINK �y J/'� CITv Costa�Mesa TEL NO.8SO�ZOOL y;?�,
�so as�o bemme sub�ect to the Workers'Com ensat on La s . ti� a
f ��� � P .3.�i, ! DISHWASHER � CONTRACTOR ��
�, , n�,��s P,R.O. Plumbin s ;�`
���..
` ;�-Date� Appli[ant � ���. CLOTHES WASHER ADDRESS '��
i S�'^"��ICE TO APPLICANT. If, af�er making this Cert f cote of wr� �F�+1$ E. Cha m8ri � -t'¢�.
"'�y qiption, you should become su6jecl to the Workers�0� SWIMMINGPOOLRKEPTOR �.ti'.,
d ��� ��r'' Oran e TE�.Nob30-8441 y�
hiparsatior.prov:sicns of}he.La6or Ccde,ycu m�st fa iF�y�. �AWNSPRINKLERSYSTEM �
�''s with cpmply with�such provisions or ihis permit shall 6e"',*�`� STATE LIC.
s "`�deemed.��oked. ¢, � ��ceNse No. 443774 anss C-36 ��
{�. . WATER HEATER,
ti{r � UCENSED CONTRACTORS DECLARATION,. ��,�4� / � -- DISTRICT Nq. PROCe55eo av
� w,r�� I hereby affirm that I am licensed under prov�vons oP Chapte 9�� Gn5 SYSTErn ouneis �� �� ;�,;
r�� (commencing with Section 7000)of Division 3 of the 8usmessf�^'-�.; pU7LET50VER
'"•and ProfessionsCode,and m license is in foll forceand effed �:� 5 PER SvSTEM �"��
��. Y �z � o��� L V LIDATION ' �,���
�`��ucense Number 4'�+3774 Lic.Ciass C 36 j,` ` J �d�f�
�: �. :
����.
d,; . '. . ��',.. FINAL �;�'-�
�'`��'. Conirador P.R.O. Plum'6in�Qie 7/9/RS t,4;F` BY ��.ctd.� � . y,,.
� �' � -.;
I am exempt under Sec ,��� ��,��
I � 8.&P.C.for this reason '��$� , �'`.'
G+' +�� k� °= Plan check fee
Date: p
1++�� � iE�"� PLUMBING PERMIT ISSUING FEE$ �U S�
I �,�,,� � Signature �a.^�,�°' %i L`l.F��
I � �,�i TOTAL FEE
a�..�,°,,,.c :r.� a r� a .j
� �' �^+Plan check oppiicant �,
.'I ' SINGLE FAMILV s j n }(�jO
!s-� ;� NOMEOWNER-BUIIDER�DECLARATION �;� Nome � . � �y;���
� q �,eby aifirm ihat I om exempt from ihe Conhactor s L cense �y--� , c �' � �d L-v(, u
! y1,. lfor the following reason($edion 7031.5, Busmass and'�?°�xW " ' ?'��
p ,°+�Professions Code)r ' srs'�� �tyfeS Tel.No. Q � � � ��� z �
�d a1�� . . yxvs''r � " ;
I,os owner of the property,will do ihe work and ihe�.Y'-1�ii y, :,
� strocture is not imended or offered for�sale (Sec�ion�� �"-!
�
� �� 7044,8usiness and Profassions Code). ' -��,.' �
l .4 '4�;� f i��
'� �'� CONSTRUCTION LEN�ING AGENCY �`'�'� �qf;.
�;r�i
.9 1 hereby affirm ihat rhere is a construction lending aqency for f�.�:' �j���
3 ."ihe performpnce ot the work for which ihis permit is ssued�4�F� r p���
!�x,r; 3:i�'`�
° ��(Sec.3097,Civ.C.). �"��. :, :
,. � i
Lender's Npme ��"'` � ?'��
kp }�{'� 4(
�r Lender's Address "`� �'�
�- I certify that I have read this application and siofe ihot ihe°��", ► � � �
i
�'t� a6ove info�mation is correct.I agrea to comply with all Co nlym:{�; ,,- -;
��ordrnances and Sfa1e laws requlating Plumbinq,and hereby-,� �' x-.:
� r�aufhor za rapresentatives of this County to enier upon iheyy�� ���
� above-meniioned prop rty for inspection purposes. �di.���. �� '
� ���� SEE REVERSE FOR EXPLANATORY LANGUAGE : 1.
;�4� �� A�'�' ��r�
I h SignaNre of Permiltee ale ���;, ' ;e�.'�
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