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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�.'� v+�^ . . �, . __�._ ._._ . ,. : . � � y . ' � ., . � - N � . � �. . ' . . � , �.+� .� . '� .�� � ',-��. . 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