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HomeMy WebLinkAbout1287A -,; _..�.- '� <,.." ,,,,..,.1. i�;.��«q y ti; � , ..� : "� A���:i Ev q�.:,:' � � . a -.. '�^ 5 � :�.i � r � �� '��,��W�.°�'^�^�� "�`�`"` -.�y �r ; � s ;;:.: � �,; `: :-,F '4 ��r �t. 7 �,_�` •WORKERS tOMPENSATION'DECL�ARATION ✓ � 5 g� 6 y � � �„yi,�.i,.�=ARPC�ATI�N�FOR PLI�M�II�G�PERM'IT ��1� t °� ,� I�hereb�affirm that.I have o certificate of consent3to se1P�Am 76P;6�Tq'�'ai'° M �'°�.aNri � . r�i � � . , q�� ,k; ."� : ,� � 3����'�> �r��e� � h�, jinsure,or n certificate of Workers'Compensa�ion Insurance�,��ce sn(aev l0iely� , � i �,i � ,tt � � . � �i . , . �,,� { +row�, ,_ for a certified copy thereof(Sec.3800,Lab.C.� �'�� �'�''��s COUNTY:OF LOS��ANGELES ti',. BUILDING AND.SAFETY ��'"'`i M �''�^ � -" d "t':t,� .� ��Y, '�! . ,�� � ,Ocy"No.NOSO�SZH�ompony F3YIR0L'S � �: FS�`. � �'r ��„,"�$-� �'. � �a:7' .,�.• Lot.38�a_ ,F�.,,„.� -.Cert fied copy is hereby furnished. ;❑ �, '�,; FORAPPLICANiTOFILLIN�PRINTORiVPE) qDDRE55 1439 S. Stonecrest P1ace � �.� :Cerllfied topy is filed wiFh ihe[ounty building nspec {r� :� NUMBER FIXTUREOR ITEM (a� FEE . d� y .. twn department. � � jr�; �ocauTY k £ � �}a WATER CIOSET � Diamp.nd $ar �, �� � .iDate Z�2./RS Applicani P-R_(1_ P7nmh�no�� ; � NEAREST � ^�� � � J, r� .._'1 CROSSST. ��� �:�, � CERTIFICATE OF EXEMPTION fROM WORKERS u� BATH TIJe �/y g : COMPENSATION INSURANCE ��€ �: SHOWER `� �� OWNER Bramalea Limited ' ����' � :(This section need not be aompleted if the work involved by��d; MAu � �: `"Ifhe permit is,for one h�adred�dollars(5700)or less) �,� ; tqVATORr /A� nooRESS 3151 Airwa AV'2. STE N -.�. �'1 certify thal in the performance of the work tor which this���„;, SINK f/!7 �-CIN TEL.NO. � �;permit is issued,1 shall noi emplay any.pereon in any manner� � QOSCB MOSd ,�� SSO—ZOOZ "�• ° k+;;so as to become subject to ihe Workers'Compensa�on laws :� � `,,� � � DISHWASHER y�[� CONTRACTOR �t� � ��,�; � � P.R.O. Plnmbing � Applicani ' 4; � CLOTHES WASHER � �� �.soare � ADDRESS 4418 E. Cha an `� 5,. '1TICE TO APPLICAN7: If, ofter making ihis Certificate oF � � ,� � �ion, ou should become sub'ea +o �he workers SWIMMINGPOOLRECEPTOR i � P v i �� an Orange ,�i.No. 630-8441 , �' ?� ,.,.,�ensation o�isions of the Labor Code, ou m st forth � t P P� Y , a LAWNSPRINKLERSVSTEM ;�� r� ifh comply with such provisions or ihis permit shall bedk�' �� Siaie uC. ����` s � deemad revoked.: , < �' WATER HEATER /_ �' ucervse rvo. 443774 CLA55 Ci-3E1 .� ,��� �:�. i u �,� LICENSED CONTRACTORS DECLARA7101+� �" '+' v� DIST21C7 NO. FROCESSED BY �y v1� I hereby affirm ihat I am licensed under provisions of Chapter 9�*.•*5°� GAS SYS7EM OUTLETS � v y ' commencin with Section 70Q0 of Divis"on 3 of ihe Bos ness���� 4 ( g ) { �`yy� OUIlETSOVER �+': � 1 r a and Professions Code,and my license is in full force and effecf'"�� � 5 PER SYSTEM FwA� VALIDATION t �"'�ti I� � t '.,License'Number 443774 Lia Class �(,'—��_,'4tt� DATE �.7'�d���" �f� �� t '. - �$ FINAL j Y� �'� I�'` �� Comractor P-Rfl_P7ivnbin�Date 7/9/RS �� BY �te.t/� � ��,��., (`��' ;k"� � c��e„'�g° ,� ° i am exempt under Sec � � �pk.' l� ; B.&P.C.for ihis reason �,{� � �� i r;; � Plan check fee � � � � ` Date:_ � � I � " �;;�'� PLUMBING PERMIT ISSUING FEE$ �E� ;; l s ' Signdt�re � ric�,.� � °� �; � �' �i TOTAL FEE � � j ��t ":�,�3 _ � ��,� . ;���Plan check applimnt c i L���1 1 .��,� SINGLE FAMILY �"y��� .�.fl � � f p�� � : � „� � HOME OWNER-BUILDER DECLARATION �,�� f Name . v , � �:=by affirm ihat I am exempt from ihe Controdor s licensep,:9 , � 2 1 ���u r,� �. 7� � � ,' • for ihe following reason(Section 7031.5, B�siness ande aoress 0 - - ,� Professions Code): ;�p� Ci1y Tei.No. � � (,{)J(�i 1 F n .. L_J I,as owner of ihe property,will do the work and ihe ,�'�'� Q 7.j r—�Qi J � ,� '�' siructure is not intended ar offered for sale (Sect on �+�s �3 : 7044,Business nnd Profassions Code). L""�... ► � ?' tl� ; CONSTRUCTdON LENDING AGENCY �y,p� � �Y i "- x; I hereby affirm ihat�here is a constr�ction lending agency for '�@, � f� �� 1he performance of fhe work for which this pe�mit s ssued � �, (Sec.3097,Civ.C.).' . �;��;�� �.l � � ���a z : Lender's Name "� � �9. Lender's Address �'�"� �: ` I ceriify ihpt I have read fhis application and state ihat ihe�� ► "}� ; �"�above intormotion is mrrect.I agree to comply wiih all Cou ty�"�; g ! ordinances and State laws regulating Pl�mbing,and hereby�cf�y � � .i authorize representatives of this County to'enier upon ihe�w�Ft ' '� � q6 -mentioned toperiy for insgetlion pur oses. �° ��'v � �"' SEE REVERSE FOR EXPLANATORY LANGUAGE . . i � ��:� � ri , . , � s f � Signature of Permiflee ate �`" ' � t � P+ . .; , .. 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