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HomeMy WebLinkAbout1713A ... . �+. .. . .... . ._ _�.. .. _ ._ .. .__ .. . ...._ _ . _a{ . . ..... _ .. _y .._. .., .. .. . ._ . . . . _. _._. . . _..... �2KS'COMPHNSAi]ONDECLARATION ' �sass�a I hereby affirm that 7 have a certificate of consent to self cE en,z-ao; ��AP�LICATfON��F��R�.PL.0 M�B:I.NG PE,�RM IT insure o a certifuate of Wurkers'Compensation Insurance,or , , � �� �,� � � . . ,�. a cert�r�ea copy thereuf(Sec.3800,l.an.e.) COU.NTY OF LOS ANGELES BUI LDtNG AND SAFETY ��,«YNo.�'�c].o68k�,�any �ilum :lssoc. � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PR�NT OR TYPE) BUILDING � Certified copy is fi(ed witN th c unty i ding in pection �. fVUMeEFt FIXTURE OR ITEM • FEE ADDRESS 2 O Sunbri ht St, �Iepar�y�t., ' LOCALITY D1 YI71GT1C�. B aI' � Date��plicant ' n.V WATER CLOSET NEqREST eATH TUB CROSS ST. 1 CERTIFICATE OF EXEMYT[ON k�ROM WORKHR � � COMPENSAT[ON INSURANCti SHOWER OWNER_ _ P�ja,]_ BOP(�.We]_1 �� (This section need not be completed iF the work involved LAVATORY qooRess s�:me by tt�e pe:mit is foc one hundxed dollars ($100)or less.) ' 'Y ' � . SINK c�rv D^��:mcnd Rr�r ��lb� ���� I certifY tha[in the performance oP the work for which this U OISHWASHER permi[is issued,I shal]no[employ any person in any manner CONTRACTOR �J'.hOIT�dS �roup .,�� �. so us to become subject to the Workerx'Compensatinn Laws. CLOTHES WASHER AO�RESS 12900 GG � V(�, ��� Date Applicant 7 ��"" SWIMMING PDOL RECEPTOR .0 NOTICE TO APYLICANT:If,after muking this Ccrtificate of CITV G`G' 937-i667 TEL.NO. �� ' Exemptiun, you shuuld become subject to the Workers' �AWNSPRINKLE�RSYSTEM : ��'�� � , STATE C, LIC. '� Compensation provisions of the La6or Code,you must forth- IICENSE NO. 35/Sj��� CLAS��'i �� with�Comply with such provisinds or this permit shalt be WATEF HEATER deemed revoked. DISTRICT NO. P OCESSE�BV � _ GAS SYSTEM OUTLETS / _ .... LICENSED CONIRAC7'ORS D�CLARATION OUTLETS OVER !� � I hereby affirm tlixt I am licensed under provisiuns of Ch�pter 5 PE R SYSTEM �•-i A..ui.+t.� 9.(commencing with Sectiun 7000)of Division�3 of the Dusi- � PINAL k ' ness und Yrofessions Code,and my license is iu full force and ) P c DATE 3_'3 i—Cb`�, VALIDATION � effect. � � �,55542 SC�.�. �p�C 52222 FINA4 '� License Numb Lic.Class p gy E Contrac[orThOm`.S a'T'OU�Jfe ��Z�VZ ! , � � I am exemp[from the licensing requirements as t am d : P.lan check fee ]icensed architect or a registered professional engineer p�UMBiNG PERMIT ISSUING FEE$ acting in my prnfessional capacity (Section 7051, Bus- � � iness and Yrofessions Cnde). , TOTAL FEE l,ic,or Re�+.No. Date � Plan eheck applicant � . 1 . E ' � . HOMH ON+NER-BUILDER DECLARATION .' Name , � [ hereby affirm that I am exempt from the Contractor's �� Address 1� `]'�,5� . , � _ License I.aw fVr Ine tollowing reason(Sectlon 7031.5,Rusi- ::'City Tel.No. ' � ness and Pcofessions Code): . #• • o m e�5 � � � I,as owner of the property,am oxclusively conVacting . . ' � a � ?, .Jr Q i - with licensed cuntrnctors to construct the project � � (Section 70a4,Susineas and Yrofessinns Code). . • v o � 2�5�� , t CONST2llC7'lON LHNIJING AGI3NCY ' ' Q 3 n 2,,,g•� � I hereby uffirm that there is a construction lending agency � for the performance of the work for which this pennit is � issued(Sec.3097,Civ.C.). � � f � Lender's Name ' � Finr,nce .:meric: i Lender's Address � � i 1 certiFy thut L have read tliis applica[ion and stx[e thnt the t ' above informa[ion is correct.1 agree to romp1Y with all County . SPP REVI?KSS NOR EXPLANATORY LANGUAGI•; 6 ordinxnces and Stxte laws regulatinK 1'�umbing, �nd hereby � author'i rep seRtatives of his County to enter -pon the � . � abuve ntiu d roperty for inspection purpose. 11 � �� ��� � � U� , � . ` Signature of Permittee Uate � t z �ti .���„,.i�.� �i � ��io � -' D!�i0 D D �O�zi •:: i � i j . -� , ..._ �,N,�.Cr.,.. : �,.,I i'" :r. � .u: v� �C I p, I � m i '�� ,-a"�m i 5_!.<,-."v ��ml D � I ! . . (1 : I�:in �� ��''m t l'��� . I , � ! L� � "DA � n,� IG) rn"Z v'N17] I i ,�, C.J :� . . . ��_I � `J�. T. 77i��I � •D I O I � ' `' ��' � � .. .. xDl � , � O� Ix =' � IS��°'�� � ;� � O �. .,r ' i �� m � y a � � I 1�` C D' , Iw'�'rx . il�. 1�1 "'�i � z iJ) I �, . � ,�r ' �ew�l �imi� !�v�i! .�A�'• � G7 �; .. � I : . ' .... � .. ," . F ' I (-�vl .0 I i i�. � �, _ ��� � '� z , ... . . G I :I v�. 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