HomeMy WebLinkAbout0808A `"°RKERS•�°""E"S"T'°"°E""RAT'°" APPLICATION FOR PLUMBING PERMIT {�
70-W�6 D%N d/87
I hereby,oHi�m tho�I have o cerr'rficaie of consen�io self in- 76A667A
sufe,or o cetiificaie ot Workers'Compensarion Insuronte,or o CE 617(REv.BiB6) - - LJ
ceAified copy Ihereof(Sec 3800,lob.C.�
pop�y No.Z�.WGD05041Q9A(�yNATIONG]IDE COUNTY OP LOS ANGELES DEPT.OF PUBLIC WORKS '
2578
� Certilied mpy is hereby furnlshed. BU�LDMG • �
FOR ADPLICANT TO FlLL IN(PRINT OR TYPE� nooRess960 SOUTH SUNNYHILL PLACE
� Cer�ified mpy is fiied with Ihe caunty building insper�ion NUMBFR il%TURE OR ITEM @ FEE �
deportment IOCAUTv .
9-1-88 NEW PLUI�ING 3 wnrea ttoser�roaeT� 6 18 DIAMOND BAR -.
Dole Applirom NEARESi
GERiIfICATE OF EXEMPTION FROM WORKERS' 2 8/TH Tue 12 cRoss sT. GRANA AVE. �
' COMPENSATION INSURANCE � 2 OWNER
SHOWER 12 BRAMALEA LIMITED
(Th(s wdion nwd erot b�eomplNad if�he work imolved by N,ait
ths pormlf is for ono hundrod dellors(5100)or bss.) tAVATORV 24 nDORE55
I certify that in the performance af rhe work for which rhis per- z $�,�K ZZ GTY COSTA MESA �Tei.No.850-1601
mi�is issued,I shall nol employ ony person in ony manner so
as lo beCome Subje[I to Ihe Workers'Compensation�aws. 1 OISHWASHER 6 �pNTRpCtO
�IEW PLUMBING C�NTRACTORS INC
Da�O Applicanl CLOiHES WASHER 6 ADORESS
N0110E i0 APPLICANT:II,ofler moking th�s Cerlifica�e o�Ex- . �LL�FL S. DIIPONT DRIVE
emptian,you should become su6jed fo ihe Workeri Compen- SwiMMtNG POOL RKEPTOR
sOlion prOvi5i0�3 oS tfle LobOr Code,yau musl forlhwNM COmp- �AWN SPRINKLER SYSTEM CITY (�AHIEM rE�.No.937-3972
ly with wch provisions or ihis permit shall be deemed revok- Si�1E ltC.
ed. , 1 WATER HEA�ER b l ucen,se r,o.426109 ClASS C-36
LICENSED CONTRACTORS DECIARATION DiSTRiCT N PROCESSED BV
I he�eby aI(irm tha�I am litensed under prpvisians of Chopler GAS SYSTEM OUTlETS 6 ��
9(commencing with Section 7000)ol Division 3 of the Business ou7tET5 OVER
and Professions Code,and my license�s in f�ll force ond ef- 1 5 vER SVSTEM 1 50 F�NA� � V LIDATION }
iecl. DATE —z�—� O .
License Number L761(19 Lic,Closs r—�� V
FINAL 2
Com�actor NEW PL[1MBING Da�e $-31-$$ . BY ��^'� O
U
� I om e:ampt und=r Sec. a
B.sP.C.fo�ih�s�eoso� Plan check fee ► y
i
Dme: .PLUMBING PERMIT ISSUING FEE S 1 O SO
Signature TOTAL FEE 111i OO
SINGLE FAMILY pion check a I cont
HOME OVINFR-BUIIDER OECLARATION PP' _^,C 8!1 C'�1
I he�eby affirm thm I am earmpi Trom the Controcror's License Name
law for�he following reo:on(Sedion 703�.5. Busine:s ond �n • . e o rj
Rofessions CodeJ: Address
� I,os owner o��he propeny,will do�he work ond Ihe ���Y Tel.No. � � •1 1 G.G n
strucNre is not intended o�offe�ed for sale(Section 7044, . �
Business and Professions Code). . - , � � � t,��"�
. CONSTRUCTION LEN�ING AGENCY � - � � O II'� � —"�
I hereby nffirm Ihot there is a ronstrutlian lending ogency for �
the periarmence of�he work fo�which this permf�is issued �
(Sec 3097.Civ.C.).
lender's Name ,
lender's Address . .
I carlify tho�1 hove read thiz applimlion ond s�me thol the . ►
obove info�mation is correct.I agree ta comply wilh all Coonty
ordinances and S�a�e lows regulaling Plum6ing,and`hereby
authorize reprasenlaiives oi this Counry fo enter upon the
obo�e-menlio�ed piopei�y fOr in5pf[lio�p�rposez. '
� //r�`� SEE REVERSE FOR EXPLANATORY LANGUAGE "
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