HomeMy WebLinkAbout0808A (4) `"°RKERS•�°""E"S"T'°"°E""RAT'°" APPLICATION FOR PLUMBING PERMIT {�
7tl-W�6 D%N d/87
I he*eby,oHi�m tho�I have o cert'rficaie of consen��o self in- 76A667p
sufe,or o cetii(icaie ot Workers'Compensarion Insuronte,or o CE 617(REv.BiB6) - - LJ
ceAified copy�hereof(Sec 3800,lob.C.�
Policy No.7_�. D{JG 05041Q9AFlnyNATIONG]IDE COUNTY OP LOS ANGElES DEPT.OF PUBIIC WORKS '
2578
� Certilied mpy ie hereby furnlshed. BU�LDMG • �
FOR AD%.ICANT 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 PLUt�II3G 3 wnrea aoser�roiteT� 6 18 DIAMOND BAR
Dote Appli[onl NFAREST
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�complNad if�he work imolved by M,qi�
ths pormlf is for ono hundrod dellnrs(5100)or bss.) tAVATORV 24 nDORE55
I certify that in the performance af rhe work for which rhis per- z S�,�K ZZ GTY COSTA MESA �Tei.No.850-1001
mil is�Ssued,I shall nol employ ony person in ony manne�so
as lo beCome Subje[I to Ihe Workers'Compensation�aws. 1 OISHWASHER 6 �pNTRpCtO
�IEW PLUMBING C6NTRACTORS INC
Da�O Applicanl CLOiHES WASHER 6 ADOR£$S
N0110E TO APPLICANT:If,ofler moking th�s Cerffica�e o�Ex- . �LL�FL S. DIIPONT DRIVE
emptian,you should become su6jed fo ihe Workeri Compen- SwiMMtNG POOL RKEPTOR
sOlion provi5i0n3 of ifle LobOr Code,yau mu51 forlhwNM COmp- �AWN SPRINKLER SYSTEM CI1Y (�AHIEM rE�.No.937-3972
ly with wch provisions or ihis permit shall be deemed revok- Si�1E ltC.
ed. , 1 WATfR HEA�ER b l ucen,se r,o,426104 ClASS C-36
LICENSED CONTRACTORS DECIARATION DiSTRiCT N PROCESSED BV
I he�eby a(l+rm thar I am licensed under pravisians of Chop�er GAS SYSTEM OUTlETS 6 �(�
9(commencing wirh Section 7000)ol Division 3 of the Business ou7tET5 OVER
and Professions Code,and my license is in f�ll force ond ef- 1 5 vER SVSTEM 1 50 F�NA� � V LIDATION }
fecl. DATE —z�—� O .
License Number G761(19 Lic,Class r—�� V
FINAL 2
Com�actor NEW PL[fMBING Da�e $-31-$$ . BY �` O
U
� I om e:ampt�nd=r Sec. y
B.BP.C.fo�ih�s�eoso� Plan check fee ► y
i
Dme: .PLUMBING PERMIT ISSUING FEE S 1 O SO
Signature TOTALFEE llji �0
SINGLE FAMILY pion check a I cont
HOME OVINFR�BUIIDfR OECLARATION PP' _^,O 8!1 s'�1
I he�eby affirm thm I am earmpi Trom the Controcror's License Name
Low for ihe following reoson(Sedion 703I.5. Business ond �s • . 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�offered for sale(Section 7044, . �
Business and Professions Code). . - , � � � t,��"�
. CONSTRUCTION LEN�ING AGENGY � - � O 8'� � —�'�
I hereby nfflrm iho�there is a construtlian lending ogency for �
the periarmcnce of�he work for which this permf�is issued �
(Sac 3097,Civ.C.).
lender's Name , ,
lender's Address . .
i ce�lify thot 1 hove read thiz applimlion and it��r thol the . ►
obove info�mation is correct.I agree ta comply wilh all Coonty
ordinances and S�ale Iaws regulaling Plum6ing,and`hereby
authorize reprasenlaiives oi this Counry fo enter upon the
obo�e-menlio�ed piopei�y fOr inSpE[lio�p�rposez. '
�`//r�`� SEE REVERSE FOR EXPLANATORY LANGUAGE "
Signotu . F ermitt _ Date �
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