HomeMy WebLinkAbout0809A (4) "'°RK`RS•`°""PE"5"T'°"°E"ARAT'°" APPUCATION FOR PLUMBING PERMIT
I hereby,affiim ihot I have a ce�tificate of consent to seli in- p�6 DPW 4iB7 � �
76A6�7A
su're,o�a certificote af Workers'Compensalion Insuronce,or a CE Bv(REV.8i8C�
cenified copy thereof(Sec.3800,tab.C.) �
coi��y No.73WC00504�Qp,p6i,yNATIONWIDE COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS 42578
� Cer�ified copy is hereby furnished. LOT PLAN:25 TRACT:
FOR APPIICANT TO FIIL IN(PRINT OR TYPE) eUILDING
1-'1 Cerfified topy is filed with the county building inspettion NUMBER FI%TURE OR ITEM @ FFE "ooaess966 SOUTH SUNNYHILL PLACE
�-� department. �- LOCAUTv
DIAMOND-BAR
Doie 9-1-88- App�iwntNEW PLUMBING 3 WATER ClOSET(TO!LET) ( 1B NEaRESt
BATH 7U6 cRoss sr. GRAND�AVE. � �
� CERTIFICATE OF EXEMPTION FROM WORKERS' 3 LB
COMPENSATION INSURANCE 1 SHOWER 6 own�ER g�ALEA LIMITED
(Thb s�cfion nad not b�eomplN�d i4 Ma work Imolred 6y �ii
�h�parmM i�for ons hundrad dollars(5100)ar less.) (4 LAVA70RY 24 aDDaE55 3151 AIRWAY AVE. SUITE N
I certify thol in Ihe per(ormonce of ihe work for which this per-
mit is i55�ed,I shall not employ any person in any monner so SINK lz CITY COSTA MESA rE�."o.g50-1001
as�o become subjetl to the Workers'Compensafion law5. DISHWASMER
coNreacroAlEW PLUMBING CONTRACTORS, INC
Date AppliCanl 1 CLOTHES WASHFR 6 pODRE55
�NOTICE i0 APPLICANT:If,oifer moking�ihis Ceriificate of EK• - Z I41 $. DUPONT DRIVE
emption,you shoold betome subject to ihe Workers'Compern SWI�d1Y,iNG POOL RECEPTOR
c�rr ANAHEIM 'E`."0 937-3972
sofion provisions of the Lobor Code,you must forthwilh comp• �AWN SP41NKlER SYSTEM
ly wilh such provisions or this permil shall be deemed revok• STATE L�C.
Bd. . 1 WATER MEATER 6 LICENSE NO. 2 1 C1A55 —
� LICENSED CONTRACTORS DECLA4ATION DiSTRKT NO. cROCE55ED BY
I hereby oHirm rhar I am litensed under p�ovisions of Chap�er Ga.S SvSTEM OuilE75 6 /D
9(commencing with Sec�ion 7000)of Division 3 of the Business OUTlEiS OVER 1 5� `
��d Professions Code,and my license is in full force ond ef• 1 5 PER SvSTEM FINAL � ALIDATION a
DATE�— --g Q
ticense Number 426109 Lic.Uoss C-36 .
U
fINAI
Connaaor NEW PLUMBING pa�e 8-3188 BY o
�
❑ I OT PxPT(fl U�dPf SPC. W
a
B.BP.C.tor this reoson ► Z
Plan check fee
Date: PIUMBING PERMIT ISSUING FEE S
Signature � � TOTAL FEE 114 00 `�8 a 9�
. SINGLE FAMILY
HOME OWNER�BUIIDER DECIARATION P�an check oppl�canr j�a r • o o�
I heraby a(firm Ihot I am e�empt from Ihe CoN�oUor's License Name � • � � [,,LO
Law far�he following reason(Sed�on 7031.5, Business ond �
Professions Code): Address • • � � 4 G��
. � I,os owner o(Ihe properly,will do Ihe work and the City Tel.No. 0 8 1 ' _J 8
s�rocrore is not in�ended or offe�ed for sale(Seciion 7044, _
Bus�ness ond Professions Code�. " ,
- CONSTRUCTION LENDING AGENCY .
I here6y affirm rhol ihere is o conshuciion lending agency for ` � �
the performanw of rhe work ior which Ihis permit is issued -
(Sec 3D97,Civ.C.�. '
lender's Name � �
Lender's Address ,
I certify�ho�I have read this oppl�coiion and stale Ihal Ihe .
a6ove informalion is corred.I agree 10 comply wilh oll Gounty � , ,
ordinances and$tale lows reguloting Plumbing,and hereby . '
aurhorize representatives of�his County io enter upon ihe
a ve-m tioned proper�y for inspec�ion purposes. � �
. �_ ' SEE REVERSE FOR EXPLANATORY LANGUAGE '
SignoWre of PermiNee � Da�e .
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