HomeMy WebLinkAbout5772Ar' 7 +c``'' `,t .' i,""; a'"'=r`+ 'n ".."F4..*
4 V Of KEi2$ CDMIfEN$d7f(i(J DECLARATION pP AfkxaN .rn.a +A&' -es s ,
Eby affirm that I have a cert i icate of Consent to,sel f
t v,.f: . s 1 ,..,. .r . 1
7bgyy7q
or &-certificate of Workers' Compensation Insurance, CE.817 (REV. 10/81)
edified cop thereof (Sec. 3H00; Lab. C.)
6oS 34-8
ompany
COUNTY OF LOS ANGELESE. State Comp
n:•,t's.,Y .,
Signature
Certified copy is hereby furnished.
y '%
t
u >•r-::.srr.,.v. * ;rw :&=.r..?+te.Ais: ;+ ,;.;r c •r.. , '::,r,,, ,. FOR APPLICANT TO FILL 1N (PRINT OR TYPEI
Certified copy is filed with the county building inspec-
tion department. NUMBER FIXTURE OR ITEM 2
2/28/85 Atpp,,,an,S0 Coast Plumbing 2 WATER CLOSET 5.00 1
FICATOFf XEMtIONFROhJ1N70RkERS
ai BATHTUB
a
ry7a" ' Y C+OM1%EN AvxTl. ON1-fx.SURAN" . 0M ,
secTron need not Co.ple} i } e works invoive:tT by 1 SHOWER 6. DJ
sforona hured dollars ($100) or less.) armnd 2 LAVATORY 5.00 1
y 'that in the performance of 't(,e work 'f6-, 'which Yhis
t v^l 4 x •. + s
c CONS UCTI CEND'11JGy`ENC
t is,issued, (shall not employ any person.in any manner SINK
to become subject to the Workers' Compensation Laws.
s 3w. DISHWASHER
i"(Sec..7. Civ. C.1.
Appllca nt CLOTHES WASHER
E ibP{PC MV.;`If after making this Certificate of
Nibn; •you siiould`becdme subject to the Workers' SWIMMING POOL RECEPTOR
ensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
comply-with such provisions or this permit shall be
ed vo ed.
LI C NS'dNTTHI C'T F1'S'ECtLA ATI(TJ `_
WATER HEATER1 ,QD
3 ss!aw"`'_s sx°1. ubyaffirermthatIamlicensedunderpodonsofCfiapfei GAS SYSTEM OUTLETS'•9
fencing with Section 7000) of Division 3 of the Business OUTLETS OVER
ofessions Code, and my license Is In full force and effect. 5 PER SYSTEM
J30$ 6 , ...._ 1 Drinking Fountain 00
BUILDING AND SAFETY
Bath House rr
INGADDREESS 24155 E. Sylvan Glen
FEE
LOCALITY Diamond Bar
00
NEAREST. Golden Spring
QQ OWNER The Anden Group
MAIL .00 ADDRESS 1074 Park ViewDr. f#201
CITY Covina TEL. NO.818-967-95 1
coNTRAcioRSouth Coast Plumbing Systems, Inc
ADDRESS 3005 Vine St.
CITY Riverside TEL. NG.714-781-45 1
STATE
i}Q LICENSE NO. 408308 CLASS C-36
DISTRICT NO. P CESSED BY
D a
FINAL"
ell VALIDATIONQDATEell
B5-
6
YAL
Y
I am exempt under Sec.
B &P C fo thisreason-,
I ,txp ' ei Plan check fee
Date
a .,,s, >a&c ;..„ a y. N. x,y PLUMBING PERMIT ISSUING FEE $ n:•,t's.,Y .,
Signature
TOTAL FEE 52. JO
y '%
t Plan check applicant
u* t'S•
NCE FAM(LY.,....
Hb}v1E 5 IafEfi i1ltDllE bECLARdiION Name
I hereby-affirmnit lam e ih>oniiacro`. `s L'censz G `5 f A2<
ai empiom
Low for the following reason (Section 7031,.5, Business and Address
kt 'Professions,Code : City Tel. No. ; n c' c
as owne of the property well do the work and the F G ^ o ' ('
y'•r st acture s not mended or offered forgle ($ect o_n
7044 fius Pro'#ess Code) F" Hess and ons
a ' ",:
T
t J i r; (j t v^l 4 x •. + s
c CONS UCTI CEND'11JGy`ENC
u. .,. ,:, r 2Y x::'tra csv-e.r' , r s rw;as»
xF hereby dttirm that ibere s o constiuchon ending agency for t.., r•e e . _.<.-.' , > >- '.'• r. J 3 Q . -' 8 6
t6e performance of the work for which this permit Is issued
i"(Sec..7. Civ. C.1.
l e t ythat 1 ha e read 'this app(imtlon •and'stetethat the
abo a fo at o s co ect I og ee to comply with all County
1•'°ordinon`ces and State laws regulating Plumbing, and hereby
SUrho re,rep ese 'yes f this County to enter upon the
ryboeedot for inspection purposes.
J 2 28 Ba
P Date
SEE REVERSE FOR.EXPf.AMATORY LANfUAGE,_ •_
ISS 4'e L f Te res
s
T _. iM'r.r..1+.iV<:'.L At .. .- ¢.. .. r N .. .,,<.iT,
APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
ROUGH PLUMBING
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED..
FINAL n[er on _>ranf
INDUSTRIAL
WASTE APPROVAL
1
IAIG Cr'T 1[l'E ASr'1TCC" ER -BUILDER DECLARATION
I hareay Wftr that I am exempt From the ::or. irac:or's
License Law far the fcllowing reason (Section 7031.5.
Business and Professions Cade) Any ciiy ar coon: y which
requires a permit to corOt L,d. alter, improve, d-' oa"sh,
or repair any structure, prior to its issuance, also re-
quires the applicant for such peraiii to fife a signed state.
mertt thaf fie is licensed pursuant to the provisions of the
Contratfor's License Law (Charpfer 9 (commencing withSection7000) of Division 3 of fho Business and Piet—
sions Code) or that he Is axempf therefrom and the basis
for the alleged exemption. Any violation of Section
7031.5 by any applicant for c permit subjects the appli-
cant to o civil penafty of not more than five hundred
dollars (5500,1.
I, as owner of the property will do Ilio we
the structure is not intended or offered for sole.