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HomeMy WebLinkAbout5772A (17)r' 7 +c``'' `,t .' i,""; a'"'=r`+ 'n ".."F4..* 4 V Of KEi2$ CDMfiEN5d7f(i(J DECLARATION pP AfkxaN .rn.a +A&' -es s , Eby affirm that I have a cert i icate of consent togel f t v,.f: . s 1 ,..,. .r . 1 76A667A or &-certificate of Workers' Compensation Insurance, CE.817 (REV. 10181) edified cop thereof (Sec. 3H00; Lab. C.) 6oS 34-8 ompany COUNTY OF LOS ANGELESE. State Comp n:,t's..Y ., w ?* Sign at ure Certified copy is hereby furnished. Plan check applicant FOR APPLICANT TO FILL 1N IFIR INT OR TYPEI Certified copy is filed with the county building inspec- Hb}v1E 5 IafEfi i1ltDllE ECLARP,iIONeby `s tion department. NUMBER FIXTURE OR ITEM 2 2/28/86 Atpplt4aniS0 Coast Plumbing 2 WATER CLOSET 5.00 1 FICATOP-f XEMtIONFROhJN7dRkERS a BATHTUB a AVONTlON1-fx.SURAN" . M , secTron need not Co.ple} i } e works invoive:tT by 1 SHOWER 6. QJ0 sforona hured dollars ($100) or less.) armnd 2 LAVATORY 5.00 1 y 'that in the performoft(,e work for vihichIhisance F" Hess and ons t is issued, I shall not employ any person.in any manner SINK to become subject to the Workers'Compensation Laws.- DISHWASHER k F performance of the work for which this permit Is issued Appllca t _ CLOTHES WASHER E iCi' AP{PL A`Mfi if aftermdking this Certificate of tlon;you s"Fould` become subject to the Workers' SWIMMING POOL RECEPTOR ensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM comply -with such provisions or this permit shall be ed vo ed. WATER HEATER1 ,QQ 9I` LI C NS'dt;TTHX C'TZ7F'ECtLA ATI(1J b'''u"ks•'"""-s' bs'"1 ubyaffirermthatamIlcensedunderposonsof flaptei'9 GAS SYSTEM OUTLETS fencing with Section 7000) of Division 3 of the Business OUTLETS OVER ofessions Code, and my license Is In full force and effect. 5 PER SYSTEM J30$ 6 , ...._ 1 DrinkingFounta4::00 BUILDING AND SAFETY Bath House rr INGADDRESS 24155 E. Sylvan Glen FEE LOCALITY Diamond Bar 00 caosssT. Golden Spring QQ OWNER The Anden Group MAIL .00 ADDRESS 1074 Park ViewDr. f#201 CITY Covina TEL. NO.818-967-95 1 CONTRACTORSouth 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. PROCESSED BY 0a FINAL "/// VALIDATIONQDATE ,, ffJJ,s, BY FINAL dr"°' I am exempt under Sec. P C fo thisreason—, i t ,txp ' e Plan check fee Date a .,,s,&c ;..„ a y. N. x,y PLUMBING PERMIT ISSUING FEE $ n:,t's..Y ., w ?* Sign at ure TOTAL FEE 52. JQ Plan check applicant SIN LE FAMILY Hb}v1E 5 IafEfi i1ltDllE ECLARP,iIONeby `s Name 2< G `5 f A s I herw affirrn-t ail am eempi om ih> oniiacro`. L'censz AddressLoforthefollowingreason (Section 7031,.5, Business and Professions,Codekt .. ) : City Tel. No. ; n c' c as owne of the property well do the work a d the F G^ 5(' 7044 fius Pro'#ess Code) F" Hess and ons T a roccxFIherebydttirm ihat ibere s a construction ending agency for J 3 Q , —' 86 performance of the work for which this permit Is issued i"(Sec..7. l e t ythat I ha a read the app(imtlon and'stetethat the. abo a fo at o s co ect I og ee to comply with all CountyH._.. y{°ordinon`ces`&nd State lows regulating Plumbing, and hereby Surho re,rep ese es f IFis County to enter upon the y bo e ed o t for inspection purposes. r SEE REVERSE FOR.EXPf.AMATORY LANfUAGE,_ PO'4'elKf P` '''Te res Date s r _. 'r...;.. "w'.r °.. .- . :.... a .._;a"-3' ..<, ~;r., .., .. .:, 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 OWNER BUILDER DECLARATION I hereby affirm that I am exempt From the Conirecor's License Law far the following reason (Section 7031..5. Business and Professions Cade) Any ciiy ar coon: y which requires a permit to construct, atter, improve, d-' oa"sh, or repair any structure, prior to its issuance, also re- quires the applicant for such permit to fife a signed state. mertt thaf fie is licensed pursuant to the provisions of the Contratfor's License Law (Chapter 9 (tomo. eating withSection7000) of Division 3 of the Business and P,-otes- sions Code) or that he Is exempt therefrom and the basis for the alleged erempfion. Any violation of Section 7031.5 by any applicant for c permit subjects the apph- cant to o civil penalty of not more than five hundred dollars (5500,1. I, as owner of the property will do thtic,we °:d the structure is not intended or offered for sole.