HomeMy WebLinkAbout1418A WORKERS'COMPENSATION DECIARAtION qpp1.ICATION FQR PLUMBING PERMIT '
I hercby aFf�rcm that I hove a co��F��ate of coroent io self �aqyyq 1
inaura,or a ce.�ifimte ai Workeri'Compeniofion Insuwoca, (I 817(REv.�Oi91)
w o�nihad�vPv�ueaf(sec.�eop lab.e.) COUNTY OF 1,05 ANGELES BUI[DING AND SAFETY
Polic{��1711047 �pony Fi etnan�ra F.md 2961,83:-1, ot. 13 �
� C@rlified copy is hareby fyrnished. ,
� FORAiMICANfTOFRIIN(YNIN�ORTVPE) �°�20649 $. rues Coux �
Cemfied copy is filed with the tounly buildi�g inspec• Nunn� FI%TURF ON ITEM � F� I
+ro�deaonmem. �a�TM Rowland Aei hts
Doro�/�8� Appli4am H,R h �'f*" 3 w��aasei $ 0'�J ��t
� cao5�*�Colima S Ra idniew Dr.
BATH TUB
CER71FiCAlE OF E%FMMIQN fROM WORKERS' �j 0"a
CpNIPEN$ATION MSURANCF �� �„� �W� � ;
(ihls sectlun naad not b�rnmp��rw!i}th�v�ork imolr�d b� � 4600 Cam us Dr�ve
fhe p�rtPlif U Fot on�hvndnd de0an(3100)ar�n+•1 i,qvn7oRr �j yL D�p nooRBS P �
I cenify tlmt in rhe performonce oi the wwk for whici+this
�ennn u nsued.i:nau�m enwbr o�r a�����+v^p^�� 2 g'"K pa arv N ort Beach T�`''�540-0500
�o m ro bemme subix+ro�re wwkv.a'campemar�wi taws. .asHwq3HEa �
6 � ��TOR R.C.R. PLIIMBING IRC
Da�s. m.�,u�t cwrHrs wns�a Q p
NOT�CE Tp I�PPLIEAM:If, ofrer moking�his CerfWrcMe o� A°°� 12785 Ma olia Ave.. ,
.y.em(�iaai, �cw �hnuid bseems *ubied ro +he i�vw►e�� swu�niuw�roo��vra+ _ 1
�� bIORQn.iSmon Aro�isiom af Hro lobor GOde,You muat forth' iAwN SPRINK:ER SYSTEM � R• • Yp.
w;�ca�r Wun w�n�vam.� tbis Aerma;nou ne ni��o 336428 � 36
dCCm.Q51�BvOk9d. WRTER MFAiFR p�
W(�P/$ED G`ONTRALT(JRS UKiARAT1�CM DISfR�fVO. �. .
i henrbr afkrm nw+i om sRerye4��amrimoro of G+oprer q 6nsavsra� our�rs pa �
Icom@eNarq wdM SA.��0)of oivis�on 3 oF�he 8usiness WrtErs oroEa w'�/ 4
qndPrDfeliiOn�C-0d0,c4d mY IiCp�se is in fyll fq¢sand effx�. 5�6�� 3 � F�wu VALIDATION 0
DATE 3"'6� V :
License Num6er 336428 i k.Ckss C-36 �
FINAL O
� ❑�� RCR Plumbing pore 8/4/83 Bv
� ;
�am exempr under 5ec. � ,,
8.8P.C.for this reofon , � � (: � ;' � �
Piqn check fee
DOYp: RUMBiNG PERMIT ISSUING fEE f O �� „ � � , �;> ,
Si9^uture :
TOIAL ifE Q 3a I ^ � �.�,.. .
Plan che[4 appliwnf - ,
Sm�GtE fan�ur , • � �
rameovvnrta-0ux.otROEc�nRnr� �� R.C.a. PLIIPffiIftG, INC.
'timehYaffi.mihWlamexemPtfromrhe�bacter'sli�eme Address Z2785 �'1RgR'DZ18 �YVC. ��.;-i:— '� , - �
' �+r for�he followi^B reason(Secnon 7031.5.Business ond .
�'�rrof�iq�s Codel� Ciy Tel.No. '
� �,as owner af ehe p*ope��y,w8�do rAe wak and rhe �
pruc�we h not iMended or offeiad for wle(SecNon ►
7W1,Buaine»and RofeRioro Code).
CONSTRUC�ION IENGING AGENCV �
1 herpby alfirm thpl lhera ia o con¢wction lending ageMy for
�he perft�moirce of the wwk!ar wAicla tRiis permit is isa�ed
(Sec.3QD7,Civ.C.). i
le�ar'a Noms
lander a ASldress �
I cenily daf I hare read this applim�ion nnd sMte tlw�tlro ► '
abore inf.ormanan is corrert.1 agree b comply with oll CouMy .
ordiponces a�d Stple lows rogvloHng Vlumb�ng.end hneby
o�lhorim repreienlafiwes o(this Co�Ny lo enter upon the
a6ove-meM�oned propenY for inspec��on purposes.
SEE REVERSE FOR EXPIANATORY LANGUAGE
RCR by:ff(�,u,Q,.,�i ;�- 8/G/83 �
Slgrmture oI Permit�T Dare �
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