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1669A
W�aK��zS��oMpFNSATr�No�:��A��AT,oH )6A66]A APPLICATION FOR PLUMBING PERMIT � 1 hereby affirm that I have a certificate of consent to self ce an(z-eo) .� insure,or u certificate of Workers'Compensation Insurance,or . a cer[ified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUI LDfNG AND SAFETY � � Yoticy No. Company � � Certified copy is here6y furnished. FOR APPLICANT TO FILL IN IPRINT OR TYPE) BUILDING /y��45 ��� � ❑ AD�RESS__r _ ,,�� , , Certified copy is fileJ with the county huilding inspection NUMBER FIXTURE OR ITEM � FEE depa�tment. WATER CLOSET LOCALITY '���mv y _ llate —4pp��c:�nt NEAREST �� . BATHTUB CROSSST. ,�� 1 CERTIFICA"PIi OP GXh:�1YTION FROM WOItKP:RS' SHOWER OWNER-��'� ,+ f y` COA4FI•:NSA7'ION INSURANCE �'I O� Ii° ��� ' _—.. - ____ �. p _— LAVATORY _ _ MAIL �„_� � � ,nr�� '}�` (This section neeA not be com leted if the work involved AOORESs /�J F`f �� by the permit i� for onc hundred dotlazs ($I00)or lessJ siNK , I , /� p ' __ CITV L/j�ntD�y .. TEL.NO. �U;. /"/. a�.! I rertify that in [he performance of tiie wnrk for wnich this DISHWASHER �{/ �� permit is issued,I shall no[empluy a y per on in any manner _ .__ CONTRACTOR J� � " • �M.y� • � � [ su as tu become subject to[he r rs'C m nsatio�l ws. CLOTHES WASHEFi I , ---�- - r -�4- �,.- oare nppi�ca�� �,� �. i AUDRESS J��'L���/lIJ//IG �1� � SWIMMING POOL RECEPTOR �2w NOTICE TO AP4'LIC.4N'1':If,nftct making this Cer 'cxtc f — ------ CITY �,�t�, �,�f�rJ�,� TEL.NO.� ,��� '(n . H:rcemption, you shnuld become subject tu the 4orkers' LAWN SPRINK�ER SYSTEM � S7ATE �/ LIC. z Compensation prooisiuns of the Labor Code,you must forth- —" . LICFNSE NO. '/�� CLASS �-' w'ith �onlply with such pru�•isioi�s �r this petmit shall be � �NATER HEATER I � deemedrevoked. GASSYSTEM OUTLETS � �ISTFICTNO. PROCFSSEDBY [.IC1iNSl?D CON"l'ItACTORS UECLARA'I'ION - OUTLETS OVER [�;' q�Y��� �,;�t�: - I hereby affirm that I am licenxed under provisions ot Chapter � 5 PER SYSTEM `— — - - 9 (eommencing with Section 7000)of Divieion 3 of the Ausi- S, � �y� .��(� DATE� ) � �/A�I�P,TI�N � ness and Professions Code,and my licer.se is in Piql furce and . �"/ `� effecL �.//�//��j � License Number_�'--`�f-��.-r Lia C9xss BV •' r Contrac[or,�/LJ��_ _ Date v��:��' �� � 1 am exempt 1'rom[he ticensing requirements as I am a P�a�ChBCk fB2 _ � IicenSecl xrchitect oE a eegistered profession�l enKineer pLUMBING PERMI7ISSUING FEE$ ' actin6 in my professional capaci4y (Sec[iun 7051, llur 6�->�`' inuss and Prof"essions Code). TOTAL FEE �%,� �tJ � � Lic.or Reg.ido.___ Uate _ Plan check applicant ' Ii0'viF,OWNF.R-BUILDER ll�CLAI2ATION Name G���1 6 G 9 A [ hereby affirm thn[ 1 um exempt from the Contr�ctor'S Address _ �n n e a •�j License Law for the followiug reuson (Sectiun 7031.5, Busi- Cicy 7e1.No. ne,ss and Profess'ions Code)� 1 �' ° 1 2,5 Q �.� I,as owner of the property,um exclusively contrnctinK • ° ° , L�.�. (�� ' with licensed contractocx [o construut the projecC (Sectiun 7044,susiness and Yroecssions coee). O P.�e'S M S Z CONSTILUCTION LENDING ACF:NCY . � � 1 hCreby aFfirm that [here is u conxtruction lendin6 agency '.for the perfqrmance of the work for which this permi[ is - ��� { issued(Sec.7097,Civ.C.). LCnder's Namr, Lender's Address I certiFy ihat I have reud this applicution and sta[e that the � , ubove Lilbrmallon is eorrect.[agree to comply with nit County SF.R R1SVliRSH FOA EXPLAMA�CORY LANGUACE ' ordinances nnd 9t.�te luws regulnting Pluml�ing, and hercby , authorize represen[atives of this County to enter upon the ; abo e- enti ned property mspection purposes. ��-�t��''!�'e� � �—�5'L�""''i Signature of Permi t e Uaee � G� p 2 ��G\,��rC, a��u' �-o �' 9 i T �{,�� p ��m.��,� m � y\ -� �D y ,� t' O y D � -�C�:t� Z �� a,,�,G y� G �G�� f ' �n A N� �,�'��i - � , � m�'��.\ . C7 �x•2^,`'. W'���'•,.N v9 �;G\ 'G Y-a\ �G��?�� . -oS7'-' �'' -,� S) f�. '`�\ pf \' '� `�=n't 1'm S1\ � N O \ , m1 \ \ \ � �`.'�„�\ O`� 1 O � �.. \, \ . 1 .;; ,,, \ •,v� . � R� �\ � \ .�,` ��` ` � . ._ ' cn` � \ � ` \N :i � � ` � ':m y }' � \���. �� +� ` \ ` ?} � � � �+ � �� � � \� � ��� � - �, m � ` \ G�2 � �a .- \ \ \ ` �'� . 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