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HomeMy WebLinkAbout1785A (224) i `v°K"�xs'�°"'P�"SAT,°"°r`"LAR"T`°" """'". APPLICATION FOR PLU.MBING PERMIT � i hereby afficm that [ have a certificate of consent to self c�s�v(z-eo� � � insure,or a certificate o1 Workers'Compensation Insurance,or � i a certiPied copy thereof(Sec.3800,Lab.C.) + � � COUNTY OF LOS ANGELES BUILDfNG AND SAFETY � Yolicy No. .Companp - .�L�� . � � Certified copy is hereby f'urnished./ FOR APPLICANT TO FILL IN(PRINT OR TVPE) BUILD�NG l � � � Cer[ified cn c filed with the count buildin fdUMBEFi FIXTURE OR ITEM � FEE ADDRESS ��� . �Y.,�pr,T py�. y g inspectinn department. LOCALITY ,/ WATER CLOSET • -LE� '/'�L'T+,.er �L� Date Applicant NEAREST ' BATH TUB CROSS ST. CfiRTII'1CATl Ob�F,XF:M17PTION FAOM WOIiKt:RS' COMP}:NSATIUN 1NSURANCt; SHOWER OWNER ..g �� (This section need not He completed if the work invotved LAVATORV qDDRESS .� � � � by the permit is foc onc hundted dollazs (S100)ox IessJ — p SINK CITY 7EL.NO3��,JnL�� U , I cer[ify[hat in the perTormance of[he work for which[his DISHWASHER � permit is issued,I shall nnt employ any person in any manncr CONTRACTOR� ��,t.�, � > ��� G �' , so as to become subject to the Workers'Compensation Laws. CLOTNES WASHEF7 r F� AD�RESS �� j ?S � 4�� L) . Date Applicant _ SWIMMING POOL RECEPTOR � N()TICE TO APPLICANT:If,after making[his Certificate of CITY����. � /' �,y`+r�y TEL.NO fY�-��'� �j . lixemption, ynu should becume aubject t�� the Workers' LAWN SPRINKLERSYSTEM �� Cnmpensation provisions of the Labor Code,y�u mus[f<xth- STATE � /( � LIC. m wi[h cumply with such provisions or this permit xhall be :NATER HEATER syA LICENSE NO. ;�/.J f CLASS��=":� leemed revoked. GAS SVSTEM OUTLETS i �ISTRICT NO. PROCESSED BV LiCENSEDCONl'RACTORSDECLARATIUN OUTLETSOVER �`�� y:'�idt�.+�.d�.� I hereby affirm th;�[1�m licensed under provisions u[Chapter 5 PER SVSTEM � � 9(commencing wi[h Soction 7000)uf'Division 3 of the Busi- FINAL � ness and Professions CoJe,und my license is in full force and DATE `��Q�. VALIDATION �. effcct. � �' � � FINAL \ l.icanse Number=��� � Li�.Clijss�_�'� � gy �L���_ / , , r-- Contri�ctor Ua[e ' . � [am ezempt from the ticensing requirements as i am u �f P�an eheck fee ���' licensed archi[ect or a regis[ered professional engineer � pWMe1NG PERMIT ISSUING FEE$ "��t / � � acting in my ptofcssional capacity (Section lOSI, Bus- ; . ° .j, iness.md Profcssions Code). � < y TOTAL FEE ��T SG� . [,ic.or Reg.No. Date __ ? Plan check applicant ��� ;` i i g.�A �� y — _ ,��. Name � � � F109�1R ON�NPR-BU[LDER llP,Ci,ARATIDN t _ .___________ �� �i e R � m e;j 3 { Address I hcreby affirm that [ s�m ezempt from the Cuntractor's � �,� �- " l.icense La�v fur[he fol�owitt�teason(Section 7031.5,Susi- � City Tel.No. � p c i ��"�` ness ea�Professions Cnde): � f� m � <, I ?.5'v"'e [,3s owner of tLe property,am exclueively cvntracting �[ with licenseil cpnErar.tors to cons[ruct thc project ! n � ' (Section 7044,Eusiness and Yrofcssions Code). �� E�tl Y'—�2 CONSTRJCTION LP:NDINC AGENCY �? ��� I hereby affitm thxt there is a conxtruction lending agency ! for the pertormance of[he work fur which this permit is y � issued(Sec.3099,Civ,C.). Lender's Nama � Lender's Address � I certify that I have read this application unJ state tha[ the +� above informa[ion is correct.I agree to comply with ull County ' SEH RHV BRSFi(�OR iiXPI.ANATORY LANUUAGE nrdinance.s and State laws reKulating Plumbing, and hereby �' autliorize ropresenta�tives of this County to enter upon the � �nbove-mentiuned property for inspection purposes. �+ ( ,���'Z.��z.�,�°,� _;-.���� Signa[urc uC Permittee Date ,a - r R 1 f ' � E I ` .., . ��� D r(U��v .D �O�� �'�j�"I -, c c: r i x n�ci `� � 'v, cn � � I i � , � � ' .... _ .��I . 1 _ I ;��._a����j;.i� n ��;;,, I 1 I 1 ' � �._ ! ' . , . -I � �j`T�' .a R'1 �i i 7i i T7 ' � , ,. � . D � � i i_, V, ,z ,j jcl � � � I i � i � • ` . . � ' _. . . . a��i I It� � � R�.'� �jv 'i,�l Q� I I f �. � � � *iA j � I�I -r s± �' �Q � � ' I i_ � _ � �Or I I I O�; -xi rr S � 1,� . I � D ��` ���' ;> IW''.7� i i � I � I . .� � . ' �.- ��,. �� i ., �'' ' :n ��� . I I ' I ! , 1 q � ' . 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