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HomeMy WebLinkAbout1325A �vUH�$�C��FIV.��n�.��.�./1k/1���nN J6A66)A , �,e�r�,Y affirm �h�t � h��e ��r�t;�«ate of��nstnt t�5��e CEB�]�2-80) APPLICATfON FOR PLUMBING PERMIT insure,or a certificxte ot Workees'Cumpeusation lnsurnnee,or � � � � a certified cuP}•thereof(Ssa 3800,Lab.C.) � � � � P �.�� COUNTY OF LOS ANGELES BUI LDING AND SAFETY Poucy No. com nny , . .. � Ccrtified copy is hereby furnished. FOR APPLICANT TD FI�L IN(PRINT OR TYPE) BUILDING ( �� �1��_„, _tlOp G \ � AD�RESS '1�K-{N �•-� �'er[ifie�copy is filed with fhe cDUnty b�u71ldL�g inspeCtion NUMBER FIXTURE OR ITEM � FEE " ` Date�epartme //f.//_ WqTER CLOSET LOCALITV ���o�� ��/ :1pp�icanl___���r��r� NEAREST \ - _ . L, BATH TU8 CROSS ST. QV�-� l S U yyyvf'�� � CLR'fIf�ICATE OP EXEh]YTION RO_ OKKERS' - - C:Oh1NL'NSATION INSURANCL SHOWER OWNER G�� G�r�`� LAVATORY MAIL (This section need not be completcd if the wock involved q�oRess__�_�`�l� � ��(L��p p a by the pecmit is for one hundred dollazs (5100) ox lessJ � � -�—� � SINK — CITV �1 p��'�� TEL.NO�j�'4"�'Z�, �CJ i certify Yhat in the performance of the work for which[hix DISHWASHER --�p � (� U permit is issued,I shalt noi employ any person in anp mmmer _— ---_ ___._ CONTRACTOR � `� � r-C11�_ ��—.-.5+ so as to become subject t�the\Vorkers'C'��mpensation[aws. CLOTHES WASHER ADDRESS ���� tU�'`�"�^ U Uute _Applicant_ � - � ��, SWIMMING POOL RECEPTOR NOTICI 1'U APYLICANY:[f,aftee making this Certificate of ---- I ^a� CITY � ��'� TEL NO.��j�� If%) l�:zemption, you shoulp become subject to the Workers' LAWN SPRINKLER SYSTEM � I STATE s, UC. / 2 �Compensation provisions of the Labor Code,you must for[h- — LICENSE NO.� � �V Z' C�ASS l.i� �� �vith com�ly with sucii rr�visions ur [his permit shall be WATER HEATER deemed revoked. I ,/� � DISTRICT NO. PROCESSED BY GAS SYSTEM OUTLETS � L[CENSED CONTRACTORS DEC[.ARATION OUTLETS OVER LC /�� . Ck�-zX-'t-' 1 herehy utf'irm th¢it I um ticenscd w�dur pruvisions of Chapter 5 PE R SYSTEM - 9 (commenaing with Section 7000)of Uivisian 3 of the Busi- • • /� FINAL �{ ness.�nd Yrofessions Code,and my license is in full force and �-7-Q �e L7-'G'�' DATE i �y��'� VALIDATION ef£eci. � FINAL F� L��ense tiumhEr, �QS^r— I,ic.Cinsn C-�S gy �,1�1`�Ly,t),9� C�ntracto�,e,.�r_ �At��.� Date p}'�-Z��- � � � � 1 am exempt from the Iicensing requirements as i am a Plan eheck fee ___ liCensed arekietect ur a fegi5teret( �rofessiunal engineef pLUM81NG PERMIT ISSIJING FEE$ �'�' acting in my professional cupncity (5ectinn 7051,Bus� — .�t•' iness:incl PrnCessions Code). TOTAL FEE �S ��) Lic.ur Rng.No. Uate _ Plan check applicanc j� _ IIOh1l 01VNER-DUII,UIiR iN?CI,ARA'C[ON � Name ���� � r��� "�, `5 L,^�' Address 7 �, • o u S I hercl>y affirm thut I um ezemp[ from the Conlructur's ,�`� ��� � �+'� License Law for the following reason {Section 7031.5, Busi- City ���.,ry.p Tel.No.L�S'yZG,L 1 m +'��v ij ness and Professions Code): � I,ae owner of the property,am exclusively contracting " '� °^L'���U c: with licensed contrac[ors to construct the projec[ (Section 7044,Business and Professions Codc). C I,C���5 C CONS1'RUL'TION LRNDING ACENCY � I hereby affi�m that there is a conslruction iending agency -fot Yhe perfurmai�ce of the w rk for a+rhicS this permit is � �� issued(Sec.3097.Civ.C.). ' Lentler's Naine _ � LenAer's Address _ t certify that 1 hUve read this npplicution vnd s[iite thut Yhe above informution is correct.1 ugree to comply wi[h ail qounty SEE REVERSE FOR EXPGANA'PORY LANGUAGE ordinances and S[ate laws regulating Ylumhing, und hcrchy au[hori c mpreseniatives of'this County tu enter upon tlie pbove-�entinned property for inspection purposes. � ZZ��Z ��g ture of Yennittee � Date � � 7� C 1 �G � ,r O � N��G��y '� '-� D ;C -1 i N Gy•tn .o �� t z Ir u' '�, ��,� '�''y�+� -° yna �., D �•{ m i Z D-�'�2 Z�,�'`i' o RG ,, c ,�� i ' �.t7 N1 ,n 31'� G� C!cp;D O Z', ��a,t� � � . ��� .� �� �� .z, � ml , �, ��' �,N .oY'.. 1 ..� ���,. , c q� . � Z �. 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