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1638A
WORK[iRS'CDMYENSAi'IOI�D�.___..,�...vN � �- �cass�a 1 hcreby affirm tha, r h��e d�er�,f;���e �f���,�„t ta s�,f �E„>,=-eo, APPLICATtON �FOR� PLUMBING PERMIT . � �.. . � insure,or n certif'icate of Workers'Compensation Insurance,ur • - . a certified copY[hereof(Sec.3800,Lab.C.) � COUNTY OF LOS ANGELES BUILDtNG AND SAFETY . � . Yolicy Nn. Company _ � / �I � Certifie9 cnpy is hereby fl�rnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING -�J.,�'];,�? '� ¢,. ✓'1 f � , NUMBER PIXTURE OR ITEM • FEE ADDRESS t-� )",:��•^'� � / �_i�/(./r Oertified copy u filed with the county building inspection �- , ' �lepnr[ment. LOCALITY ��*':Jl.' " � U,�[e Applicunt - WP�TER CLOSET L��'�/ . NEqREST � �v���� �;(,,,� , BATH TUB CROSS ST. r,��,�� , CL:IdT[I�[CATE OF EXEMP"PIUN PROM WONKh;RS' - � • �"` —� •�"'� � COMYENSATION[NSURANL'E SHOWER OWNER �� . � LAVATORV MAIL � (This section need not he completed if the work involved �. ---—_— qooa���� - --- � , /� by the permit ls for one Irundxed dollxrs ($100)or less.) S W K � j CITY � .r1i;7 I� TEL.�VO C�' � � l certify that in thc perfocmanee �S�wor,' �r which this DISHWASHER � �� - C.1 permit is issued.I shtill not employ�y peSA"� ln any manner �� i CONTRACTOR �' . '�[1 � � so as t b�ty�t y,l»ect to❑�g �fk$ �' � mpqns Laws. - ' ' 77 � � ry j'� / �,y� CLOTHESWASHFR j ADDRESS �^�. !!��``//���/,,� �"��. ��j ..Llate ',Y.�''L���rA'P�I's�an`/ �� .AL9'/ -,..., .�sJf �. .-iG-i�E�l�C✓'� �. i � i�� SWIMMINGPOOLfiECEPTOP ��L'�� s /._.. �C) uU'ilCi!'fU AYYLZC,ANT:It atter meKing[his(:er4ific�te of - -� CITY . � � �9��'" TEL.NO[ .S U,1 k,xemption, y:rU sllould hec��m� 5ubjecl [o [he W�xkers' ., LAWNSPRINKLERSVSTEM I � STATE �� � LIC. � Compensation provisirnis of the i,nhor Cude,you must Corth- — -- q � WATER HEATER I LICENSE NO...- CLASS with comply with such [�rovisions or thie pennit shall be , deemed revoked. �ISTRICT NO. PROCESSED gY !J GAS SVSTEM OUTLETS '� ,Gr�j i- � LICENSEDCONTRACTORSDI!(:I.ARAT[ON ` OUT�ET50Ve ,! �� 'x � Z t� L_'G.r_.t...::•t, , I herehy;�Pfirm thal I�m licenscd under provisions uf Chapter 5 PER SYSTEM — - Y (commencing}vith Sec[iva 7000)af Division 3 of thc i3usi- , � ' FINAL . nes5 snd Professions Code,and my license Is in full fbrcc and �'�+-�G� .%�_-���Y1 L �'�� DATE �� L/ �(f, VA���AT��N effect. .'r,' /� . � �" . „ License Number Lic.C1ass.�Lr.�'„� FINAL �'_, ��.� -- e`' � '1'L u�''� � `,:;::� , 9 �.; .�.3�:b..:. Contract� � ate �•� ___ ���;� Q [am exemGt from the�icensing reyuirements as I am a � Plan check fee __ .' licensd amhiYect oc a iegistered professional engineer ,<<� ���'�„ ucfing in my professional capacity (Sectiun 7051, Bus� PLUMBING PERMIT ISSUING FEE$ � 5 y �[������. �� iner.s and Professions Code). ( F' TOTAL FEE 'f. .� F.(' F,�'���;.",��' 7 Lic.ur Reg.No. llute____ � Plan check applicant • `�� � HOM};p�VNh:R-PUII,llF.RDECLARATION " Name . � � , ----- �1 6 3 8 H ( L hereby affirm that [ am exempt from the Cnnirador's Address --__— ! I.icense faw fur[he f'ollowin reflson Section 7031.5, Rusi- �� o � • • •J K � CitV Tel.Na. � ness and Yrofessions Codr.): ' � • 1 b 5 0 ' � l,xs owner of[he property,am exclusiveiy contrncting (, vith licensed conhactors to construct the prnjec[ a i ��l�� � � (Section 7044,Business and PeoTwssions Code). � o e CONSTRUCfION LkNllING A(,I?NCY ��'2`�"`�'2 i hereby affirm that [here is a construction]ending agency � for the performance ur the�1�ork for which Yhis permit is -- -- . � iecued(Sec.3097,Civ.C.). Lender's Name ' LendePs Addmss I ctrtify th.it �hace reud ehis application and state [hal tlie ahove infor [ion is c rrect.I agree tu comply wi[h all County SEF:RF,VF.RSif FOI2 LXPLANATORY LAN(�UAGF: � ordinances and S[ e la�M1rs regulnting I'lumbing, und hereby autt�S>riz �res�� ativcs of this Coun[y to en[er upon the ' a ve- ti�n property forinspection purposes. ; ��--�,���- ig�at o }'e�mittee Date � � c� �' 0 2 c� r`'a �'`N ,�\m pv -c� '';�1 TJN���`tL t''\:a\Z N�`•.'A Z� � �.f \as m -o ��� C' ,,n\a � �-p� � �,�TW��O � R��' �, `O�, ���`�, W�•p�:N v�\ � O� G'�'-1 G� �' � � \ �' :.,.:: , . �� � �. �-�\ m. m ��.'�'�r,(�=:�`; °c � `\ o\ `� p\ a c� � , , � � � � �, � `�m ��� ��. i � 1 �,. � ,, � � ; ,,� 1 +P N .� 4 \ ''� \m ;5 - a ��\ `�� { :` � �\' � �:z ;.N .,\ �� �� `` ��,` ; � , -o - �• � c� � \ ` \'' \�' �\'� � � � `� . � � rn N ,\ � � � O� , N � ' � � � y � ,, , � �\ � ` Z \ � � ` . � �y ` \ � m � \ � �; � �� � �.� � ' .1,� � � � � � : !E � � ��, � � ��, � � � i � ; 1 ; �+m�. \` \ � `, } i , � \t � `� � i;1,. 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