HomeMy WebLinkAboutNo Permit Number (1235)Lenders Name
Lender's 60dress
I certify that I hove read this application and stale that the 00aboveinformationisconed. I agree to comply with all County
ordinances and State lows regulating Plumbing, and hereby
authorize representatives his County to enter upan the
above -menti ed pr r f inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
t tgnortne r 1Date ?
wfirm APPLICATION FOR PLUMBING PERMIT
thatIherebytsffumtlhpr I have a certificate of consent 10 selfIhavNSAiroNcateof 76A667A
insure, a o certificate of Workers' Compensation Insurance, GE $1711tEV. 10/811
or a certified copy thpof (Sec. 3800. Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
0 8-1030QZ CompanyO^aut Tract 32576 Lot 41
Certified copy is hereby furnished. BUILDINGFOR
Certified copy is filed with the county building inspec-
APPLICANT TO Fit L IN (PRINT OR TYPE)
ADDREM
tion deportment. NUMBER FIXTURE OR ITEM a FEE
WATER CtOBFr Diamond Bar. DotelG:.L L..'d..LAppfirrpnt RPIuF-dprP Plmlfo,
CERTIFICATE OF EXEMPTION IFROM WORKERS' G RATH TUB Pathfinder
COMPENSATION INSURANCE
srloWER Er M. J. Brock RSons
IaMlen eeed net be completed ff this work involved by
permltister one hsltdnd callers (SI00) er fess.)4 LAVATORY
I asndy dtat in the performance of the wads fo which thispermis1SINKisissued, I shall not atnploy any person in any manner TEL. 81Brea
so as ag become subject to the Workers' Compensoton Laws.
1 DISHWASHER CONTRACTOR00 Belvedere Plumbing
Date Appi,Wnt— _ CIOFHFS WASHER 00 ADDm45 13350 Ector St. NOTICE TO APPLICANT: If, after making this Cemficate of
option, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY rE1. Ivo. 8hperaantionprovisions of the Labor Cade, You,must forth. IAWN SPRIMIER SYSTEM 62.4401
with comply with such ptavisiara or this permit shall be STATE LIC.
deemed r3rvoked. WATER HEATER L43NSE NO. 17 168 CLASS C 36
UCENSIP CONTRACTORS DECLARATION DISTRtCTffO. P7,11D By
1 heraWaffirm that I om licensed under prav(;ions of Chapter 9 1 OAS SYSTEM OUTLETS 6 O0 d/ commencing with Section 7000) of Division 3 of the Business OUTLETS OVER d
and Professiora Cade, and my license is in full face and effect. S PER SYSTEM FINALOVALIDATION
DAA /-t,.i v
License Number 179168 tic. class C 36
Contractor Plumbing Dolce
FINAL `, y -G•'
er
O
VV
I am exempt under Sec. d
S&P. C. for This reason Plan check fee
Dote:
PLUMBING PERMIT ISSUING FEES 10.50Signature
10q.50TOTALFEE
Plus, check applicant
SINGLE FAMIIY..
HOME OWNER -BUILDER DECLARATION Name
yeby affirm that I am exempt from the Contractor's license Address
s e r
1 for the following reason (Section 7031.5. Business and
Profession Code): City Tel. No.
1, as owner of the property, will do the work and the
structure is not intended or offered fa sale (Section
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the wok far which this permit is issued
Sec. 3097. Cir. C.).
Lenders Name
Lender's 60dress
I certify that I hove read this application and stale that the 00aboveinformationisconed. I agree to comply with all County
ordinances and State lows regulating Plumbing, and hereby
authorize representatives his County to enter upan the
above -menti ed pr r f inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
t tgnortne r 1Date ?
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