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HomeMy WebLinkAbout1202A ,. ._.:. ,_:..m. _��..,�.._.� �_.��.�,�� .,.�.�<.:.�:.. w,_ X ... - .. ...� _._...... ,._�. . �y . . . � _ .. r , . .... .... � WORKERS'CO1v1P�N$ATlbl+l'FS`ECCA�R�P�N ��PLtCQTI`i� �R F�L��BII���'ERAAIT� I hereby affirm thot I��ho e p ceriificate of conse�l 10 self 20-0026 DPWS/87 . � inm e or d'tert f cote of Workers'Compensation Insuronce, 76A667A . , � � o o-cer+�fied cooy rhereof(Sec 3800,lab.C.) , '� '"�"' "" �` """"'""'"`" �..,,�/�,� COUNTYOF LOS ANG�LE$ DEP�'f' OF�PUBLrCTIVOI�iCS Oty No.�A�,7�LEompany .�/� b'ustl,� ._ . .. . , . . . � ..� � - - ..a Carrified copy is hewby furnished. � � -��� � �� � "� �� '� FOR APPLICqNT TO F�LL IN(DaIK1T"bR"fVA�'1� ���+� BUILDING � � � Certif4ed copy is filed wirh the county bwiding inspea � ��� �� ���'� �� � ��• � ADDRE55p� � . p o - � . tiondepariment. NUMBER FI%7UREORITEM �e) FEE �,OCALITY ���� a��� Dote�A i�ani��%Un/� .F.S,�-�t^fi WATE0.QOSET ... . . � pP 4 . '/-c-.� , . ..., . .. NEAREST '� - .CERiIFICAYE`bP�EXEAtiPfI`d�F�RO"1�V�7J'C�R`�'E�2$_,�- ���F ���� . CROSs'ST. � aG� i��{L- &ATH TUB � � �� �� �" COMPENSATIpN INSURAN�E���- SHOWER OWNER o ,� ���.L �� (Thfs�adion nead nol�bm eomplafed!f The work ievolvod by ^ ��~ - the perm{T Is For one hundrad eiollar�(5100}ar less.) �n�AiORY MA�� ADORESS A 6 (O (�Q/f �'�I certify Ihat in Ihe performarca of the work tor which this � perrriit is iss�ed,1 shall not emplay any person In any manner SiNK aTv TEL NO. . 'so as to become subject ro the Workers'Compensafian Laws. ���� , - DISHWASHER tOMRAETOR . . . . . . _ . ' , . . . . � �� � � �ate Appiicani CLO7HE5 WASHER �� ADORESS a , ���NOTICE TO APPtiCANT: If,�oiter`making this Certificaie of � � d"Y ,2/+/ft.� .�,Exemplion, you�should become subject io the Workers' SWtMMMG POOI RECEPTOR� � � ����Compensalion provisions of the Labor Code,you muzt forth- � . . CITY �T TEL NO. IAWNSPRINKLERSYSTEM �- �� with compiy ifh Such provisions or this permit shall 6e SiATE r�LIC. . deemed revoked. , . WATER HEA7Ek L�CENSE NO.` �, � d.} CLASS — � ��OCENSED CONTRACTORS�DECLARATION�� oi57RiCr No. PROCE5SED BY I hereby of�irm fhat I am I censed under p ovisions of Chapter 9 GAS SVS7EM OUTLEiS ,� Cli� OL� v,�.� � F � �(commencing wrth Secrion 7000)ot Divis�on 3 of the Business OUTLETSO4ER �• ' and Professions Code,qnd my license is in 4ull force and effect. 5 PEa SYSTEM PIN l �" ;., , ,, AIIDATION p; � DATE ,�%� U, License Number +���-�� Lic Class_�'� �. � � t � {��,, FINAL �omrocror �� ��ate�.�`�� BY _, ..,, � ❑ i I om ezempl onder Sec U W a.aa:C.'"fo�r6is�eason plan check fee � � . _ Da�e: PLUMBING PERA7ili(SSUING�FEE S��� � �) �ZJ . ' � ' �� , .. .,.. ,.,... . �, s�9�a,��e a� rorA�Fee 3 1 2�2 A .� ���� � � � �.. Plon chetk app�itont � , ,. '{}'o s � a o'j �. .,.-..`, . � � ._,. ,..... �. .. SINGLE�FAAARV � . . ..."`" . ....," "" ..,.. : " �� � � HOME�DWNER-6UILf7ER��ECLARATION�- � � - ��� Name „ ( , a 1 �J�, I hereby affirm ihpt I am ezempl from ihe Coniracfor's Li<e�se Address Law for�he 4ol�owing reasan (SeUion 7031.5, Business and . � �, �., y 1 Professions Code: .' S.`.'" Q... � City Tel.No. I,os owner of ihe property,will dn rhe work and the ��•�E'��`� structure is not intended or offered for sale(Section � � 7044,Business and Professions Code). , ; , ,_; , � � � . ............ �.._., .....:. .. . ,.... . ,_ .._.... .., .._. ...,_ . .._.- ... CONSTRUCTION lENDING AGENCY �hereby affirm�hat there is a consiructian lending ogenty for fhe performonce of rhe work for whlch this permi+is issued (Sec 3097,Civ.C). . . . . . . . . ' � . . . ... .._, . Lender'sName - . , . '.w�,,.--..�.,,�...,�.,,o,a„,,.�..�.�.......:...�......-,.�..r.��,....�.J.:.»....�,..,.__.,.._...._..,.,:..,�.......,.,,.,... -. . . , . . . .�....u..... . Lender's Addrezs _ ._ .z�...,,.:.�.,,. — -.W-w*.:-=..:..........t.,.,.,.,....�......�. �:>....,� ...�....,.__�... .,......_... „»..._..... _.. . ...._,..... .. _.. . .:.:..-..�..,.:.�_..,4-. ...-n.__.>.o.._,...,. I certify thar i�hove reod 7his applicalion ond state that+he � . above infor, �tion is correcl.I agree ro comply wirh oll Coun?y .� �ordmonc d S�ote lows regulating Plumbing and he�eby � a�+hon r presen�otives of rn's Ccunty to enter upon Ihe - � . ........ _., _..,_..:_.. . . . ..... ...:.,.. _,_. .... .......�,.�.... . - abov m nt oned'prop ny{ inspection purposes. . . _ .- . � .�...-�.. - � � � SEE REVERSE FO'R EXPL6i`NAY`ORY'CAIJ��s`UIL�E � d i /' � s oture of Pe�mittee ' ote �. . � � � � � .. � .'..�.. �,�.<�;'..«w..�A.:�.e.,F�,.�..�' "�es4'�.'�.�s.'�..x._-�'`a''� ,,��5, �S, "�,'a'3L� ';�.-.°",�'� :" .. _.,, . . �_,.... , �,..,.�.�„ :.��.,�.....,.v .._-. . �.� ,�� .. .. :Y,aars ,,,."'�'��� ,�: ^s�� � . . -x�,.�.t ,.,, - __.. . . .,� ___.__.___ _ _ _ _. -. .�._ .��,.�,..�..�,._.�_ �.,� e.�. _ . . :� r -r �� � -- -- ___ ._. . . . .......em �;a{s.'.a'.."L h.'k,..(': ° "'-- , . � ..'. � E .,._...�_ ._�_�r-..._...v.�...-....... .. �_a...,.. .,. �., ['.� ..."�k� ' � •� \ b \ � .'"__ ._.. _._._., --�..�._._ ..._._.._ ,.f , s..,,e; . . 7, . � ' � ¢ ` . ,:_o�N.;S:n � ° ` . . .. .. � .. . .,. .. .. . . ..� . : ...._..�.. 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