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HomeMy WebLinkAbout0989A 3��� '�P��"a�,'�.g",,�x �n- :."'.� �; ;,.-e+ '�� , .>.g -i t ., �1�V ����� � f ``[� .. � � c,.�--, .. T� ♦ Sr ? b I �t . � '� f Tr. `. j 1e' aC�'- .'� G 32: Y �R+� ? 4� "V � -�'`�.r c e{„ � t ' p� `1�L[��� +, s a4 �` 'h �j 3 �.Y.�a.-v�;*m w.wJ ;e�, � �WORKEf2� �OJUiF�ENSA�ION DECLARATI�N s .. :- ��p���C I � V � 6�IY{BI�G �G��i� y�. �..l, ., . . � .,r ,.�a .e..>: . -�.. . . . . , .. . _ . 1 y I hereby a�fi�m thaf�l�have a ce 1 fiwte.o, conseM ta self 76A667A � 1 msure or a cert ficafe ot Wq ke s Compensahon Insurance CE 817�RFV t0i8� . - r af tof a ceriified copy ihereof(Sec 3800 tob C) COUMTY OF LO$ANGELES BUILDING AND SAFETY �Pdic y�o F :1rr � ..Gom an ..�,•. �'x:".._.: ��..�r � ,:.;:.. :�,�;- ;':y�. :�ai �'�u, �" . �.* '��,.��,;" GS,��`�"`,�..��-.,'x^ °rr'�e�'T3�!�3"�.i�,r.�. .:�`. .. , ,�, Y N P Y . . .. . . �. .'.. � . _.. ..,.. . _ , . . . ._ ...,. .... ., ,,._ . ,,M1� Ce t f�ed mpy is hereby furnished �� -�" � ' �� BUILDING fOR APPIICANT TO FII,L IN!PRINT OR TYPEI qppRESS �E Ce t f ed mpy s filed w th the tounty bu Id ng mspec --•-� . , ...._._.. . _ . . . t on depart enf NUMBER FIXTURE OR ITEM QL �EE �pCALITY srt "�'�,y�`S� �t"5� �,o-�����. �, � '�'. ! ';. ' :` WAiERClJSET �.-..:. �a�e Applicant � . ° NEAREST . ..' ... � _� .... . .. n, p.�a�:� RVs ��.:4k ^aa7 j�:..�,w�z. r.b 'F � ..,,.. - CROSS ST. . . '` "�'-'K�'GERTIFI�ATEOF'EXEMP�ION fROM WOpR�ICE�Sr eAiHiUe � . , ..-,.....-. __ ... �•; .��,� .y�§,COMP�NS/STIdN INSU�ANCE �� SHOWER OWNER 3� fhe p�ermif is.far ona hundred dollars(S700)or I� � � ...„ _ Tl�is sechon need no4 be complefed if the work inyoC ed 6Y ro,q�t . .. .. . `" .... "' .. �, ess J .IAVATOR" �.. ADDRE55' ':. .' ' ....w.... r,>. 1 certify ihot�i,n'the performance of the work fpr which,ihis ��"" - ` � �. � �"��-� 'pejmit is�issued,I shall not employ anq person in any ma��er�� SINK CITY TEL NO. , _ ., �"sd"ds fo bemme subject to the Wo kers;Compensation Laws. '� '� �� '" - - """ _ t _ � . , Df5HWA5HER CONTRACTOR - :. �.t�; ��' �.. .,.�� -�.'�..• . . - Date Applicanl CLOTHES�VASHER � . ADDRESS � � �'N�.74�E TO APPLICANT If after makmg this Cert f mte of � � "� '" ' . _ ,. , .>.-.�..,. -M.� � SWIMMING POOL RECEPTOR "`" . 'k .�xeq+phon, you sliould become, sulied to the Workers ,.� w.M..�..�.. . .., . I -.-- . CITV . . . . . 7EL.ND. ,� �o,mpensofiqn provisions af ihe La6or Code,you must forfh- �AWN SPF'INKLER SYSTEM . W fh comply th such pro is ons or Ihis permit shall,ba � , STATE� �� � � �-���LIC.����� " -�������"� � dEemed revo�c,ed . LVATER HEAiER LICENSE NO., ' CLA55 ^ �*�`�"�� .LICENSED CONTRACTORS DECLAkATf�N�� _ .- DISTRICi NO. PROCESSED BY . � �'' w GAS SYSTEM OUTLEiS � �� I hereby aff m that I am licensed u de prov s ons 9f�Chapter 9�� , ; . � ' , •�"^ �`commenang wrth Sect on 7000)of D isio 3 of the 8us ness � [�UT�ETS OVER � �•. � _�-� � �- �� 3nd prpfess ons Code and my I cense s in full fo ce and effect 5 PfR SVSTEM FINAL��(/ ('`7 VALIDATION � �^{ `�-r� DATE j X l � y� Lc�,eiise Number Lic Class - - -� � �'� Fa w.�s+'"" • , ' ..... .a�..., _ .,...�- . FINAL �a ..�.:f. �<<.��� .,.M "� .,,. �,..,; _ � CQpitanor, � Date ,. ' .. .. �y '" , . ¢�. � . . . .., ._ . , . _ . . ry+' I qm e empt unde Sec PY. ro °"�§yP �� +rr ,�� * o �. 6`� i'. B&P C°�4or rh s reason � � � � -��- ",' � s�. �- ..� �d�. a �, Plan che<K fee � - ac. Date - , —. ...., .....,. � wW ar, .. � t ,e,-�_^ PWMBIMG PERMIT ISSUING FEE�$ � n.. � ' S'qnawre — .. '�„ x',�.:..�,,,�n.;,,,� +t, �e,,,,�, TOTAL FEE . . . . � a.. . . . ..... .... ....... _... . ar�'7 ��" -. ': ��' � � Plon che.k applicont � �'' '�z � - SINGCEFAMILY � � � �� .. _.. ,...., ....,... �"��. .,c.as HOME BWNEIt$I�iLDER DECL/iRlCTION � Name � � t�..., '�. ,.... . _.�..,r,�„w�-. .,.„., .... . . . .. .. . ,..„ . +�� I h�reby dfif m Ihdi I am exempt from fhe CoMractor s L eense.' � �'��� �� 3 -� law for ihe folloyv�n,g reason(Sectian 7031.5, 8us ness and /address a ,y V.. . ... k', ! 5 Patafessioni Code): City ' Tel.No �� -� � � - (6��..J I as owne of the property will do the work and the � . '...'.... . ".`-'..` .'"..,'_..,..,...._. ... .._,.,.._.._,... .... , t�� ��.,,'struUure s not�intended o offered fo sale(Secton,. �v- ..,: . ..,.. ,,... . :,... . .,,:,. , o,,:..�: .. ........:.. .::;.. � ;.:� , .,,. ,.,,, . � �t . ,.� ,,,,�;;;:7b44,Bus�nessand�PiolessionsCode).""'��""�� � .� :'''t r '`;CONSYR�ICTIOt�CENbIN'GAGENCV. . . . ,. .. . .: � ...; .... �. _.. .., ,... .. . . ,_ _ . , .... .�.. . _.�. . �.� �p-, ..,. . ..�.. , .,.:. ,. .:.: ,. _ _ -..._.,. ... .. " ,... _:... ..,. , ..� �..m. . � I herejayaaffirm that there is�a co s1 yciion leni�ing agency for�. . .. .:..� . �:,"` ..'� .".:..,. �� •" � . . a ;�- Y.a r �„����ili�perf,ormance of the work for which_ihis permit s issued , , , � _(''se4 3tl97 C v.C). �ertd'er 5,Na m e � ,,h r ., ��: x.;.� .��. a j rF �.,. y'�^ l, v��.:-�}-- h Ar"+ ,2 +: y.� -�a���x .., �:,,�.,� . ..�<.�£.,. ��:'`�. ..ti..,s .. -- . .., . t . . t=-, .:.�` ., . . , ., +.7i. ..���, '� .< ..���4 .:� ,� i<< , e �erie�ar's Address �. . .. . . .., . . . ... , . _ .. . . . . . _ , ... . , .. �c�rffy�thol I ho�e readlFs applimtion and sfofe f��at t�he� _ �. ..� • �.� . �� ��., . �•,. �. '�6oYe mformatio s�co eci I;agree to comply with oll Coumy , �irc3�anees and Statg I.,.,s�regula�ing Plumbing,ond.hereby ouPhonFe rep�ese tat es of th s Ce ty to enter upo the a�o e ment oned p ope�y fo nspecnon pu po es r �z.���:�'�w��y'��� x.C'�� ;fk� ,� M .,_� .,a u k , .� ..,SEE REVEItSE FOR EXPLAPIATORY��LANGUAGE�, ��,,..,�' ��.z�,YsT. r_c.. -.e.�z�.�t z- z,':�r.,rtt r` y+G' i r. " ..., a.,- .,. .:�'�, :r: - •. .:.... ++„ h.� x.� .�_'� . � '�: Signaiur`e�ofPermifiee-",., . . .'- 'bote . ...,. . . . . . .� ..�. . -.. �� . .. .�..'��.. � � �K�:� ¢, �a � f r! ... pb. X.)`t `w ,,::A� k"r;�__.. �^+r X�'�e.'���,,,,`�{5'"�.'�. _,f d 'n :_�' _ �"Y_.�___ ,. _ "._. ---_.-�' _. -�,.,-.._..� ... . . -•-- . . . .,,,..-<. _ ,.__... _.- �:_ .�__._ _..... _. . _ __ ; ,. ,. : .;. . ; � ._ _ -- ---- --- - --- -- - -- , .. �y . �+. ����'���#� ."�� ����.°�g '3_�.�� �"��?t #d/+x�i �� �� nv`��..��`�iYx..� - . �.�s. ., r . �' � � �� �: .�. ',e � ��., � -� ,.� � � , . . . . , a ��� � . . � . 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