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HomeMy WebLinkAbout1746A (19) �SATION➢ECLARAT.J� ]�AfNA �'I .,��C a certiCicate oe�o�,�,t to sr�P ceev(z-so) .RPPLI�ATION FOR PLUMBING PERMIT �v�� - � ,,vf Workers'f;omPensation[nsuranc,e.Rr . . � . ._. .. . . . . . �.� , . . . � . � . . reof(Scc.3800,Lab.CJ . ' . ' . ' . .. - . ' ,�`�'� �f' ���� COUNTV OF LOS ANCaELES + BUILDtNG AND SAFETY I . , ComPanYj. G�_..�_ I � a.ertified copy is hereby furnished. FOR APP�ICANT TQ FILL 4N(PFINT OR TYPE) BUILDING ADDRESS 1/ + � CertiP�ed copy�filed wiEh t county b�jilding irtspection NUMBER FIXTURE OR tTEM • FEE � Dat��Aeparttne � �j/ „�, WpTER CLOSET LOCALITY Apylicant �������Y�a"� NEAREST BATIi TU8 CROSS ST. - � CERT[FICA7E OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE SHOWER OWNEH �� LAVATORY MA�� } I fThis section need not be completed if the wotk invotved aooaES fo�.��� a � by Aie permit is foi one hundced doltuc(5100)ox less.) SINK CITY TEL.NO.��j V j I certity fhaf in the performance oF the work for which this DISHWASHER � � permit is issund,1 shall not employ any person in uny manner CONTHACTOH so as to bewme sub}eet to the Workers'Cnmpertsation Lews. CLOTHES WASHER iy E � ADOHESS ` �ate Appiicant �B «� V ! SWIMMING POOL RECEPTOR •� W NOTiCE 70 APPLICANT:[f,affet making this Certificate of � CITV TEL.NO��— �7� y ; ExempBon, you shoukd become subject to the Workers' LAWN SPRINKLER SY5TEM STATE ^� U0. z � Compensatian provigione of the Eabor Code,you must forth- yyqFER HEAFER LICENSE NO.��J�C_J CLASS with comply wi[h auch provisiuns or this permit ahall be ��� � deemed revoked. DISTRICT NO. PROCESSED BY ; f GAS SYSTEM OUTLETS n� � L[CENSED WNTRACTORS DECLARASION OUTLETS OVER � �d y�r.t�� � I hereby effirm that!am licensed under prnvisions of Chapter 6 PER SYSTEM 9 (commencing with Section 7000)o[Division 3 0€the Busi- FINAL � ness and Profasions Code,and my license is in fuli.force and '� '�� DATE VALIDATION � effect. �] I License Number�✓`Q� Lic.Gass ��� F�NAL . � /n. E�;}�, �/ BY � Contractor%y��',�c�� �����uT � /o n-�p� � � Pian check fee ��'. . G`� ' Jt� 1 am exempt from the licensing requirements as f am a l/ � licensed srcAitect or a Eegistered profess�ona4 engineer p�UMBING PERMIT ISSUING FEE$ �' � Gl(,PV""� i acti�g in my professional capacity (Section 7051, 8us- f� � v-�- b iness and�Nrofessions Code). �� F TOTAL FEE � E.ic.ur Reg.No. Date plan check applicant ���' . - � �_i i e:6 p � HOME OWNER-BU(LDER DECLARATION Name � j�p5� �p o � . r i 1 hereby afC�rm that I am exempt frum the Contractor's Aaaress n` �jJ'� • � f License Law for the followin reason Section 7031.5,Busi- `- � �� ''-�'��U g � City Tel.No. ness and Professions Code): « V�,�,,v;.,,1: � I,as owner ot the pcoperty,am exclusively contracting �� " with ticensed contractors to construct the project . �;�L j_S%(i (Section 9044,Business and ProCessians Code). CONSTRUCTWN LENDING AGENCY � I hareby afflrm that there is a construction lending agency for the performance of the work For which this permit is , issued(Sec.3097,Civ.CJ. � � j Lender's Name -'s Address � �t I have read thix applicatlon and state that ihr - '�n is correct.f agree to comply with all County � SEE REVERSE FOR EXPLANATORY LANGUAGE '!te laws-regulating Plumbing, and he�eby '��es of this Caunty to enter upon thc � � •for inapection purposes. ' - ��� , llate . .h�j � y � !S S O�S a�� � � .:Q y ."'.i � N� I ' � ' �rnf � LO �G� r4'r`ti Cl � Oli ` � V �ZT �: a� � � � �O v .1 y�.Q A.O k y 4� y C> i` O � � Cdi,p O j .. �_ o .=M1, °' e o.o o s 3 > `'� . C i r w. �• i E S F' O � i O� y v � 3 � . � �� o 'm•" ` 3� o o, 4� � ci �'C 4 0 �'�.. ' � .. i.�. L o`",,.'�.,.'". o E � d.�= m .. fi : ,.��„b c a Ez a � p, � . j E`� ° o�, ��1 � o m �o o � o � e _�= o� E G �.� 0 4 v0,tti' 'd4.V o� �fi � � � ►�� fi� eo�o 4 t.'�' -c'� `i'�i h��3� � ! . 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