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HomeMy Public PortalAbout5750 ALESSANDRO AVE_Plumbing__ ION DECLARATI WORKER'S I have a certificate of consent to 76A667 DPW 9fe9 APPLICATION FOR PLUMBING PERMIT" r 76A667A I ht;etS'y.aafi�rt7 that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) Policy No. 994Q6990 Company Repub1 i r Tndernnity COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 5 7.50 Alessandro Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temp le City, CA 6/24/92 F. , Date Applic WATER CLOSET NEAREST BATH TUB CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER C✓ MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORYOWNER John Georgino/C.A. Allison DeV. I certify that in the performance of the work for which this permit S is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS 215 E. Las Tunas Drive become subject to the Workers' Compensation Laws. DISWASHER CITY San Gabriel TEL.No287-9605 Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Frank Marrone & Sons Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 9860 Lower Azusa Road provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE El Monte 444-2548 ©©© (commencing with Section 7000) of Division 3 of the Business and LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS 397884 C/36 V OUTLETS OVER DISTRICT NO. sy PROCESSED BY Q 3978845 PER SYSTEM <.--if /1� �c'e�C/ �� OI_ License Number Lic.Class C/36 U FINALW DATE - Z-g La VALIDATION Contractor Marrone & Sons Date 12/31Z92 N ❑ I am exempt under Sec. FIN6Y AL Z B.&P.C.for this reason Plan check fee , Date: �f ��—Dat PLUMBING PERMIT ISSUING FEE$ Signature r_1y TOTAL FEE 3 Plan check applicant --E SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name €'$';i ! ,a I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): ❑ City Tel. No. _ i '-'�E�'•=' I, as owner of the property,will do the work and the structure —�; —n•- is not intended or offered for sale (Section 7044, Business 1 i i;y_ `fin and Professions Code). , - i f_v3 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.) + Lender's NamWr e Lender's Address I certify that I have read this application and state that the above ' information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this Countylo enter upon the above-mentioned pr p ty for in pection Orpos SEE REVERSE FOR EXPLANATORY LANGUAGE X. Ignature of Permittee Date