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Home My Public Portal About4847 ARDEN DR_Plumbing__ WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS NUMBER FIXTURE OR ITEM FEE LOCALITY department. @ l� WATER CLOSET(TOILET)- Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS SL COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars (;100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per SINK CITY TEL. NO. mit is issued, I shall not employ any person in any manner so as to become subject to the WorkeP/g pensation Laws. DISHWASHER yy CONTRACTOR r l�v ISN �GLCS G Date �G `t" Applicant �'�� - CLOTHES WASHER � _ NOTICE TO AP (CANT: If, after-mis Cer/eCompen of Ex- ADDRESS .�_�, Box, G(�dc emption,you should become subje To The Work - SWIMMINGPOOL RECEPTORr - CITY ��/j`�,( TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ' `� +4 ly with such provisions or this permit shall be deemed revok- STATEc� LIC. ed. WATER HEATER LICENSE NO. 9 P- CLASS G LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS J— {;!_a 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �"and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALVKtIB�' ATION ' ^` fect. / '��] HOSE BIB DATE �� _ --T –aS^ License Numberr, �Q i �%j LiLc.. Class _ _ f= O 1 Ifl]Lt d uL(_ D �J I FINAL / ! s 1 t?) 8 2 Contractor Cit BY ;E •1% w I am exempt under Sec. E X0 B.&P.C. foy this son C-1- ��t� ! Drat—Pian check fee PLUMBING PERMIT ISSUING FEE$ �� Q Signature -7iG FJ/Q... TOTAL FEE SINGLE FAMILY f D �3 `= yit=+) HO OWNER-BUILDER CLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address ❑ 1, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for 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 work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name 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 outhorizle representatives of this County to enter upon the above- entioned�pr �pection purposes. r ' r /bSEE REVERSE FOR EXPLANATORY LANGUAGE Signal refPer Date DECLARAT (WORKER'S COMPENSATION of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a certificate of consent to sell insure, or a certificate of Wprker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No. 994965 company REPUBLIC INDII9NITY COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ ertifi6d copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 4847 N. ARDEN DRIVE Certified co is filed with the count building ADDRESS copy� y g inspection department. I NUMBER FIXTURE OR ITEM @ FEE LOCALITY TEMPLE CITY Date 6/24/94 Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. 1Z. BATH TUB a,�•—GG COMPENSATION INSURANCE ASSESSOR MAP BOOK OV O� PAGE��'S� PARCELeef (This section need not be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) C LAVATORYOWNER INTEGRAL BUILDERS I certify that in the performance of the work for which this permit 1717.26 is issued, I shall not employ any person in any manner so as to / SINK ADDRESS 829 S. LEMON AVE, A-11 "B"become subject to the Workers'Compensation Laws. r DISWASHER 5 CITY WALNUr, CATEL.`909/869-1075 Date Applicant / CLOTHES WASHER /5 CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of FRANK MARRONE & SONS INC. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 9860 LOWER AZUSA ROAD provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.N08 } I hereby affirm that I am licensed under provisions of Chapter 9 STATWATER HEATER / EL NQNTE CA 018/4<44-2544 CL (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENS No. 397884 CLASS C/36 C 16 �U Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY 0 397884 C/36 C/16 5 PER SYSTEM License Number Lic.Class FINAL VALIDATION Contractor""p""` W DATE � t�� _�MARRONE & SONS, ��. 12/31/94 d � - � ❑ I am exempt under Sec. FINAL B.&P.C.for this reason Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE t�s Plan check applicant SINGLE FAMILY a HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address V .t T Code): a I �_ EJ City Tel.No. TOT•• [� p I,as owner of the property,will do the work and the structure i i•-L t-=1 •5 is not intended or offered for sale (Section 7044, Business "-_jC{''% t+= and Professions Code). , "' 'r% -• r.i i-r CONSTRUCTION LENDING AGENCY 4 L ° I 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.) y D — Lender's Name 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 County to enter upon the above-mentioned property for in pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date