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Home My Public Portal About4849 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 n certified copy thereof(Sec. 3800, Lab. C.) U Policy No.—Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ompany Certified copy is hereby furnished. BUILDING Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers' pensation aws. DISHWASHER i ONTRACTOR eaok le le«u b L- D.te. 7 Applicant CLOTHES WASHER �!,.� NOTICE A PLICANT: If, after m. ng this Certifi to of x- ADDRESS �U /J emption, you should become subj ct to the Work s'Compen- SWIMMING POOL RECEPTOR CITY � TEL. NO. -� cation provisions of the Lab•x rode,you must forthwith comp- i C LAWN SPRINKLER SYSTEMS Q ly with such provisions or this permit shall be deemed revok- STATE n / LIC. �y ed. WATER HEATER LICENSE NO. oG 17 3,9 (> CLASS -S? / LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM. OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. fJ �/ HOSE BIB DATE License Number 2l 12 I n Lic. Class � _�_�• FINAL O Contractor.(6hecee kot � �o 10/el 4- BY V _o I am exempt under Sec. /CI B.BP.C. for this reason "t Plan check fee r a Date: (c Cal PLUMBING PERMIT ISSUING FEE$ / � f-'=( °� Z Signature TOTAL FEE Q SINGLE FAMI 3 - i11Ecy HO OWNER-BUILD ECLARATION Plan check applicant - I hereby affirm that I am exempt from the Contractor's License Name TAT-AL 5 30 Low for the following reason (Section 7031.5, Business and Professions Code): Address CHECK ) I, as owner of the property, will do the work and the City Tel. No. i•i t?33+3 °�I�` structure is not intended or offered for sale(Section 7044, Business and Professions Code). 914 CONSTRUCTION LENDING AGENCY , ,rEtJ. s/10 I hereby affirm that there is a construction lending agency for Lsii it D° 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 Pool information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby autbove-ho ize representatives of this County.to enter upon the aentioned property for inspection purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE /Si na a Pe of rmitte Date WORKER'S COMPENSATION a certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT LJ 76A667A I hereby, affirm that I'have a certificate of consent to self insure, or a•gertificate-of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No. 994965 Company RF.PIM1,TC TNDFMNTTY 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) ADDRESS 48j N. ARDII�I DRIVE UILDING Certified copy is filed with the county buildin inspection department. NUMBER FIXTURE OR ITEM FEE LOCALITY T13KPLE CITY, CA Date 6/24/94 Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' p CROSS ST. COMPENSATION INSURANCE BATH TUB RD (This section need not be completed if the work involved by the SHOWER MAPEBOOK PAGE�� PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY INTEGRAL BUILDERS is issued, I shall not employ any person in any manner so as toSINK MAIL become subject to the Workers'Compensation Laws. ADDRESS 829 S. LEMON AVE — I'll', DISWASHER CITY WA=S CA TEL.rtk9/869-1075 Date Applicant / CLOTHES WASHER CONTRACTOR FRANK MARRONE & SONS, INC. NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with.such ADDRESS 9860 LOWER AZUSA ROAD provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER EL 818 44G-2548 (commencing with Section 7000) of Division 3 of the Business and / GAS SYSTEM OUTLETS / LICENSE No. 397884 LASS C/36 C/16 0U Professions Code, and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY a: 5 PER SYSTEM p 0 License Number 397884 Lic.Class C/36 C/16 v �o E ' D FINAL VALIDATION U F. MARRONE & SONS INC DATE _ a Contractor ' bate 12/31/94 ❑ I am exempt under Sec. FINALl__. _s By B.&P.C.for this reason Plan check fee Date: Signature PLUMBING PERMIT ISSUING FEE$ _ iP _ ❑ TOTAL FEE Q5 CHEi_,; Plan check applicant s: �yLJ.3 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): EJ 1, Tel.No. sus='T _ � 4? •.__ I, as owner of the property,will do the work and the 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 authorize representatives of this County to enter upon the above-mentioned proper for.inspe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date