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HomeMy Public PortalAbout4851 ARDEN DR_Plumbing__ WORKER'S I. COMPENSATION ate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 20-0026 0-002 A I hereby affirm that I.h'ave 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.994965 Company Republic Indenmity 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 48 N. [RD» DRIVE Certified copy is filed with the county build' inspection ADDRESS ( J department. NUMBER FIXTURE OR ITEM @ FEE 6/24/94 c LOCALITY TEMPLE CITY Date Applicant WATER CLOSET �� S NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' p� CROSS ST. a BATH TUB O Iv COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK jS' PAGE Q/3 PARCEL dIV 17 permit is for one hundred dollars($100)or less.) OWNER INTEGRAL BUILDERS I certify that in the performance of the work for which this permit T7 ,25 1 LAVATORY is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS 829 S. LEMON AVE. A-11, "B"become subject to the Workers'Compensation Laws. / DISWASHER CITY WALNUT, CA TEL.N(3909/869-1075 Dale Applicant CLOTHES WASHER 5 CONTRACTOR �K NARRM & SONS INC. NOTICE TO APPLICANT: If, after making this Certificate of � Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 9860 LMR AZUSA ROAD provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION / CITY EL MDN1E CA TEL.NO.818/444-2548 �- I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and '397884 CLASS C/36 C/16 Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. V OUTLETS OVER DISTRICT NO. PROCESSED BY cc 5 PER SYSTEM License Number 3978,94 Lic.Class C/36 C/16 O� 9-0 FINAL VZ — FRANK MARRONE & SON$�ate 12/31/94 DATE V/4LI'DATIONIL Contractor T '1.00y EJI am exempt under Sec. BY AL TOTAL 28 •t I{A k 5E B.&P.C.for this reason Li' "•;+ Plan check fee A, _� Date: Signature PLUMBING PERMIT ISSUING FEE$ ElTOTAL FEE 1L Plan check applicantf . a SINGLE FAMILY ati---- f •.•�• _. HOME OWNER-BUILDER DECLARATION Name 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, 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 propert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /-l�'91 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, 76A66 affirm that I have a certificate of consent to self in- 6 DPW 4/90 sure,or certificate of Workers'Compensation Insurance,or a 6A667A certified copy thereof (Sec. 3800, Lab. C.)certified 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 department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Dote Applicant 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($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ anyper n in any manner so SINK CITY TEL. NO. as to become subject to the Workers' o ,pensation Laws. DISHWASHER �j CONTRACTOR UmcC �f' Dote. (� q Applicant/ ��. i CLOTHES WASHER O // ©6 NOTICE T APP (CANT: If, after mak' g this Certifica of_ x- SWIMMING POOL RECEPTOR ADDRESS (Jct emption,you should become subje to the Workers' ompen CITY TEL.'NO. �}7 7 sation provisions of the Lab•x Code,you must forith comp- !0<1 LAWN SPRINKLER SYSTEMS � � ly with such provisions or this permit shall be deemed revok- STATE " C. �f ed. WATER HEATER LICENSE NO. p27 32+6 CLASS LICENSED CONTRACTORS.DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS r h ' 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATIONfect. HOSE.BIB DATE License Number � �6 Lic. Class ��� 5��}-9 * FINAL (-< O U Cher- et icwe& ;Rfe 0 BYContractor I am exempt under Sec. _ 1 i El E! O B.BP.C. for this reason TAT -' a7 300 Plan check fee , - sr� — 9L Dal PLUMBING PERMIT ISSUING FEE$ ISE'_:. •�=t x � 040 Si nature f v — SINGLE FA TOTAL FEE 3 CHANGE HO ! WNER-BUILDEATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name 00 0-0-001-111 111 5f ii_ll'?y Law for the following reason (Section 7031.5, Business and Professions Code): Address + _ beat El I, a•s 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). ► i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructiori 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- ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa u f¢ermittee Date