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Home My Public Portal About5750ALESSANDRO AVE_Plumbing (2) WORKERS' COMPENSATION DECLARATION .2026 APPLICATION FOR PLUMBING PERMIT 1 hereby, affirm that I have a certificate of consent to self in- 76A6PW 4/87 67A sur. orb mrtificate of Workers'Compensation Insurance, or a CE 817(REV. 8/86) - ified copy thereof (Se . 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS o CG �0 ?_ 7 Policy No. Company � AVJ0-V-: