HomeMy Public PortalAbout6335 TRELAWNEY AVE_Plumbing_10/16/1985_water line DEC
TION
WORKERS'that
Ihave COMPENSATION cafe of corse APPLICATION FOR PLUMBING PERMIT
I hereby aHvm that I have a certificate of consent to esti 7
n1ure, or O certificate of Workers'Compensation Insurance CE�REV I0/81)
or a certified cop thereof (Sec 3900, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P❑olrcy No Company
ifed copy is hereby furnished BU IDI NG
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 2L Q���E6
Certifi c is filed it o building mspec- aJJ
ti n n NUMBER FIXTURE OR ITEM ® HEE CAUrrTY
Date Appl WATER CLOSET NEAREST �� i
RTIFICATE OF EX ON RS BATH TUB CROSS ST
COMPENSATION RAN SHOWER OWNER
(This section need not be completed H the work Involved by,
the permit is for one hundred dollars ($100)or leu ) MAIL MAILADD
I certify that in the performance of the work for which this _
permit is issued I shall not employ any person in any manner SINK CITY TEL NO
so as to become subject to the Workers'Compensation Laws �s�Ir1��s� �
DISHWASHER CONTRACT �iJ0%eIs'/
Date Applicant CLOTHES WASHER n'
NOTICE TO APPLICANT If after making this Cenrficote of ADDRESS
Exemption, you should become subject to the Workers
SWIMMING POOL RECEPTOR CITU 44V,4,914 TEL NO O
Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be qL
deemed revoked WATER NEATER STATE STATELICENSE NO G�/ CLASS A _J
IC
LICENSED CONTRACTORS DECLARATION DISTRICT BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 6:
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
Od
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINALVA ATION d
License Number L¢ Cksss DATE , V
FI cc
Contractor Dote 1BY O
❑ 1 am exempt under Sec W
d
N
B 8P C for this reason Plan check fee ?
Sigrwture Dote
PLUMBING PERMITISSUING FEE$
TOTAL FEE 3
' Nan check applicant
SINGLE FAMILY '- �-„
HOME OWNER-BUILDER DECLARATION Name W_Wa5 /rQ W�r� dp0
I hereby affirm that 1 am exempt from the Controctoi s LicenseF 31 Z 7 A
Low for the following reason (Section 7031 5 Business and Address37Zs E A.XJA,(-T4/r.J V/49(,4J
Professions Code) City # e it e e e 5
❑ �� A JC/� Tel Na�36/ 9
1, as owner of the property will do the work and the
structure is not Intended or offered for sole (Section , ) s • 1 6 5 0
44
70Business and Professions Code)
CONSTRUCTION LENDING AGENCY e s s 16 5 Q 5
I hereby affirm that there n a construction lending agency for
the performance of the work for which this permit is issued I a 16—8 5
(Sec 3097, Civ C )
Lender's Name
Lender ngddress
I certify that I have read this application and state that the ►
information n correct I agree to comply with all County
0 and State lows regulating Plumbing and hereby
e
4"ntroLsfCfor nspechon purp sesSEE REVERSE f-0R EXPLANATORY LANGUAGE
e Da