HomeMy Public PortalAbout9441 1/2 - 9445 1/2 LAS TUNAS DR_Plumbing_12/6/1988_kitchen fixtures i
WbRKERS' COMPENSATION DECLARATION ' APPLICATION FOR PLUMBING PERMIT
•fit - =20-0026 DPW 4/87
'11,hereby, affirm"that I have`a certificate ofconsent to self In=, 76A667A' .' � - • ,
isuie,o4"a certificate of Workers'Compensation Insurance or a, CE-817(REV 8/86)
)IC,ertified-copy thereof (Sec:•3800;Lab C ) S
. P K
Policy:No, Company OF's UBLIG RFS
COUNTY OF`LOS"ANGELE DEPT WO
.Certified copy is hereby furnished
Certified co s filed:`•with the count building,ins ection ='ADIDRESS '..(i(/ �( � p'
PY Y. . .P TY
NUMBER, A FIXTU FIXTURE ITEM'
IN R @PE) FEE.
FOR (PRINT O
depdrtment.
o�CciZ
. .( •. , . .. . ',• LOCALITY
Date Applicant' NEAREST s
WATER CLOSET(TOILET)
,
' •
CERTIFICATE OF-EXEMPTION FROM.WORKERS' BATH TUB CROSS ST
.-,COMPENSATION INSURANCE-,' r OWNER: '
SHOWER
(This section'need not be completed if the work involved by MAIL
the permit is for.one hundred dollars (5100)or less;) LAVATORY ADDRESS s.IL
I.ce�tify that in tF e,p"erforinance of the work forwh:ch-this pec-
mit is issued, I shall riot employ.any persan;ih qny manner so SINK :• s DD CITY TEL NO.
as,to become subject'to the Workers'Compensation.Laws.
DISHWASHER ,
Date �� Applicant / CLOTHES WASHER
_ CONTRACTORAIVL
Q�
NOTICE TO AP.PLICANT:`If; after makGn s Certificate of Ez- ADDRESS
9 SWIMMING POOL RECEPTOR
emption, you'.should become subject to the-Workers'"Compen
CITY � TEL. NO
sation provisions of the Labor Code, you,must'forthwith comp-. LAWN-SPRINKLER SYSTEM `�""� � �� �v
IT
ly with;such•provisions or-this permit shall be deemed revok- . STATELIC.
ed_ WATER HEATER O/1 LICENSE NO. LASS
" CJ
LICENSED CONTRACTORS.DECLARATION DISTRICT NO. /PROCESSED BY
I hereby.ciffirm that I am.licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing-with Section 7000).of Division 3 of the Business OUTLETS OVER:. `�-S ` D
and.Professions Code,'and my,license is in.full force and-ef: 5 PER'SYSTENI FINAL VALIDATION
fect r a0`
C� �Q DATE �.
License Number' / "90 Lica Class
iia-y— �' . o-�ccQ L .
Contractor ate lbs �' Z_- 00 (J
I,om exein`pt un8er' ec. LU
B:&P C for-this reason tL
Plan check fee , z
Date: ►
'PLUMBING PERMIT;ISSUING FEE$ Q' 2. p
9
Signature
TOTAL FEE #.o'o,•o-//0 055
Ak
SINGLE FAMILY ~' 2S f?v
HOME OWNER-BUILDER DECLARATION Plan check applicant :d-®'oo =
1-hereby affirm that l am-exempt from the Contractor's License ' Name G 6-88
Law for the-following reason.(Secticn.,7031.5,.Business and
Professions_Code): Address
` 1,.as owner of the property,Ywill do the •work and"the :Jr
Cit
structure is not intended or offered for sale(Section 7044,
Business and Professions Code) ' /./u/f'j � .SG�?.8 P ,V%".B%�� QyG
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,CGv C.) ,
Lender's Name 'r
'Lender's Address . . ,
I certify.that I have'read this application and,stote that the `
above>information is correct. I'agree to comply with all CountyPOO
ordinances and Stcite laws regulating Plumbing;.and,hereby
authorize'representatives of this County'to.enter upon the '
�ave-mentiorted pro or inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig rit.re 0f Permittee Date ;