HomeMy Public PortalAbout9441 1/2 - 9445 1/2 LAS TUNAS DR_Plumbing_9/28/1988_floor drain, laundry tray {
WORKERS;}COMP,ENSATION_DECLARATION- "
20-0026 DPW?4/•87
r APPLICATION F®:R PLUMING PEItIUIIT
44..
{rfirm tMdtl-have a,certfficate;of consent to - . 76AWA -
sure,or'a certificaie,of Work&,s•Compensation Insurgnce;'or a `,-CE:817(REV.,8/86)'
-,certtifidd"copy i4reof (Sec''"''3800'.Lab C )i '-;
y: - > :- ,
f COUNTY OE.LOS ANGELES DEPT OF'�PUBLIC WORKS
Policy No
do ��Oq Company: /i}PalrGs r'�i
�.,:. _
Cer!ifetl copy is hereby,furnished
4 }
FOR'APPLICANTjci FILL IN (PRINT OR,TYPE) , BUILDING r P ,
Certified copy-is,filed with the'counly�building•inspection•I ADDRESS.:
deportment?N' MBER FIXTURE OR ITEM as .FEE' LOCALITY
L
NU
Date Applicant.' I E NEAREST
WATER CLOSET(TO T)
CROSS ST
CERTIFICATE OF`EXEMPTION.FROM'WORKERS':.^
BATH TUB.
.r
COMPENSATION.,INSURANCE owNER
y r SHOWER'.: A
(-This section need;thot be`completed if'thework involJed'by MAIL
the permit is for one,hu 'dr?&dldllars ($100)'or less.) t LAVATORY ADDRESS -
I certify.tt bt m the perfo�riance of the work,for�wbich fhis-per=.. -1 + n
r. ._ SINK• CITY. TL,N'
„m+t is,issued;Lsf all'not employ_dnyperson..`i-i any:mannerso `
,as to become sub ect to the'Workers-.Com ensation'Laws _
-;I, �i ...:. p' _ `•s 4 CONTRACTORS.. : oj
9 -.�.. .
''DISHWASHER
Dare Applicant CLOTHES WASHER'`. t
a �. ADDRESS
NOTICE APPLICANT'If, after makong.this Certificate of Ex-
em hon, ou'should become sub"ect to the:Workers Com en,•'
i:SWIMMING POOL'RECEPT0. �`" - _
P ... Y. P e:•a_- CITY' TEL. O.,
sotionrprovisionsFof the Laboc Code;,. musi,f8rIhwith comp-'_ , . LAWN SPRINKLER<SYSTEM P '"
Iy with siich provisions.or-`•this permit shall-be deemed revok STATE CIC.
e_d s WATER HEATERCLASS
LICENSED CONT,RACTORS`DECLARATION-•,, _'. NSE DISOTRI O PROC ED BY- ^"
LICE
GAS SYSTEM OUTLETS
.I hereby-affirm that I,am!licensed under'provigions:of-•Chapter` /
9'(commp—`r' gwith-Section 7000):of-Division 3 of the'Business "OUTLETS'OVER
and Professions Code„and;m -license is�in full-force;and ef,:` 5 PER SYSTEM N
y FIN EL�
fect z \ x
License.Number�'� _ S' Lir Claa"s G Y U.
v,
D
t FIA L
Conlfdcl � %} B
l ar exempt under'Sec e o 7,8 4 W,
for this reason'
# o o a .e oCL
C s 0 s Z
bate: r�
a
Plan eck fee ® 7 0 5
PLUMBING PERMIT ISSUING FEE $• .5
Signature
TOTAL'FEE S
LAI
77,
-� Plan."checks licant 0
SINGLE FAMILY 9,2 8 8 8
H_ ME OWNER=BUILDER DECLARATION, ".
PP '
I`.here b"affirm tl'ot,l arri,ezem`ifrom the Cor tractor'slGcense
Y . 4 P Name
L'dvv.for the folloWmg reason (Section 7031.5 Business
Erofessions Address ._., r a
I as`owner of the,property;will do the work'•and the City Tel No. `
structure isnot intend'
offered forsdle(Section 7044
Businbss and.Professions Code) k
CONSTRUCTION LENDING AGENCY
h hereby'affirm that there is:a construction lending agency for-, a a• ,','
_, .
tFe performance of the.work fon which this„permit is'issued `
(Sec 3097' CIV C. } q3M v
Lender s Name
Lender s`A'ddress' r• E'
;. .T „,' ti r andrstdte that the;
(.certify Ghat I have read this appI c o
mply with'alJ County r
obd naneesr'and State lavvstreaulat nto Plumbmg'`.and hereby`
9 at 9
authari e:trepresentatives, of thisL:CountyL to_,enter'upon"the; _
"4a,<bove=mentioposes.
' r s.•• SEE REVERSE FOR EXPLANATORY,LANGUAGE
S atu •of Perm ittee r a Date-,
„