HomeMy Public PortalAbout9441 1/2 - 9445 1/2 LAS TUNAS DR_Plumbing_7/7/1988_water closet, water lavatory J r �QVC�kAERS'COMPENSATION DECLARATION APPLICATION', FOR PLUMBING' P'ERNlIT
^I'bhereb dffA'm.that I,have'a certificbte4of•to'nsent to self in- ?0:0026 DPW a/87
_ Y,., .. 76A667A - .. ..
sure,or a cefiificate'of Workers'Compensation Insurance,.or a CE 817(REV..B/86)- '
certified copy thereof (Sec..3800, Lab C )
P,olicyNoQQObFiQ -Company` ��,lV€a"-:Ti'—;nCe•'COr F
COUNTY OF LOS:ANGELES_ DEPT...O `PUBLIC WORKS
Certified aopy;is hereby furnished.
FOR APPLICANT TO flLL IN`(PRINT OR'TYPE) .' BUILDING
d'withthecountybuildmginspection- ADDRESS ast" Las 'TUI1dS
NUMBER` FIXTURE OR ITEM FE1E -
Certified copy'iis file 9445
departmeni, � �° LOCALITY
Date 7/6/88 Jps- baht Cadi,l'1'1 P1bg -: Coe WATER.CLOSET(TOILET) 6 NEAREST
BATI 'TUB CROSS ST Oak'
*..
CERTIFICATE OF,.,EXEMPTI'ON FROM-WORKERS"` f
" COMPENSATION INSURANCE` ` OWNER
SHOWER' Potomac West"Assn
(This"section need not be-complefed if.the work involved by- MAIL
the ermit_is fo-r one hundred dollars $,100 orless.) 8 'L'AVATORY ,
P ( ). 6a 4 OO . 'ADDRESS
I'certify that in tke;performance of the work for whichthisper-; SINK
mitis issued;,)shall not employ ciny person in onyroanner so a .• CITY TEL NO
as to become subject to the,Workers'Compensation Laws ; -
DISHWASHER CONTRACTOR._J
Date Applicant' CLOTHES.WASHER ADDRESS
_ ose h Cade l l i ::O b Co
.'NOTICE'TO,APPLICANT: If;:after_making,this:Certificate'of Ex •SWIMMING POOL RECEPTOR
emption,' -ou should become•sub'ectto,the Workers:Compen'-` CITY'' 'TIATA.
satio'hpsuch i6nio ons•oaGhr Co'cle,oh'm'ust.forthwith comp LAWN SPRINKLER SYSTEM DS lemena C
4201
IY P P. kie deemed,revok, STATE 13473) LIC.
ed 'HEATER LICENSE NO. CLASS
LICENSED'CONTRACTORS•DECLARATION' DISTRICT NO. PROCESSE -BY
GAS SYSTEM OUTLETS G
Thereby affirm that am.licensed.under pr"ovisions'of Chapter JTV
9
-
'
co
m
.m
encing with Section 7000)of Division 3 of the Business OUT,LETS'OVER
feet.Professions Code and my license is m full force and•ef FINAL"_ _ a
5 PER SYSTEM
,'i - •,f.
• DATE ! 1, VALIDA N
134835:. C=36:
tieease Number Lic. Class
FN
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�{{�� Cad%1 l i P1 b C 7 6/88' -BY A o
C�o15Tfd'ctb'r g ®dte r /
I:am exempt under Sec _ W
CL
B BP.0 for this reason -
, � • Plan check
Date
P,LUMBING.PERMIT.ISSUING FEE$
10.1 n
4 S71
ignature
TO EE,
[TOTAL F 106 50
SINGLE FAMILY
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'HOME OWNER-BUILDER-DECLARATION k
Plan thee applicant
I hereby affirm that-I am-exempt from the-Contractor's.License Name 0,09.
Law for the-.following reason (Section 7031.5 Business an'd
Professio6s'Code')`.. :. Address #:s a o:q 0:5
❑ I tas;"owner',of theproperty, will d'o the work and the Ciiy. Tel.'No': `. ): '+�'0�'5.0-
structureis not Intended'ar'ffered for sale(Section 7044 - 1 _
Business and_Professions Code)_,' 1. O v
~' m 0 5
• 1
CONSTRUCTION LENDING AGENCY e p 7.0 7,�:8$ •:
I hereby affirm;that.thee is a construction'lending,agency for r
the•performance of the'work-for which:this permit-is issued - -
(Sec` 3097; Civ: C:).
'Lender's"Name:, ..
4..
Lender's'Addfess
I certifyhat I have read'this application,and state'1hat the :f
above,information is correct. I agree to comply with all County
ordinances-and State.Idws,regulating Plumbing,.and hereby' "
• a
authorize representatives of this County:to enter upon-the
above-• endo'ed pro it,y.for inspection puTose � ` _• - ' ' ".
SEE.REVERSE FOR EXPLANATORY LANGUAGE
S'" at' a of Permittee Date _