HomeMy Public PortalAbout9445 LAS TUNAS DR_Plumbing_12/27/1988_lawn sprinkler system WORKED'•COMPENSATION DECLARATION
20-0026DPW4/87 APPLICATION FOR PLUMBING PERMIT
I'hereby,,affirm,that I'have a certificate of`conserit to self in 76A667A
sure or.a certificate,of Workers'Compensation Insurance,or a CE 817(REV.
certified,cop--therebf.(Sec.�,3800, Lab,C.):-
Policy Nb.-'C4�3 27dCom,p6ny;$dam 'ils�l5 STR. %A15..
COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
R�Wied copy is hereby.furnished
:.` ,. . "< FOR APPLICANT TO FILL IN(PRINPOR.TYPE) BUILDING'.
`Certified co is filed with the'count buildm ins ection NUMBER `FIXTURE OR'iTEM FEE ADDRESS'
PY Y 9• P
�! department.•+ _ , - - 1 @ LOCALITY - „• -
WATER CLOSET'(TOILET)
Date / Applicant NEAREST,
r.
CERTIFICATE OF EXEMPTIO FRON1'WORKERS'f BATH TUB T L.oS N S •� 0i¢K S./..
CROSS ST_..
COMPENSATION INSURANCE 't� •' - OWNER
t , dd^
SHO
WER' d, D�iY-.� �5,
(This section need not be completed•if the work•involved,by y MAIL
the permi`t`s foErone hundred dollars ($100)>or less.): LAVATORY ••, ADDRESS^ /`7�Z 1d70/QOi¢j�
P.certify that mth"e,performonce of the work"forwhich this per=
mit is issued, I shall not employ any person.in any manner so . SINKTY'STL/Q/Q, e/T
'as to become subject to the Workers' to*mpensotion laws .• DISHWASHER s
CI TEL NO
CONTRACTOR,
,- NDS
Date ' Applicant CLOTHES WASHER
ADDRESS'''�"30 'LALLO r✓
NOTICE.TO APPLICANT If,'after making this Certificate of Ex- SWIMMING POOL REGEPTOR
emption you should become subject Lo,ihe Workers'Compen, CITY �Te S ,TEL NO [!3
sation provis ons of the Labor Code,you must forthwith comp- 'LAWN.SPRINKLER SYSTEM �:.. 7_
ly with such provisions or this permit shall be deemed revok- STATE -' LIC
L, /
ed WATER•HEATER LICENSE NO. ST�7(o' CLASS C°.. ?7
LICENSED CONTRACTORS,DECLARATION DISTRICT No., PROCE D BY
Ichereby affirm that I am<licensed underip'roJiswr s of Chapter »' GAS SYSTEM
OUTLETS•
1.
9(commencing•with Section 7000)of Division 3;of the Business OUTLETS'OVER
and Professions Code, and my license is in full force and ef- 5 PER'SYSTEM FINAL
fect VALID TON
01*d
Z-�
DAT `'2
�q 2�4_ Lic. Class C
m
License Nuber-
/- . FINA
Contractor�7/r<tc W•+b�/L4i:D9 �te,� BY O`
Lm aexemptrundecLU
Sec: '• - ' � , .: W0.
B &P"C forhis'reason" '
; .
Plan check fee", z
'"PLUMBING"PERMIT.ISSUJNG'FEE $
�Mt
TOTAL FEE mss— 21 4 Q 9 A
SINGLE,FAMILY �J Q #•o'o o e o 5
NER-BUILDER DECLARATION. Plan check applicant
1"Hereby affirm'tliat I am exempt-froni the Contractor's License Name ;o 0 1
L'aw foc;the:;follow,ing ,reason (Section,7031".5,-Business an d 5 Q
Professor s Code)." " ` Address
01 Q�
aa.0',." of the property, will do the work and the City Tel No.
structure is not intended or offered for sale{Section 7044, 2 8
5
Business and Professions Code)
i •278
CONSTRUCTION:LENDING AGENCY*•.
F hereby affirm that there is o•construction,,lendin•g.agency.for, _
the perf&rmbnce'" f the w'o'rk,fb'r which.this.'permit.is•issued
(Sec 3097
"
Y4,
I'.
i. •Lender's Narne'
3
-Lende"s'Address-
.. r
11 certify that 1 have'read•this application and state that the
above information is correct.,I agree•to comply with'all County.
ordinances and State laws reguloiing.Plumbing,"arid hereby,
"
authonie::representatives of-this C unt'y to enter upon the
a e-mentioned pr pe f .ins coon purposes. i. ..
(� LANGUAGE
t Z/..�d SEE - •, _
_ REVERSE FOR EXPLANATORY ,
` ature of Permittee �. Date