HomeMy Public PortalAbout9445 LAS TUNAS DR_Plumbing_7/7/1988_water closet, lavatory WORKERS'COMPENSATION DECLARATION0-0026 APPLICATION FOR PLUMBING PERMIT
I-hereby, affirm that•I have a.cer(ificate of consent to self in= 76A667A PW 4/87
sure,or a certificate of Workers'Compensation Insurarice,`or a CE 817,(REV..B/86)
certified copy thereof (Sec. 3800, Lab. C.).
COUNTY. OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No Company
t�dC C :C :
Certified co is hereby furnished. /l�rel F
copy y . ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING t `
Certified copy is filed with-the county building inspection ADDRESS. 9445j S$ Las -Tuna
department. NUMBER:, FIXTURE OR ITEM @ FEE
LOCALITY
/ Date 1/6/88 J pht Cadsti P1 bo. + WATER CLOSET(TOILET) • T^Mill city
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. OA
COMPENSATION INSURANCE SHOWER towc West Am=
OWNER Pn
(This-section need not be completed if the.work-involved by • MAIL
{ 'the permit is for one hundred dollars(000)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this'per- SI
mitis issued; I shall not,employ.any person in any manner so NK CITY 'TEL.NO.
as io become subject to the Workers'Coriripensotion Laws. DISHWASHER
CONTRACTOR j6960h Cad#11fi P1 bg. Co,`'
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate,of Ex SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen-' F�.; d r3e��1 v�F►1
sation.provisions of the Labor Code, you must forthwith comp- LAWN.SPRINKLER SYSTEM CITY Rosemead Cal 1�. TELA _280-420 t..
ly with such provisions or this permit shall`be deemed revok-: STATE 134935
4rGi 1 1 UC_ CC-f336V �f L
ed. WATER HEATER LICENSE NO. CLASS -
LICENSED CONTRACTORS DECLARATION DISTRICT NO; PROCESSED BY
I-hereby affirm that.1 am licensed under,provisions of Chapter GAS SYSTEM OUT
9.(ccmmencing with Section,7000)of Division 3 of the.Business OUTLETS OVER d.
an Professions Code,
and my license is in full force and ef.- 5 PER SYSTEM' '. FINAL VALIDATIrON V
fec134935` 4—36 DATE
License Number. Lic. Class ..� W
+y�p ®«� g FINAL J
h'tYt i .s�9 81: PIb • '.C%,,e 716/ BY . ti
> ,
I am exempt under Sec. cc
B.BP.0 for this reason Plan Check fee , 0
Dater PLUMBING PERMIT ISSUING FEE$ W
Signature
TOTAL FEE 5
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plari check applicant
I hereby affirm that I am exempt from the Contractor's License Name ) y +E4f ?e�`1
Caw fo"r the following reason (Section`7031.5; Business and'-
Professions Code): Address -. T qf'� ' 1!el �, t�
L, as owner of.the property; will do the work and•the,. City, Teh. No.
structure isnot intended or offered for sale(Section 7044,
Business and-Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for. `ftajt )r i
the performance-of the work for which this.permit is,issued
(Sec.•3097, Civ. C.)..
Lender's Name
Lender's Address,
I-certify'that.-I have read this application:.and state that the
above information is correct: l agree to comply with all County ►
ordinances and State.laws regulating Plumbing,'and hereby .
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes.:
,{{r '• SEE'REVERSE FOR EXPLANATORY LANGUAGE'
' Signature of'Perm'ittee r Date