HomeMy Public PortalAbout4941 DOREEN AVE_Plumbing__ �26
„W,that I have q certificate
DECLARATION 76A667 DPW 9/89 APPLICATION FOR PLUMBING PERMIT
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I•hereby affirm that I have 3 certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.) - -
ollcyNo. 10n048,96 mPany !`TTA Tne (`n -
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS ;::DEPT..OF P,UBLIC•WORKS DIV.
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Certifled.copy is hereby furnished.
r—. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
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Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM r@ FEE LOCALITY Temple City
Date 2-3-92 Applicant Owen Bros. Plumbi WATER CLOSET '
1 NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE ASSESSOR - ' 'r
(This`aection need not be completed If the work Involved by the SHOWER 1 (' MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) ^ L OWNER (
I certify that in the performance of the work for which this permit LAVATORY ,/
is issued, I shall not employ any person in any manner so as to SINK 5 MAIL
ADDRESS 1.15 La Porte Street
become subject to the Workers' Compensation Laws.
DISWASHER L CITY
Date TEL.NO. 574-7355
Date Applicant CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of Owen Bros. Plumbing, Inc.
Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR ADDRESS 4265 N. Baldwin .Avenue
provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM .443-007
LICENSED CONTRACTORS DECLARATION CITY TEL.NO. }
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER d
(commencing with Section 7000) of Division 3 of the Business and STATE 231 741 LIC. V
Processions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS C� LICENSE NO. CLASS C36-20-16
OUTLETS OVER •J DISTRICT NO. PROCESSED BY
231 741 C36-20-If 5PER SYSTEM d/ n� O
License Number Lic.Class 6
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n DATE Z VALIDATION a
Owen Bros. Plmb. 2-3-92 W
Contractor Date
❑ I am exempt under Sec. FINAL Z
BY
BAP.C.for this reason
Date: Plan check fee
Signature PLUMBING PERMIT ISSUING FEE$ Alm
❑ TOTAL FEE
S
INGLE FAMILY Plan check applicant
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HOME OWNER-BUILDER DECLARATION Name
1 hereby affirm that I am exempt from the Contractor's License Law - �I;i s
for the following reason (Section 7031.5, Business and Professions Address - ..
Code): =-`)7
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City Tel. No. r
I, as owner of the properly,will do the work and the structure
is not intended or offered for sale (Section 7044, Business
and Professions Code). D Iflir j eft
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CONSTRUCTION LENDING AGENCY � -.- - --. - ,.i�_i_+� -2;`11 .').-
I
hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097,
Civ.C.)
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Lender's Name +t_ is
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Lender's Address iii`tL_f:
I certify that I have read this application and state that the above - D
information is correct. I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
XPentative of this County enter upon the above-mentioned
t f ectionj os SEE REVERSE FOR EXPLANATORY LANGUAGE
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Si nature of Per a atm '