HomeMy Public PortalAbout9006 GARIBALDI AVE_Plumbing__ yiIDWER'S COMPE748ATK*t OECLAFIATION 240070 DPW G/EB
' I hgrsby afflrm-tha3 I have a oerttfloWe of oonsant to self Insure, '°"'°°'A APPLICATION FOR PLUMBING PERMIT
or a cert)flgpte of Wo*V's Compensadoh Insurance, or a oerttfled
oopy tb (Seo.3800 Lab.C.)
IPoasoy PPor -JCOU TY OF LOS ANGEIES� QEQT..OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Lf Certflled oopy is hereby f rrmshed. FOR SANT TO RLL N(PRINT OR TYPE)
Ceriffled oopy Is fled with the county buhdbvktapactlon
`` '' NUUBE 3 FUTURE OR ITEM FEE
Dole Appian aezj PWG, WATE31 CL08ET NEAFOBT
CERTIFICATE OF D031PTtON FROM WORKS S' dices ST
IOBATHTUB .
COMPEN8ATN JfWRANGE A18Oq
MAP GOOF( I PAGE PAACEI..
(This asodon need not be completed V the work W"Ned by the BFbWER If�
permit to for one hundred doUars($100)or less.) owNER
I oertl}y that In the performance of the work for■hloh this permit LAVATORY
is Issued, I shall not employ any person In any manner to as to Sw MAIL
ADOnES8O
become s4pjact to the Workers'Compensaton Law.
btSWABN ER C}T Y
Data Ap~ CLOTI�WASHER T� a
NOTICE TO APPLICANT: If, Brier making this Certificate o}
Exemption,you should beoome aub)eat W the,Worker'Comp.ha.tlon SMnMUM POOL RECEPTOR ADORf88
provlsiona.of the Labor Cods, you must forthwhh comply with aioh
t)119
proVlstons or this permit shall tib deemed revoked. LAWN SmMdER SYSTEM
LICENSED CONTRACTORS DECLARATION 65 -
I hereby affirm that I ■m licensed Under provisions of Chapter 9. WATER HEATER
(commendnp with Section 7000)of Dfvlalon 3 of the Business andSTATE
Profeeslons Code,and my Rcerms Is In full foroe and ef}ecL _W SYSTEM OUTLETS LICEIJSE NO. CLASS
J) f Df8TR1CT NO. PROCI )BY
tloen..Number `7 5 L Lia C1..; ✓r 6 PE�1 SYB H o ,�d
t7y �l_ a DATE LI
1-�-� VADATION
C D�
F-1 FINAL
I am axeMpt under Seo. BY
B.AP.C.for dile reason
Plan check fee
Date: , c
Pt.UMBM PERMrr ISSUING FEE$
■T
F-1TOTAL FEE {
SINGLE FAMILY Pier aPP
HOME O -WIDECLARATION Name
I Hereby amrrn Wt�A I�that I am exempt from the Contractor's LJoerme live - TOTAL ,�'� 1�
for the fdlowing reason (Section 7031.6, Businees and Professtors Addreaa
Code): C�E(Yi - 1.93.10
Tel.No.
❑ I,as matework}of the property,wUl do the woand the stricture �Y .l0
Isnot Intended or`offered for sale (Section 7044, Business '
and Professions Code).
CONSTRUCTION LENDING ADEENCY -r 1 4/�Ir{�cf/7p
4
I hereby affirm that there is a oonstruction lending agency for the 4751 1 til 7 J
performance of the work for which this permit Is lasued (Sec. 3097,
j Ctv. C.)
Lurder'a Name
Lerxlere Address
I certify that I have read this applloation and state that the above '
Inlorm-a on Is I agree to oompty with all County ordlnanws
and State i■ regulatih um g, and hereby autho}Ize
repress til ty tb an upon the above-mentioned
r / SEE REVERSE FOR E]PLA\HATORY LANGUAGE
re Of P& ee Date
"'°AKEFr$C°'"PENft'losteo ` ntto °P'"°'°° APPLICATION FOR PLUMBING PERMIT
7aAae7A
I hereby affirm that I have n certlTloata o} consent to calf Insure,
or a certffloate of Worker's CompergaUon Insurance, or a oerttfled
not(Sec.3800 Lab.C.) . . •
3(� arry � �£ COUNTY OF LOS ANQEL.F8 DEPT.OF PUBLIC WORKS DEPT. OF PUBLIO WORKS DI1C.
Ncr❑ ce tuw copy Is harsby tumiahed. BUILDING
❑ FOR APPLIC.MT TO Flt W(PRINT OR TYPES ADDRESS
Is(fled with th6
NUMBER FDCRfR£OR ITEM • FEF LOC."
Date `I ( Appaoarrt WATER CLOSET HEST
TE OF EXEMPIlON FROMBATHTUB 00068 ST
IOW . (J
COMPEpN ATN INSURCE
(rhis aaotion rteed not be completed M the work Involve by the SHOWER ""'r�`^ ` PAC�e PARCEL
permit 4 for o#ra hundred doUare($1 DO)or Iso&) OWNFA
I certify that In the pbrformarrce of the work for which this permit LLAL
LAVATORY
Is Issued, I shall not employ any parson In any manner mo as to 81W ADDRESS
become std Ject to the Workers'Compensation Laws.
biSWABHER CITY TEL NO.
De Applicant CLOTHES WABFIER oDwrRAcToA
NOTICE TO APPLICANT: If, after making this Csrtiffoate of
' Exemption,you should become subfect to the Workers'Comperrea3w SWU0,4I G POOL RECEPTOR . ADDRESS
provisions of the Labor Code, you must forthwith comply with such (/►>
provisions or this permit shall be deemed revoked. LAWN SPRINXLER SYSTEM / A
LICENSED SIO
ORB DECLARATN CnY CIA ' TEL NO. fL
I hereby affirm that J am licensed under provisions of Chapter ° WATER HEATER
(commencing with Secdon 7000) of Divtslon 3 of the Bualness and CRAB SYSTEM OLML.EfS 8TH NO. CLLJCASS Q_ 8
Professions Code,and my Iloense U In full force and affect. D48TFdCT NO PROCESSO BY
. OP
Lkwm NuMber 535 'SS Uo.Class G y�
RNAL
DATE ` VAUDATION a
C CDZ
❑ I am exampt under Sao. BY ACCLIL T
b.&P.ti.for this reason - _
DPlan check fee 001.ov-
PLUMBING PERMrT ISSUING FEF: b 1 ITEMS
TOTAL FEF TOTAL } 1 _ tic
F-1 - -
ctreck eppkerrt CHECK 41.
SINGLE FAMILY
HOME OWNEP BUILDER DECLARATION Name _ ■al
I hereby affirm that I am exempt from the ContrsoWs Lloensa Law
for the folkrning reason (Section 7031.5, BU*Inon and Professions. Address
Ctty Tel.No. �—l�}�1 1�1yI 1/94
F-1 1.as ownertr
of the property,wIII do the work and the wuctrrrs 7514 r'114 1 12•aj
Is not Intended or offered for aale (Section 7A44, Busrne"
and P.ofeeelons,Code). '
CONSTRUCTION LENDING AGENCY
I hereby affirm that there to a oonstructlon lending agency for the
performanoe of the work for which this permit Is Issued (Seo. 3097,
Chi.C•)
Lades Nama
Larders Address
I certify that I have read this application and state that the above ,
Information Is correct I agree to comply with all County ordinances
and State laws rogulatin lumbing, and hereby authoriis
representat of t u enter upon the entlonad
P. P BEE REVER88 FOR EXPLANATORY LANGUAGE
81gnaturo of