HomeMy Public PortalAbout9008 GARIBALDI AVE_Plumbing__ YdD '8 OQNPENSATI N DECLMATKON 20-0028 DPW Orae I'
I herebyattlrm thoMI haw a osrHAoate of content to telt Insure, APPLICATION FOR PLUMBING PERMIT L�
or a 0e01cae of Workars- ompentailon Insursnoe, or ■ oerttfled
abpy thwW 18ac.--V=Lab.C.)
ILYA COUNTY OF LOS ANGEI FR DEPT.OF PUBLIC WORKS QEPT.OF PUBLIC WORKS DIV.
COMM"
p❑ CerttfMd copy Y hereby furnished. FOR APPLICANT TO FILL IN(PRbrT OR TYPES BURRING O
�1
Certtfled copy b fled with the aoumty b�rG�P"� � .
R, /K� NUMBER FIXTURE OR ITEM � FEE �m
Dae Appfbartti�L6�I;.J� WATER cLoeErTCRO88 ST. U
CERTFrA-rE OF EXEMPTK)N FROM WORKS sATH TUB
COMPBJ8ATN INSURANCE
IQABSESBOR
(rhIs seobpn need not be oopl rW If tM wort MvoFred by the SHOWER MAP BOOK PAGE PARCEL
n
pmult It for one hundred dollars({100)or lett.) OWPH1bp
I certify that In the performanoe of the work for which this permit LAVATORY
Is Issued, I shall not employ any person In any,mariner to as to qrW AR�JL1E40A0 /Lt: /
become subject to the Workers'Compensatlon Lire.
f DISWASI-FR CITYEI 50Z,173
Dae Apploant CLOTHES WASHERC
NOTICE TO APPLICANT: If, after making this Certiffcate of
Exemption,you should become subject to the Worker' Comperkatlon SWMM POOL RECEPTOR
previsions of the Labor Code,you mutt forthwith oomply with such
proyls4ons,or this permit shall be deemed revoked. LAWN ER SYSTEM
LICEPIBED CONTRACTOf18 DECZARATTON WATER HEATER >
I herdby aTTlrm that I am licensed under provisions of Chapter 0
(commencing with 8eotlon 7000)of DKWon 3 of the Business and STATE
Prof»rlon$Code,and my ken"V In full tome and affect
GAB SYSTEM OIJTLET6 NO. CLf188
D98TRICT NO. PROCE88®BY Q
t DMW Rumber �/1 Lkr.cies.-6-3(e �� �
DATE VAU DATI ON w
�"� co
Conhealarco
-
❑ I am m mmpt under Sea BYE
B•bP.C.for this reason
Dew. Plan chgck fee ,
_
t PLUMBING PERMIT ISSUING FEF S
TOTAL FEE
Plan&o%ck appftoarrt � ? ,r.1�r
SINGLE FAMILY i I �
HOME OWR�BUU-DER DECLARATION Name 1
for the followingrm rreeason($ectlonfrom 7031 8.Business arned Proffsssfaoones �ns Address - TOTAL 293 - 10
Cod.:
)
F-1 1.at owner of the property,will do the work and the structure Tel.No � 1 lei.1l]
to not Intended or offered for sale (Section 7044, Business ' l
and Profeetlons Coda).
CONSTRUCTION LENDWG AGENCY 130 1 4/11'94
I herby affirm that there Is a construction lending agency for the
pertormanoe of the work fpr whlah this permft is Issued (800. 3097, 4752 1 AM 171,
ctv.C.)
Lenders Name
Lenders Address
I oerttty that I have read this application and state that the above '
tnformalon Is convcL I agree to oompty with all County ordinanoee
and State laws rep ng Plumbing, and hereby authorize
rep r o Coun to enter upon the above-mentloned
i Pu Zr SEE FlIEVERBE FDR EMAIMTORY UNGUAOE
re Of lttee Date
TION
DPW
"'°RKERB rt"loate of convent to 7&AJWA 89 APPLICATION FOR PLUMBING PERMIT
I here-by affirm that I have a osrtlTlcate of consent to salt Insure,
or a certificate of Worker's Compensation Insurance, or a°ertlfled
S
W
eof(Sec.3800 Lab.CJ T comp"
COUNTY OF LOS ANOFI FR dEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ CerttW copy J.hereby tvnLtied To FE1 W(ANT OR TYPE) LM
FOR APPtJc.ANT BtaN
LOo
❑ 17f1
ttM1si.flied with the oounty ADDRESS
NULBER RXTURE OR FEW r FIE LOCALITYDeur Apploent WATER CLOSET NF�AREST Al 40 .
CROS8 ST.
TE OF D�IlON FT10►1 BATH TUB
OOMP1 N8ATKA WSURAWN E ASSESSOR
(rhis section need eat be coorplated if the work Invo#wd by the SIJOWEh YAP BOOK PAGE PARCEL
perrsft to for one hundred dollars(=100)or Woo,) OWNER
I oprttfy that In the performance of the work for which this permit MArL
LAVATORY
to Issued,I shall not employ any person In arty manner so as to gpKADDRESS
become subject to the Worker.'Compensation Laws.
DfSWA�iIER qTY ,��/ ' -TE .NO.
Date APPfrt CLOTHts WASHER CONTRACTOR Q 4, �
NOTICE TO APPLICANT: If, atter making. this Certlfloet• 01
Exemption,you should beooms subject to the Workers'Comper�ration SWIMMING POOL FETOR
provisions of the Labor Cods, you must forthwith comply with such ADDRESS r �i /�•
provisions or this pWrmtt shall be deemed revoked. LAWN�iQ-ER SYSTEM
LICE99ED CONTRACTORS DECLARATION! crrY � TEL- e—ss�Z
I hereby affirm that I am licensed under provisions of Chapter ° WATERS
(oommenoing with Section 7000)of DNb1on 3 of the Business and GAR er OUTLETS
LI NO. CLASS e"L
Professions Code,and my"nos Is In full force and effect" NQ,0
OUTLETS R8Y OVER 17t81Tr1OTr PRocEes»BY
k 6 PER BYSTF]d
Lloonse Number,/ Llc.Mass FINALv
1 C/a � DATE � u� LU
Contractor Date *f A/f DATE
❑ I am exec WKW Seo. BY ANT.Ir ?
B_8P.C.for thio reason M •, 41.85
DaUK Plan check fee1 ITEMS
80-tura PLUMBING PERMrr ISSUING FEE i �- D , TCITAL 41 - 85 .
TQTAL FEE Em 41.'+�yK
❑ SINGLE FAMILY Pian check app'loent C T3iTVL •w
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the ContiaoWs Llcense Law
1�e;following reason (Section 7031.6, Business and Professions Address - 1 11J 1r 74
❑ Tel No.
I,as owner of the property,will do the wad and the structure 7515 1 r 111 l�1
Is not Intended or offered for safe (Section 7044, Business
and Prdfeallons Code). '
CONSTRUCTFON LENDWG AGENCY
I hereby afllrm that there to a construction lending agsnoy for the
pertormarwe of the work torr which this permit Is Issued"(Sec. 3057,
CN.C.)
Landers Name
Lenders Address
I oertify that I have road this application and state that the above ,
Information to correct, I agree to comply with all County ordinanoss
and Stats laws regulating Plumbing, and hereby authorize
repenter enter upon the above-mentioned
p 2pu SEE REVERSE FOR EXPLANATORY L.ANOLAW
G, It/17
Sigruiure of