HomeMy Public PortalAbout9050 GARIBALDI AVE_Plumbing__ it tTp �At �7A.
I hereby afrgthat ihae rpoate of nietoealf Ip.ur., APPLICATION FOR PLUMBING PERMIT
or a tertN(oat6 of Worker`s CampenWlon 1nsuninoe, or a oertlfle&
oopy thefeof($eo.3800 Lab.C.) 1
Poafay c« ry -5kk �tl�� COUNTY OF LOS ANGtLES DEPT.OF PUBLIC WOM(S DEPT.OF PUBLIC WORKS DIV.
Cadff d copy is hereby hirNshed
FOR APPLICANT TO RLL N(PRINT OR TYPE) ADDRESS
LI Cepartr copy b flied with the county bulldlrp trupectfon LOCALrry
aeprvnenpt. �� /y�//] NIA�I FanJff ora ITEM i FEE I t C 1
Data I ' !5 Applicant /J/.ef��Sd.� WATER CLOSET NEAREST
BATH ll.iB
E�ITIF)CATE OF E�MPTI N FROfr WORJCEZS �? CR0888T.
J j
COMPENSATION INSURANCE MAP BOOT( PACC♦E D PAFKA���
(ThV seatlon need not be oompieted H the work InvoFwd by the
permit 4 for one hundred donsue(5100)or Mw.) o1yf� I
I certlty that In the perfgrmanoe of the work for which this permit LAVATORY
Is Issued, I @hall not employ any person In any manner so as to B�pC MAIADM h
beoome subject to the Workers'Corhpensatkm Laws. p
DISWASHER CITY �(� t+`1 TEL.
No'7.Of"
Dole Appkmtt I CLOTHES WASHER
NOTICE TO APPLICANT: It, after making this Certifloate of
Exempti(>n,you should become subject to the Workers'Gompetwtlon SWIM MM POOL.FETOR
provisions of the Labor Code, you must forthwith oompty with such ADDRE88 C1116 V0. T
provision or this permit @hall be deemed revoked. LAWN 8PRINILER SYSTEM
LICENSED CONTRAGTORB DECLARATK)N a" f\ZUS - a
I hereby afflrm that I am licensed under provisions of Chapter 8 WATER HEATER
(oommenoing with 8eotfon 7000) of Division 3 of the Business and ' (�A8 SYSTEM � � �LIC8i8E NO. P771 1 q9 ATE � i S
Profession Code,and my Roans•b In full force and effect 1
OUTLETS OVER DISTTUCT NO.6 PER SYSTEM V/`G� �� .1� 326.1110
P"bbmm By
Lk»rw Nurnber �1^"C l Llo.Ciaee C� 30
DATEFRAV ON W
Corrtry r A—Date �-3 ��
❑ I am exempt under sea. BGCHXI�J 1 1!3 i/fi 1
B.aP.C.for thio ra..bn W- 1 AM 9:43
Plan check fee
Date:
PLUMBING PERMff ISSUING FEE.$ 6
❑ TOTAL FEE Q
Pian oheok applicant
SINGLE FAMILY
HONE OWNEFI-BUILDER DECLARATION Name
I hereby afflan.that I am exempt from the Contractor's License Law
for the foll0wlnq'reason (Seotlan 7W1.6, Business and Professlons Addrq- ti
Code):
Ctty Tel.No.
El 1,as owner of the property,will do the work antr
d the euoturs
Is not Intended ar offered for sale(Section 7044, business
and Professions Cods). ,
CONSTRUCTION LENDING AGENCY -
I hereby affirm that them to a oonstructlon lending agency for the
perlormanoe of the work for which this permit Is Issued (Seo. 3097,
Chi.C.)
Landes Name (7
I_utdees Address
I mortify that I have read this application and attte that the above ,
Information Is oorreot I agree to oomply with all County ordlnanoee
and State laws regulating Plumbing, and hereby authorize
representatives of this County to •nter upon the above-mentioned
prop"for I GEE REVERSE FOR EXPLANATORY LA14DUAGE
awrtaitao be Pwmltttee Deme
WORKERS'COMPENSATION DECLARATION20-0026 APPLICATION FOR PLUMBING PERMIT
1 hereby, affirm that I have a certtficate of consent to self In- 7pDPW 4/40
sure,oC a certificate of Workers'Compensation Insurance,or a
certified copy thereof (Sec. 3800, Lab. C.)
Policy No.. Company COUNTY OF LOS.ANGELES DEPT. OF PUBLIC WORKS
Certified copy Is hereby fumished.
Certified copy Is filed with the county building Inspection FOR APPLI(�fr RLL IN(PRINT OR TYPES BUD IQ�Q
department. J�{jr
ent. (} A�/ NUMBER FIXTURE OR ITEM FEE LOCALITY
Dcrte 6— (P Applicant I I /S ' ^""�"'�`7 WATER CLOSET(TOILET) TF� loor
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CC'S ST.
COMPENSATION INSURANCE SHOWER OWNI3t
(This seeill n need not be cornply*If the work Involved by MAIL
the permh to for one hundred dollars(=100)or lees.) LAVATORY ADDRESS
I certify that In the performance of the work for which this per- SINK CITY TEL- NO
mit is Issued, I shall not employ any person In any manner so
as to become subject to the Workers'Compensation Laws. DISHWASHER
Date. Applicant CLOTHES WaS11-11ER
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
SWIMMING S
emptlon,you should become sublact to the Workers'Compen- CITY TEL- NO.
sation provisions of the Labor Code,you must forthwith cramp- LAWN SMNy3ER SYSTEMS
ly with such provisions or this permit shall.be doomed revok- y
ed. WATER HEATER LICENSE NO. CLAMa /
LICENSED CONTRACTORS DECLARATION. DISMCT NO. 51PROMSStEb BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
415.Z-11
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER.
and Professions Code, and my license is In full force and of- S PER SYSTEM FINAL (DATION
fect. � `� �-� / HOSE BIB DATE Z _ J.��FS 121.•35 >_
License Number Lic. Class 1 1TEMS a
j',` FINAL O
Contractor�LY &JUAL) Date U
. BY 1� 1 0.
❑ ,
I am exempt under Sec. f'
U
B.$P.C. for this reasonCWNGELU
Plan check fee . ► .00a.
a.
Date: PLUMBING PERMrT ISSUING FEE;
SignatureTOTAL FEE MO -"1 b/ 6/95
SINGLE FAMILY 0772 1 PM 5'15
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractors License Name
Low for the following reason (Section 7031.5, Business dnd
Professlons Code): Address
❑ I, as owner of the property, will do the work and the City Tel. No. }
structure Is not Intended or offered for sale(Sectron 704/,
Business and Professions Code). Poo-
CONSTRUCTION
CONSTRUCTION LENDING AGENCY
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.).
Lender's Name
Lenders Address
I certify that I have res this appJlcatlon and state that the ,
above InformAofo-.r
gree to comply with all Countyordinances aulating Plumbing, and hereby
authorize rehis County to enter upon the
abov IInspection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE '
S1giiatureVWrmIttoo bute