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Home My Public Portal About9412 GIDLEY ST_Plumbing__ WORKEFrS COMPEN8ATkPN DECLARATION 20-OM DPW 9/80 I horobj!kMrip that I have a oertNloate of consent to &elf Insure, 7&MMA APPLICATION FOR PLUMBING PERMIT or a cerdNoate of Workers Compenratlon Insuranos; or a certifled copy thereof(Seo.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Poky No. Company ❑ Certified copy 1 hereby hirlletred. FOR APPL IcANT TO FILL iN(PFdfr OR Typq S"AI JG ❑ ADDt� -CerttfMd copy V tied with the county erglinspoobon departmsrrt. NU)AB8f FD(TURE OR ITEM • FEE L.OG4JTY Dots Appttcent WATER CLOBZ r QST CER17r,ATE OF DO WTW N FROM WORKER& BATH TUB CFKM ST. .COMPEN SATFON JNBURANCE ASR (This Motion need not be oornptstsd H the work InvbNed by the Sl IOMf13f MAP B" PAGE PAACa perrdtt Is for one hundred dolLars(111100)or Mas.) OWNER I oerttfy,that In the performance of the work for whloh this permit LAVATORY Is Issued, I shall not employ any person In any manner so as toYAJL beoome sub}eat to the Workers'Compensation Leve. Stw ADDRESS / C IDISWASHER C7Ty TEL NO Date Z 7—tp APplipaM CLOTHES WASHER NOTICE TO APPLICANT: If, after making ihls Certltloate of CONTRACTOR Exemption,you should become aub)ect to the Workers'Compensation 8WMWNG POOL FETOR provia"of the Labor Cods, you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SMNKLr=R SYSTEM LYCFTIBED CONTRACTOR8 DECLARAT}ON, Ct7Y TEL.NO. I hereby affirm that I am Iloenoed under provisions of Chapter 9 WATER HEATER (oommenoing with Sactlon 7000) of Division 3 of the Business and License rcGAS BYSTEY 8 STATE NO �� Professions Code,and my ense Is to full foe and affect OUTLETS OVER Dt8llalCT NO. BY b PER 8YBT91 License Ntunber�� Lk,Ci*ae,g 4/-7,v O FN/J_ comraok,. !�+• G'O, Db. S=3/--'1/ OA1� ( o—l�—61,� VA,41[T�11I730N a X07 2p,� I am exempt urrder Bea BY 1 ITu t,7 B-&P.C.for thY reason Plan Check fee , TOTAL 20- 50 Date: PLUMBING PERMIT ISSUING FEE$ CWK 20.HCl ❑ TOTAL FEE d DWI . Plan dxx*epp9owit ROME OWNER-O ILER DYEGLAFIATION Name LKw-0 01 9/27/90 I hereby affirm,that I am exempt from the Contractor's License Law �y-`,� for the following reason (Section 7031.8, Byalne"and Professions Address 3034 1 _ AM 3:LIS Code): City Tal.Na ❑ I,as owner of the property,will do the work and the structure is not intendbd or offered for sale (8eotion 7044, Bustnsss and Professions Code). ' CONSTRUCTK)N L�WDING AGENCY I hereby affirm that there Is a oohatructlon lending agency for the performarioe of the work for whtoh this permlt Is Issued (Boo. 3097, Civ.C.) t Lenders Name Lenders Address I osrttfy that I have read this applloatlon and state that the above Information Is oorreot I agree to oompty with all County ordtnanoes Pol- and and State laws regulating Plumbing, and hereby authorize r repreurttattves of this County to enter upon thO'above-mentlonsd property for Irapeotfon purposes. SEE REVERSE FOR EXPLANATOf[Y LAMMA13E WORI(ER S COMPENSATION DECLARATION 26002EDPW 9/89 I hdsby ittlrm that I have a certMoat• of consent to MIT Insure, � APPUCATION FOR PLUMBING PERMIT or a oagllloata of Workers Compenn astdon Insureoe, or a certified Dopy thereof(Seo.3800 Lab.C.) COUNTY OF LOSANOFIES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Poky No Company ❑ CertMed copy in hereby hlrrrahed BUl LDi Nt3 , FOR ARPLICANf TO FILL IN PRINT OR TYPE? AD[X1E88 ❑ CertMad copy Is flied with the oouMy buildtrp Inipeorion departrr-* NUMBER FDCRIRE OR ITEM • FEE LOC,1`L`Ty Data Applicant WATER CLOSET NEAREST C STrF-ATE OF EXEMPTION FROM WORIaERS' CR088 ST.' COM?ENSATION URANCE BATH Tt18 IMSABSEBSOR MLs Motion need not be oompMted If the work ktrotved by the SHOWIER MAP BOOK PAGE PARCIE peenit-M for one hundred dollars(=100)or Mea,) LAVATORY I certify that In the performance of the work for which this permit Is Issued, I ■hall not employ any person In any manner so as to g MAIL become aubject to the Workers'Compeneatlon Law. ADDRE88- DISWASHER CITY TEL NO. Date APpil CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should be imia subject to the Workers'Compensation SWt,p1 a POOL RECi-TOR provlsions of the Labor Code,you must forthwith oomply with such AODRESI3 provisions or this permit shall be deemed revoked. LAWN SPFtR4<LER SYSTE61 LICENSFp CONTRACTORS DECLARATION CITY TEL NO. �+ I hereby affirm that L am Ilosnesd under provisions of Chapter 9 WATT HEATER (8� (oommenaing with Section 7000)of Divlslon 3 of the Business and STATE IENSE No LIC' I'rofeeslons Code,and my lkxxua to In full foroe and effect. GAS SYSTEM OUTLETS OUTLETS OVER E P91 SYSTEM 57Ar a LberrmtNurnber LkL Class DATE �� _ _ D ON Contraobr Data ❑ I am exempt under Seo. BY B-BP.C.for Ude reason Plan check fee , Duce: PLUMBING PERMfT MWING FEE_ ❑ TOTAL FEF SINGLE FAMILY Pl$n check applicant 5 HOME OWNEPBUILDER DECLARATION . Name AGCT.T I hereby affirm Uut I am exempt from the Contractor's License law for the following reason (Section 7X)31.6, Bustnees and Profepione AdoYeee7 (r0 Coday. .00 ❑ I,as owTw of the property,win do the work and the sVucture Ci Tel.No. .U1 ITEM EF7 43- 00 Is riot Intended or offerdd for sale (Section 7D44, Business TOTAL and Professions Code). 001. CI-EpS 43.0(1 CONSTRUCTION LENDING AGENCY rytA1YS I hereby affirm that there Is a conatrvotlon lend Ing-,agency for the tiryau .13 pert x-mahoe of the work for which this permit Is Issued (Sec. 3097, Ctv.C.) 000D-M1 8/21190 Lenders Name - X49 i Ali 9:42 Lenders Address I oerttfy that I have read this application end state that the above , Information Is correct I agree to comply with all County ordinan6es and State laws regulating Plumbing, and hereby authorize reprasentathrss of this County to enter upon the above-mentioned property for Inspectlon purposes. SEE REVERSE FOR ED931LAMTORY LANGUAf3E r - 7°A697 APPLICATION FOR PLUMBING PERMIT 1 D"7 O-ID ID MON OF B=MQ.AND SAFETY � D. .om t 01 CoEngin— Count! of Los Angel" BUaLDINGI 7 JOHN A. LAMBIE, COUNTY ENOINx" ADDREHa (/ CASSATT D.GRIFFIN,EUF"T or EUILDINO LOCAL I-I-Y Ott O 1 o F=i. IN N SO m OWNI1k D1DT It 0, GROUP ZONFL auvT ro■ 1X2PXCTro0x MA14 .y rA I'['YN INDUSTRIAL . WAOTI APPfiOVAL PLUMFJB:R ENSPEMON RECORD ADDREIS J - CITY TSE-L- NO. LICHN-SK NO. v Human OF FULTu"OR TTXI FRE WATER CLOSIT CTOI ) 11.00 DO BATH TU6 1.00 9HOWER if 1.00 LAVATORY (WASHBAa1N) $1.00 fl KITCH INK sI.coo DISHWASHER ® •1.00. LAUNDAY TUE OR TRAY $1.00 CLOTHRO W HER 9 Y.00 WATE WATER 11.00 y� GAO QYSI-[M 41.00 f� APMOVAIS DATE I PECTORAL$IGNATURE U KR SLAB WORK PERMIT * I 00 RO GH PLUMBING G"PIPING TOTAL FEE GAS VENT, L'IESCRIBED EREBY ACIUfOWLEDGE THAT 1 HAYS READ T1iI3 APPLICATIQX HOT W TIR ANDI�cTIi THAT TiE A)30YE IE CORRECT AILD AGREE TO COYPI.Y ALb COUNTY ORDIKANCE0 AND' STATE LAWS REGULATING PLUMBING FIXT REd BING. _ EREBY CERTIFY THAT I A[ PFIQPERLT RE IST£RF-0 AND/OR GAS SED ASREOUIREb RY 9 ANGELFt COUNTY AND STATE OF ORNIA OR THHAAT I H LEGAL OWN�1'OP THQ ASQVE uTIL.ITY CO.NOTIFI REQIDEXT ATU RE PIRAIITT¢ FINAL JOHN?,.L"BlE, CouNTY ENQ1NE4R VAI DATION ROBERT A.}HOOD, CHIEF PLBG. INSP[CTQR LA - 51 .1 1 ; FEB 14 3 7.0 0 p