HomeMy Public PortalAbout6249 GOLDEN WEST AVE_Plumbing__ f W6FIXFR'8 COMPENSATION DECLAAA710N 20-0028 DPW 9/80
I r"af(1rm thaf'i/ have a certlfloate of consent to @elf Insure, ^
tyAPPLICATION FOR PLUMBING PERMIT
or a oertlfloate'of Worker's Pompensaflon Insurance, or a certlfled
copy th6reof(Sec.3@00 Lab.C.
PoOvy No. C04NTYO,F LOS ANGELES DEPT.,OF PUBLIC WORKS SPT.OF PJIJLJC WORKS DIV.
❑ Certfrod oopy in hereby tumlehed. BU0DM
FORAPPLJCJ.Wr TO Flit a(PRM OR TYPE) ADDivss
CerttM1sd copy Is fled with the qty butYQectSon lUng Ir
r NUMBER FDCTURE OR ITI31 • FEE L(N IJJTY
77
Date Appl{carrt r WATER CLOSET NEAFdEST
CERTIFICATE OF EXEI PTION FROM WOF0(E:RS' D ( ST.
COMPENSATION INSURANCE BATH TUBASSESSOR
f�
Cl-his section hoenot be completed H the work Involved trythe SHOWERMAP B" PAGE 4; PARCEL d!
permit Is for ono hundred dollars($100)of Ioss.) LAVATORY OWNER 1*4
I oertffy that In the performance of the work for which this permit MAIL
Is Issued, I shall not employ any person In any manner so ae to SIW r 1
become subject to the Worker'CoMpensatlon Laws. ZVO
Dt8WA81 FR
Dote Applloerrt CLOTHES WASHER
NOTICE TO APPLICANT: 11, after making this Certificate of
Ehempbon'you should become subject to the Workers'Comperuratlon SWp,1A1INo POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS J
provisions or this pwmtt shall be deemed revolted. LAWN SPRINtQEA SYSTEM
LICENSED CONTRACTORS DECLARATION CxT1 TEL NO.
I hereby affirlm that I am Ilconsed under provisions of Chapter 0 WATER
(commencing with Section 7000) of Division 3 of the Business ■nd GAS SYSTEM OUTLETS BTLI;E NO o�-��(o LIC.
SS
Professions Cods,and my license Is In full force and effoot
,�,�/y (/� OUTLETS OVERDISTRICTDTRICr NO. BY
Ucenee Number I u 3 6
_ " —0
FINAL
DATE ���r� V ATION .Wa.
W
vaomr
cortCIll _e - FINAL 1 ITEMS �
F-1I am exempt order Seo.
TOTAL 272- 10
B.aP.C.for thls reason By
Date: Plah check fee , CHECK 272,10
PLUMBING PERMIT ISSUING Fes; X00
❑ TOTAL FEF Q
Plan check appfbaM 1 11/23/92
SINGLE FAMILY wtr n
HOMEA 1OWNER•SUILDER DECLARATION Wma 6"7 1 10 16
1 hereby affirm that I am exempt ham the Contractor's Llcerms Law
for the following reason (Section 7031.6, Buslnses and Professlons Address
Code): City Tel.No.
❑ 1,as owner of the property,will do the work end the structure
Is not Intended or offered for sale (Section 7044, Business
and Professions Code). '
CONSTRUCTION LENDING AGENCY
I hereby affirm that there to a oon@tructlon lending agency for the
performance of the work for which this pormft Ia tsaued (8ec. 3007,
Ctv.C.)
Lenders Name
Lenders Address
I oe this upp11cetlo and state that the above ,
1 rtnatfon Is Corr agree to Damp with all County ordlnanoee
an to laws regulating Plumb g, end hereby authorize
repnsse of this County to t he above-mentioned
n pu'> @ SEE REVERSE FOR EXPLANATORY LANQUAt]E
a
8 ature Zi Petro