HomeMy Public PortalAbout8908 HERMOSA DR_Plumbing__ DEC
TION
WORKERS't I have
a certificate
cafe of corse APPLICATION FOR PLUMBING PERMIT {�
I hereby affirm that I have o certificate of consent to self 7pgy67A �J
insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy CNA
Certified copy is hereby fredif
hd
F FOR APPLICANT i0 FILL IN(PRINT OR TYPE) BUILDING p
Certified copy is filed wibui
nspec- ADDRESS 8 08 Hermosa Dr .
tion department. NUMBER FIXTURE OR ITEM C FEE LOCALITY
Temple Cit
Dale 8L ---L— pplico WATER CLOSET NEAREST
CERTIFICATE OF EXEMPOR RS' BATH TUB CROSS ST.
COMPENSATIO SHOWER OWNER Huber
(This section need not be comwork Involv by MAIL
the permit is for one hundred )or less.) . LAVATORY ADDRESS 8908 Hermosa Dr .
I certify-that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITYTemple City TEL. N0309-0323
so as to become subject to the Workers Compensation Laws. DISHWASHER
CONTRACTOR VerCO Plumbing, Inc .
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of 501 W. Maple #F
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITYTEL. NO.
Compensation provisions of the Labor Code, you must forth- Orange 771-7533
with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC.
deemed revoked. 1 WATER HEATER 6 .O 6 OO LICENSE NO. 484333 CLASS C36
LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY
I hereby off irm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) f Division 3 of the Business OUTLETS OVER
and Professions Code, and my Ii se is in full force and effect. 5 PER SYSTEM FINAL VA ATION
License N b r Li<. Class
C36 DATE 2 Z� O
Contra or to 8 21 87 BY U
❑ 0
1 xempt under S c.
B.8 . for this reason LU
Plan check fee p,
Date: PLUMBING PERMIT ISSUING FEE$ 10 , 50 Z
Signature
TOTAL FEE 16 50
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name �,�,� 6 A
I hereby affirm that I am exempt from the Contractor's License gddress
Low for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No. 'o o e e ..5
❑ I, as owner of the property, will do the work and the o.01 65,0
structure is not intended or offered for sale (Section 1 t
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for 'o(e q1 65,05
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.). 08,27,-87
Lender's Name
Lender's Address
I certify that I have read Ihi pplimtion and state that the ►
above iafor ion is correct. gree to comply with all County
ordinanc an Slate laws guloting Plumbing, and hereby
hart re esentotives this County to enter upon the
ab ve- a oned ropers for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
8/21/87
TO
of Permitte Date