The URL can be used to link to this page

Home My Public Portal About8909 LAS TUNAS DR_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I•have a certificate of consent to self 76A667A ins ore, or a certificate of Workers' Compensation Insurance, CE 17 REV 10/81) or-a''certified copy thereof (Sec. 3800, Lab. C ) COUNTY OF LOS ANGELES !/ BUILDING AND SAFETY cy�^� Pollv`No.71-7238— r,Oany ._ Cer3i ied copy`'s hereby furnished- FOR FOR APPLICANT TO FILL IN PRINT OR TYPE BUILDING � e vp y,�, j. ( ) ADDRESS 8909 Las Tunas �ertuti,ed "copy isY eu�n7fk7i t�AA" �u TT c- tiori°de artinent. NUMBER FIXTURE OR ITEM �, FEE t p,•_". C - .,, LOCALITY �6�83 WATER CLOSET Datei_� Appligant' NEAREST -S;CERTIFICATE,OF EXEMPTIO' QNI WORKERS BATH TUB CROSS ST. Reno COMPENSATION INSURANCE. OWNER Home Savings & Loan F'• -• SHOWER '(T,his.sec'tion need not be completed if'-the work Involved by MAIL the,peYmit9s for one hundred-dollars ($100).'orloss.) LAVATORY ADDRESS. 8909 Las Tunas I certify that in the performance- of the work for which this permit-is issued, I shall riot employ any person'n any manner SINK CITY TEL. NO Temple City so as to•become subject to the Work p'' ensahon ws. DISHWASHER CONTRACTOR 01 Burcco Lawn rinkler Co. Date-9--06-83 App'hcant CLOTHES WASHER ADDRESS 18756 Erwin Stlreet. NOTICE'TO APPLICANT: If, after° king this Ce" lcate of SWIMMING POOL RECEPTOR Exemption, you should 'becom r'sOlijecY to- th Workers' 1. Compensation provisions.of the`•Lobor' ode,:,you'must forth- LAWN SPRINKLER SYSTEM CITY Reseda Calif 91335L. NO. 345-7603 with-,,comply with such provisions or this permit shall be �D STATE ort LIC LL deemed.revoked. WATER HEATER LICENSE NO. •,2465,99 CLASS Ci-61 LICENSED CONTRACTORS DECLARATION, DISTRICT NO,' ` PR ESSED IY OUTLETS I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM (commencing with Section'7000) of Division.3 of the Business OUTLETS OVER and Professjons Code,,and my license is in full force and effect 5 PER.SYSTEM FINAL ` /( VALIDATION O n1 DATE ! � V License Number 246590 Lic. Class G-Al 0C "Bureo Lawn-'Sprinkler E � . FINAL' � �� O Comirbctor'' Date — - BY V W n' El. !-am,exempt under Sec - d �U 7 H ' B.'&P,.C. for this reasonZ 'Plan check.fee_ _'� b 9 0 5A Date: v -PLUMBING PERMIT ISSUING FEE$ • • . • .'� Signature v TOTAL FEE z& Z • • 1 650 Plan check applicant SINGLE FAMILY • " • 1 6 F 0= HOME OWNER-BUILDER DECLARATION, Name I hereby affirm that I am exempt from the Contracto'r's License 1 1. 7-83 Law for'ihe following reason (Section 7031"5, Business and Address Prof essions.Code): City Tel. No. aj, as owner of the property, will do the work and the 'trucfure is not intended or -offered for sale (Section I .7044„Business and Professions Code). , �CONSTRUCTIO.N LEND I NGA'GENCY 3 I hereby-affilm th'ot'there' is a con'struEtion lending agency for the performance of the C•vork'.for wh''icF1 this permit is issued _ (Sec. kO—e;Civ.��C•): ; 5 i, Lender''s: lame, L+"ender's-Address- E' I.certifyttdt'I;have read this applicationi'and state,that the above'4ififormaiion 1s co[rect.'.I agree to'comply�yrth al'KCounty ordindnc's cind,State jaws regulating Plumbing, and`,he�eby a,ut r, representatives of this County' to enter upon the one'd,property for), ' nspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7i7 ` Signature ';,,e ittee` ate- ' WORKERS'COMPENSATION DECLARATION i ) APPLICATION FOR PLUMBING PERMIT I herebya CE $1 affirm that I have certificate of consent to self ce e�z z-eo insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) TM COUNTY OF LOS ANGELES f BUILDING AND SAFETY Policy No��■y"�pany {� / Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified copy is filed with the county ui ding inspection NUMBER FIXTURE OR ITEM • FEE part a t. s LOCALITY Tom.I Date Applicantf ! WATER CLOSET NEAREST BATH TUB CROSS ST. Pimad CERTIFICATE OF EXEMPTION FROM WORKERS' C COMPENSATION INSURANCE SHOWER OWNER Ho w- Savlap & Loan LAVATORY MAIL (This section need not be completed if the work involved ADDRESS J by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. LLI certify that in the performance of the work for which this DISHWASHER 148 "m3 an } permit is issued, I shall not employ any,•person in a y manner CONTRACTOR cc so as to become subject to the Workeii,CQ pp. ,tion Laws. CLOTHES WASHER ADDRESS 1C Date Applicant ' '18796 Endo Stre SWIMMING POOL RECEPTOR 0 NOTICE TO APPLICANT: If, after making thO'Certificate of CITY L.NO. l 913 Exemption, you should become subject tor' the Workers' LAWN SPRINKLER SYSTEM W STATE Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS ~ with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE effect. ^ t FINAL 246590 tr License Number Lic.Class -6l BY Contractor Buro 1 011' I am exempt from the licensing requirements as I am a Plan check fee f s_ licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address ' ��" License Law for the following reason (Section 7031.5, Busi- City Tel.No. ness and Professions Code): 1, as owner of the property, am exclusively contracting with licensed contractors to construct thero ect (Section 7044, Business and Professions Code). p I e s CONSTRUCTION LENDING AGENCY C I hereby affirm that there is a construction lending agency j for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name 'f Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all County ordinances and Sta le laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE authorize repre tatives of this County to enter upon the above mentio ed propert fohi Ipection purposes. ;f Sigr afore of Permittee Date I