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Home My Public Portal About10548 LIVE OAK AVE_Plumbing__ WORKER'S COMPENSATION DECLARATION 200026 DPW 9/69 /i,�d��a��®� ®�9 ��t�lA1l9�I1�� B—��"1BtlB�� r 76A667A I hereby affirm that I have a certificate of consent to,self insure, A I� �!/ -, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab' C) i Policy No I'LL-3��-9 Company ST/ut� RUn►D COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Certified copy is hereby furnished / ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS O l..jl p L Certified copy is filed with the county building inspection department NUMBER FIXTURE OR ITEM @ FEE 3 LOCALITY ?�11h � GI Y Date 1 Applicant WATER ek�N WATER CLOSET NEAREST ` CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST Pal. � COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER , MAP BOOK -05.6co PAGE I i PARCEL 7 2,L permit is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS 1BOaC)I5 ^ISSIZf f Y>tL become subject to the Workers' Compensation Laws DISWASHER CITY TEL NO 8 Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT If, after making this Certificate of Terc" riOt4ion, Exemption,you should become subject to the Workers'Compensation x- ation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 1 tCr-A s. SAN Ls p g(tACL. provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION'' CITY C � d�� TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER Q„ (commencing with Section 7000) of Division 3 of the Business and STATE LIC 0 Professions Code,and my license is in full force and effect _ GAS SYSTEM OUTLETS LICENSE NO �j`(09-1 CLASS U DISTRICT NO PROCESSED BY OUTLETS OVER Q 5 PER SYSTEM �O O License Number ��'1 t7g�� Lic Class a FINAL �_ VALIDATION a DATE ContractorT XZ o N C,0 art S-f, Date 1°�7—�3 EJI am exempt under Sec BY AL z B&P C for this reason Date Plan check fee \ Signature PLUMBING PERMIT ISSUING FEE$ 0 i � , ❑ TOTAL FEE SINGLE FAMILY Plan check applicant p N 60 M ST y �- � ACCT HOME OWNER-BUILDER DECLARATION Name H!�'' °s I hereby affirm that I am exempt from the Contractor's License Law 2� .4 [kms _ for the following reason (Section 7031 5, Business and Professions Address, ha =' C2, 41°-15 Code) iTEN r_1 - City Tel No I,as owner of the property,will do the work and the structure 1_TAA 4 85 is not intended or offered for sale (Section 7044, Business !I t —� and Professions Code) ® CHECK 41 55 CONSTRUCTION LENDING AGENCY {:H1=1 31 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 1072 1 Ail r. ! ti °!E2 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 PIP and State laws regulating Plumbing, and hereby authorize represent es of this County toe a upon the above-mentioned m cti p rpo es SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date gig ® PLUMBING p p apy® WORKER'S COMPENSATION DECLARATION 766667 DPW 9/89 APPLICATION PPL IC�p TION FOR Ir I�IL�YFI BIND PERMIT,, '7666676' d°iC L i� I hereoy affirm that I have a certificate of consent to self insure,qr a certificate of Worker's Compensation Insurance, or a certified , i copy thereof(Sec 3800 Lab C) i' 364193 State Fund COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No - Company Cenihed copy is hereby furnished r s, ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the count buildin insp coon ADDRESS 10548 Live Oak department ABP I C. NUMBER FIXTURE OR-ITEM ® FEE LOCALITY Temple City Date 3/16/93 Applicant Progressive Plbg• 7 WATER CLOSET �� J NEAREST El Monte Ave.,. , CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK �.l O,rw .• PAGE��pa PARCEt permit is for one hundred dollars($100)or less.) OWNER Starts International Calif.Inc. I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ'any person in any manner so as toSINK MAIL become subject,to the Workers'Compensation Laws - / bt7 ADDRESS 601 S. Figueroa St. #4650 DISWASHER CITYLos Angeles TEL NO Date Applicant CLOTHES WASHER B-0 CONTRACTOR NOTICE TO APPLICANT If, after making this Certificate of Progressive Plumbing Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labof Code, you must forthwith comply with such ADDRESS 5257 Auction Ave. #F provisions or this permit shall be deemed,revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION cn`yBaldwin Park TEL No 962-2428 0 I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER � O STATE LIC (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS dv LICENSE NO 478794 CLASS C-36 0 Professions Code,and my license is in full force and effect OUTLETS OVER � _ DISTRICT NO PROCESSED BY cc 5 PER SYSTEM Q License Number 478794 Lic Class' C-36 FINAL VALIDATION LU r ressive Plbg. Data 3-16-93 pp DATE �' a. ContractorP i \ AL . --,3137 ■L:i Z r_1I am exempt under Sec BY 1 ITEMS 1� B&P C for this reason Date Plan check fee TOTAL 310 ® 65 �® -, c PLUMBING PERMIT ISSUING FEE$ .�E_� Signature CHECK :r10.h•: El Signature FEE v CHANGE HANGE SINGLE FAMILY ■IlIJ Plan check applicant \I�G _ HOME OWNER-BUILDER DECLARATION Name i D I hereby affirm that I am exempt from the Contractor's License Law C0030-0001 1/17/9~ for the following,reason (Section 7031 5, Business and Professions Address Code) 8871,E ) 1 (N 8:49 ❑ City Tel No I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code) 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 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 State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspectio urposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3/16/93 Signat a of Per ittee Date