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Home My Public Portal About10552 LIVE OAK AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPMCAMNt FDR PL U M1MIG PONT I hjareby affirm that I- have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Policy No 3641-93 Company State Fund Certified,copy is hereby Jurnished /— —55T ~ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING t " aCertified copy is filed with the county building inspec- ADDRESS 10552'1 'Live Oak ' tion department 'ABPP NL C./ NUMBER FIXTURE OR ITEM (q FEE LOCALITY 3/16/93 Progressive Pl WATER CLOSET Temple City Date Appli4ant � �' •� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST El Monte Ave. COMPENSATION INSURANCEOWNER (This section need not be completed if the work involved by SHOWER .� Z7 d Starts International Cali ..Inc. the permit is for one hundred dollars $100 or less. dO MAIL p ( ) ) LAVATORY ADDRESS 601 S. F1 ue OaV St #4650 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK &_0 CITY Los Angeles TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER S Q O CONTRACTOR Progressive Plumbing Date Applicant CLOTHES WASHER / ADDRESS NOTICE TO APPLICANT- If, after making this Certificate of 4257 Auction Ave. #F Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR — Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Baldwin Pa TEL NO(818� 8 with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO 478794 CLASS C-36 LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER D and Professions Code,and my license is to full force and effect 5 PER SYSTEM FINALD TION License Number 478794 Lic Class C-36 / o-o DATE g_,7_� WA, 4 0, 15O P-0 FINAL x-17 325.65� ContractorDot,pate �1 6/93 BY O. ❑ I am exempt under Sec. 1 T��` Dare: W BAP C. for this reason S fD_ Plan check fee D va TOTAL �32 m�--5 Z . � PLUMBING PERMIT ISSUING FEE$ CHEF.'( 25°65 Signature - � ..rt•J TOTAL FEE CHAWK ° Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License d� �-0001 5/1771`' Law for the following reason (Section 7031 5, Business and Address 871` 1 �� Professions Code)- City Tel No ❑ 1, 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 I above information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorizerepre tatives of this County to enter upon the ob -menti d property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3/16/93 Sig oture o ertee Date WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 -- T hereby affirm that I have a certificate of consent to self*m76A667A APPLICATION FOR PLUMBING PERMITsure, ' or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab'C) y P �IL!. �'f Com any�a;rAcCE r r+D COUNTY OF LOS ANGELES DEPT.'OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. �cY No Certified copyT is hereby furnished ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) , UILDING ADDRESS IDrj�j 'Lr �,tVsG Certified copy is filed with the county budding inspection departmenntt, NUMBER FIXTURE OR ITEM @ FEE LOCALITY Data 1 '��/ Applicant 1120'97000Y WATER CLOSET UZ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' J CROSS ST BATH TUB L COMPENSATION INSURANCE _ ASSESSOR �+ (This section need not be completed if the work inLolved by the SHOWER MAP BOOK 85d&40 PAGE 2 ,PARCEL 7.. permit is for one hundred dollars'($100)or less) OWNER <'r,64iX'S t�IZL r;rV. 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 to MAIL 1 become subject to the Workers'Compensation Laws SINK ADDRESS $ 1 S S 10 fJ DISWASHER CITY TEL NO 5_,)J Date Applicant ` CLOTHES WASHER NOTICE TO APPLICANT' If, after making this Certificate of CONTRACTOR y_,r Exemption,you should become subject to the Workers'Compensation ! SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS VVtLA�,S VC+, 0 provisions or this permit shall be deemed revoked I LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY Fs —S� TEL NO JA( I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATERSTATE'W 4LIC d (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO �1 t7 t CLASS �V Professions Code, and my license is in full force and effect OUTLETS OVER DISTRICT NO �� PROCESSED BY a:5 PER SYSTEM Q License Number 7 ` Lic Class FINAL DATE VALIDATION W Contractor'S@k�ON Date 1 —1 N ❑ I am exempt under Sec F FINAL Z B&P C for this reason Plan check fee _ Date .. Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check applicant SINGLE FAMILY •T a HOME OWNER-BUILDER DECLARATION Name WNT.a I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Professions Address JJ0-J -,e 'A-4 Code) Clty �t4�P f G AA � Tel No �LA� % i f Ea El1,as owner of the property,will do the work and the structure _ '�� ''�•—� is not intended or offered for sale (Section 7044, Business I'�-_t m 8 and Professions Code) ® CHUCKt t CONSTRUCTION LENDING AGENCY lHArI uj(11 I hereby affirm,that there is a construction lending agency for the 1 l performance of the work for which this permit is issued (Sec 3097, - Civ C) �- UE i�1_i-113001 ?F � JiI Lender'!Name 1070 1 Lender's Address i I certify that I have read this application and state that the above information is correct I a e to co I with all County ordinances and State laws I ng Plu bi g, and hereby authorize representative f 1 0unty t o r upon the above-mentioned propert s ti r oses SEE REVERSE FOR EXPLANATORY LANGUAGE �� r gnature of Permittee Date