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Home My Public Portal About10556 LIVE OAK AVE_Plumbing__ WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 76A364C �I APP��CAT�®r�n ®'R PER��t A 61 U I herefiy affirm that I have a,certificate of consent to self Insure,••,' UE ora certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING -AIR CONDITIONING copy_thereof(Sec 3800 La N wrc Policy No ompany' `' COUNTY OF LOS ANGELES 1 DEPT,OFI PUBLIC WORKS BUILDING AND.SAFETY DIV. ❑ Certified copy is hereby furnished 4 FOR APPLICANT TO BUILDIN < Certified copy Is filed with the county budding Inspection FILL IN ADDRESS' .depart n C. Q� ��{./� ��{� (PRINT OR TYPE ONLY) Date Applicant 'C'�+'�I5"r-'7 '-__ LOCALITY �yP L L' / T NO TYPE•OF APPLIANCE OR EQUIPMENT FEE " NEAREST,• 'CERTIFICATE OF EXEMPTION FROM WORKERS' } COMPENSATION INSURANCE r" CROSS ST �L. - _ � ABSORPTION UNIT,BTU •`'6 � ASSESSOR,' - (This section,need not be completed hf the work Involved by the MAP.BOOK' PAGE PARCEL ' ermit.Is for one hundred dollars $100 or less. r P. (, ) ) AIR HANDLING UNIT;CFM a - > - DISTRICT NO PROCESSED BY , (,'cert fy that iii�the'performance of the work for which this permit " is,issued, I shall not'employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws - COMPRESSOR„BTU j APPROVALS' DATE INSPECTOR'S SIGNATURE , Date' Applicant-' VENTILATION SYSTEM NOTICE TO APPLICANT If; after,.making this'Certificate of ROUGH L Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER 59, provisions 16f the*Labor Code, you must forthwith comply with such FINAL' ' provisions or this permit shall be deemed redoked I 9 FURNACE” " ' FAU' LICENSED CONTRACTORS DECLARATION. v ` FLOOR BT os` VALIDATION ,j.hereby,affirm that I-am licensed under,provisions of Chapter 9 HEATER SUSPENDED UNIT ;(commencing with:Section'7000pof�Drvision 3 of the Business and WALL Professions,Code,"and,my license is inrfull force and'effect .'��-O �QO �/✓LE �! 4%d�/T L d "Hi:i Tea License Nuinlier Lic Class Contractor ' C Date '$ T L`�f{L 3 ami ''®' V ❑' 'Plan check fee , _ t am exempt under Sec w } B'&P C for this reason PERMIT ISSUING FEE'$ CHECK . . 18 .6-51 0 �.: CHANGE Date ■j11 UOTTALFEE � Signature „ • �;. ;f (A PLAN,CH ECK,APPLICANT OWNER-BUILDER DECLARATION �- :0001,j=000 j 6 I hereby affirm that I am exempt,from the Contractor's License Law, NAME�i V`' 4 tt�s i �t,t - for the following reason (Section 7031.5, Business and Professioris /�C' �S ,g�1/lC,�• "' �� D'r +.023 1 AM ]�M- '. ❑Code) ADDRESS%¢' �j'Q't l:.•6!- ,C.od^-'" -^�O�•,. , 1,as owner of the property, or my employees with wages as their sole compensation, will do the work and,the CITY,,4AA&w, TEL,NOS715:1,—->7 structure'is not.intended or'offered for sale (Section 7044, " `'Business and Professions Code) OWNER ��► f+ /�`Tt,b�� ^/p��J_ ❑ I„as owner of the property, am exclusively contracting, MAIL ADDRESS.�/ ,with licensed contractors to construct the project (Sec-Dr. t9 'tion 7044, Business and Professions Code) - , - CONSTRUCTION LENDING AGENCY TEL I hereby affirm that there Is a construction'lending agency for the performance of the work for which this.permit is Issued CONTRACTOR /� L�,�p /C � /'�-, (Sec-3097,Civ C_) _ l—�9 ��S /G �C� D• ' • ADDRESS` A 174,'' Lender's Name ,�•-- CITY �•QCiA7�//� (,TEL NO Lender's Address r wa STATE LIC'' = • 'I certify that I have read this application antl state that the above LICENSE NO 3 . Q CLASS C X0 ='information Is correct I agree to comply with all County ordinances ,l and State law el ng to building construction,and hereby authorize { representati this Cou y to enter upon.the above-mentioned property f tion pu oses SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR GENT - DTE •� WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 3 I hereby affirm gist I have a-certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PEF4WT or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) Policy No 3641-93 State Fund COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS ; ;DEPT.OF PUBLIC WORKS DIV. Company Certified copy is hereby furnished /—�— BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 10556 Live Oak Certified copy is filed with the count buildin insp tion department \ ABP IIV�, NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date 3/16/93 Applicant Progressive Plbq. WATER CLOSET Temple City _ J r, NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST El Monte Ave. COMPENSATION INSURANCE �� ASSESSOR p" f �/ (This section need not be completed if the work involved by'the SHOWER / 49-0 MAP BOOK .� (J C—' , PAGE�� PARG�C� permit is for one hundred dollars($100)or less) OWNER I certify that in the performance of the work for which this permit LAVATORY C Starts International Calif. Inc. SINK p p ADDRESS601 S. Figueroa St. #4650 is issued, I shall not employ any person in any manner so as to MAIL ' become subject to the Workers' Compensation Laws DISWASHER �-D CITY TEL NO Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of fJD CONTRACTOR-Progressive Plumbing Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 4257 Auction'Ave. #F provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CI TEL NO 962-2428 I hereby affirm that I am licensed under provisions of Chapter 9 ' WATER HEATER B� "'Baldwin Park STATE LIC (L (commencing with Section 7000) of Division 3 of the Business andGAS SYSTEM OUTLETS LICENSE NO 478794 CLASS C-36 0 Professions Code,and my license is in full force and effect �t7 5 OUTLETS OVER DISTRICT NO PROCESSED BY I 5 PER SYSTEM License Number 478794 Lic Class C-36 �� U 1 FINAL VALIDATION W Progressive Plbq. 3/16/93 � 00 DATE a. Contractor Date cc ❑ I am exempt under Sec BY AL B&P C for this reason 'Date Plan check fee - PLUMBING PERMIT ISSUING FEE$ Signature y� ❑ TOTAL FEE SINGLE FAMILY Plan check applicant 5 " HOME OWNER-BUILDER DECLARATION Name T I hereby affirm that I am exempt from the Contractor's License Law A��•i og for the following reason (Section 7031 5, Business and Professions Address 3� Code) J]LJ71___325.65f ❑ 1 I, as owner of the property,will do the work and the structure City Tel No ITEM is not intended or offered for sale (Section 7044, Business TOTAL 13-525 5 and Professions Code) ® C CONSTRUCTION LENDING AGENCY 'HECK •.1 5.i,5 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, CHANGE .011 Civ C) Lender's Name 00713—IX01 3/17/9-1 Lender's Address ' 8716 1 Art 8:511 1 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 inspe n purposes SEeREVERSE FOR EXPLANATORY LANGUAGE 3/16/93 Sig ature 01 Permittee Date I WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 I he affirm that I have a certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PERMIT u or a certificate of Worker's Compensation Insurance, or a certified ` - copy thereof(Sec 3800 Lab C) 1L,N� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. , Policy No �ZCompany ��E ., - - - • Certified copy is hereby furnished i - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county budding inspection ADDRESS i [p U VIE O/�1¢. department - NUMBER FIXTURE OR ITEM FEE - q k LOCALITY �� UZZ L Date ,��L-1_ ` Applicant Te � N WATER CLOSET NEAREST , yy _. CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST FP�= BATH TUB COMPENSATION INSURANCE, ASSESSOR (This section need not be completed it the work involved by the SHOWER MAP BOOK SS I PAGE 1L— PARCEL21 permit Is for,one,hundred dollars($100)or less.) l OWNER I certify that m the performance of the work for which this permit LAVATORY TS INrT` 0QV is issued, I shall not employ any person in any manner so as to _ SINK MAIL become subject to the Workers'Compensation Laws ADDRESS g� yVlt�S . oti DISWASHER ,- CITY �STEE NO NO Date ` Applicant CLOTHES WASHER O CONTRACTOR NOTICE TO APPLICANT If, after making this Certificate of :rte __Vr Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such DDRESS (�a 1 Stt � provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY 4WNV. �� d � TEL NO's d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATEA q(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO �� 1� p CLASS t7 O Professions Code, and my license is in full force and effect -VER DISTRICT NO PROCESSED BY 0 OUTLETS PEREYSOTEM Q License Number Lic Class FINAL ^N, /� VALIDATION W Contractor Ttick'T -�OH� 'rJ - DATE y— 6 .. U) CR+ Date 1 ElI am exempt under Sec FFY AL i Z B&P C for this reason Date Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ ) ❑ TOTAL FEE J SINGLE FAMILY Plan check applicant-'r ' v ,HOMEOWNER-BUILDER DECLARATION Names ti+11`l_ i_�.E °s I hereby affirm'that I am exempt from the Contractor's License Law for the following reason (Section-7031 5, Business and Professions Address �� G� f L 10-70 ` , 73l13 Code) t ❑ 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 TOTAL TAL 4- ® 11;315 and Professions Code) ? {{ ® CHU-�l �1 s 65CONSTRUCTION LENDING AGENCY t i I hereby affirm that there is a construction lending agency for the CHANGE performance of the work for which this permit is issued (Sec 3097, Civ C) Lender's Name f069 1. Ali 9:D,", 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 I ws regulating PI bang, and hereby authorize �^ rap res s f th County nter upon the above-mentioned pr rt i rp 7 SEE REVERSE FOR EXPLANATORY LANGUAGE - 7 ' Signature of Permittee Date , _