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HomeMy Public PortalAbout10560 LIVE OAK AVE_Plumbing__ „ WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 7� IL11 I hereby affirm,that,I have a certificate of consent to self insure, 76A667A - APPLICATION FOR PLUMBING PERMIT ` or a cnrtifrcate of Worker's Compensation Insurance, or a certified Copy tnereof(Sec 3800 Lab C) Policy No 3641-93 ComState Fund COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS' DEPT—OF PUBLICNORKS DIV. Company G z ti ❑ Certified copy is hereby furnished / BUILDING © FOR APPLICANT TO FILL IN(PRINT OR TYPE) - ADDRESS 10560 Live Oak Certified copy is filed with the count buildm inspection ,department NUMBER FIXTURE OR ITEM Q ?FEE ABP IIC./ LOCALRY Temple City Date 3/16/93 Applicant PrOCJr44'1 Ve P1W. WATER CLOSET pv 1. NEAREST � J CROSS ST El Monte Ave. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR r— COMPENSATION INSURANCE- ” (This section need not be completed if the work involved by the ISHOWER MAP BOOK �,� PAGE PARCE�T/ permit is for one hundred dollars($100)or less.)" ' �y OWNER I certify that m the performance of the work for which this permit �y LAVATORY d0 Starts International Calif.1, Inc is issued, I shall not employ any person in any manner so as to SINKMAIL become subject to the Workers' Compensation Laws �() ADDRESS 601 S'. Figueroa St. #4650 j DISWASHER O CITY LOS An ales TEL NO-' 1 Date Applicant' �' - CLOTHES WASHER i NOTICE TO,APPLICANT If, after making this Certificate of Do CONTRACTOR. Pro ressive P1urubin -Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 4257 Auction Ave. #F provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY Baldwin Park, TEL N0962-2428 } 1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER- , d ` d (commencing with Section 7000) of Division 3 of the Business and STATE LIC r LICENSE NO 478794 CLASS C-36 0 GAS SYSTEM OUTLETS Professions Code, and my license is in full force and effect p 4� V DISTRICT NO' PROCESSED BY OUTLETS OVER p cc 5 PER SYSTEM License Number 478794 Lic Class C-36 . n FINAL + •1_7 J VALIDATION a �-J- p� Contractor,Progress 1.Ve P1bq.Da1e 3/16/93 DATE , ❑ I am exempt under Sec Fly AL C B&P C for this reason fiCC!e a' bate Plan check fee _ ® , 10e5 Signature PLUMBING PERMIT ISSUING-FEE$ i - �TE� _, TOTAL•FEE ` j,Q 'jy 5 - - TOTAL 3 Plan check applicant CHECK K SINGLE FAMILY - � � HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License'Law CHANGE, 0(I for the following reason (Section°7031 5, Business and Professions Address Code) " Clty ' _ ❑ I,as owner of the property,will do the work and the structure Tel No LIOI1V� i1 __3/17 is not intended or offered for sale(Section 7044, Business and Professions Code) ® 1718 1 AM tui51 CONSTRUCTION LENDING AGENCY I hereby,affirm that there is a construction lending agency for the l 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 j representatives of this County to enter upon the above-mentioned property f r I mspyg purposes SEE REVERSE'FOR EXPLANATORY LANGUAGE 3/16/93 - � • ' Sign re of ermittee Date WORKER'S COMPENSATION DECLARATION60U7ADPW 9/89 ���������®� ��� ��U����G ������ I hereby rm affithat I have a certificate of consent to self insure, � or a certificate of Worker's Compensation Insurance, or a certified ` s copy thereof(Sec 3800 Lab C) - + COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No !zz l`r Ll Company^'TArGE l'.11T M� t i ❑ _ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) _ r BUILDING ❑ Certified copy is filed with the county building inspection I ADDRESS (fl S COZY l..l v E flepa ent NUMBER FIXTURE OR ITEM @ FEE -\ LOCALITY Date Applicantb� -WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' -BATH ST P�� 0 1� BATH TUB COMPENSATION INSURANCE ASSESSOR z'IPL (This section need not be completed If the work SHOWER MAP BOOK � PAGE ARCE involved by the - permit is for one hundred dollars($100)or less.) OWNER <-T/41,r I certify that in\the performance of the work for which this permit LAVATORY 5I tt"C�.► is issued, I shall not employ any person in any manner-so as to SINK ADDRESS VAI SIOP become subject to the Workers'Compensation Laws I DISWASHER CITYTEL NO/L— Date Applicant r CLOTHES WASHER CONTRACTOR NOTIC TO APPLICANT If, after making this Certificate of '-'C�•_�, Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR \ provisions of the Labor Code, you must forthwith,comply with such ADDRESS provisions or this permit shall be deemed revoked r ' LAWN SPRINKLER SYSTEM +� LICENSED CONTRACTORS DECLARATIONWATER HEATER CITY l--��"�-Ay TEL NO � a I hereby affirm that I am licensed under provisions of'Chapter 9 STATE LIC0 (commencing with Section 7000)of Division 3 of the Business and ' GAS-SYSTEM OUTLETS 'LICENSE NO CLAS V Professions Code,and my license is in full force and effect i OUTLETS OVER DISTRICT NO PROCESSED BY —r Q 5 PER SYSTEM Q License Number Vy Lic Class L f V FINAL r� VALIDATION W ,yc.r— Cmf�!VT 2 DATE �1/ d Contractor Date fn ❑ I am exempt under Sec gy AL / Z i B&P C for this reason Po Date Plan check fee o. PLUMBING PERMIT,ISSUING FEE$ Signature ❑ TOTAL FEE SINGLE FAMILY Plan check applicant c • `• � HOME OWNER-BUILDER DECLARATIONName el_�r Ce fVS fit_•°.i av hereby affirm that I am exempt from the Contractor's License Law ^, �` 'r. for the following reason'(Section 7031 5, Business and Professions Address A` d IBJ c,_ u 33033 Code) ❑ City Tel No i ITEM EM I,as owner of the property,will do the work and the structureTOTAL '� 17 is not intended or offered for sale (Section 7044, Business 85 and Professions Code) ® 41 a a, CONSTRUCTION LENDING AGENCY CHANGE I hereby affirm that there is a construction lending agency for the / gill performance of the work for which this permit is issued (Sec 3097,- Civ C) Lender's Name 1067 1 AN 91-i I s Lender's Address 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 Plumbs nd hereby authorize representatives of �rposes�to on the above-mentioned property for in eco SEE REVERSE FOR EXPLANATORY LANGUAGE 91 J 1 re of Permittee I 1 ate