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Home My Public Portal About10562 LIVE OAK AVE_Plumbing__ ION „WORKER'S I have a certificate of consent to 76A666DPW9/89 PPLL CATBON FOR PLUMBING PERMIT 76A667A L�9 - I hereby affirm that I have a certificate of consent to self insure, , or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) '.,,�,, f, awn COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No�Company��f�—' v , Certified copy is`hereby furnished /�� FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADD ESS 'QS COZ U V r 0A44 • UILDING ❑ Certrfie copy is fled with the county buildinginspection t ` NUMBER FIXTURE OR ITEM p FEE LOCALITY 1.r.►- �2 T Date Applicant WATER CLOSET NEAREST I 11 CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST , COMPENSATION INSURANCE \ ASSESSOR sSS co PAGE 1- PARCELSSOR Z� (This section need not be completed if the work Involved by the SHOWER permit is for one hundred dollars($100)or less.) , LAVATORY OWNERS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS become subject to the Workers'Compensation Laws DISWASHER CITY - TEL NO Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR DDRESS I 0 provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYT L NO } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER G. STATE LIC (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO S CLAS Professions Code,and my license is in full force and effect OUTLETS OVER DISTRICT NO C(� PROCESSED BY O 5 PER SYSTEM License Number ��0_q1Ic Class;J�_ �!K FINAL DATE VALIDATION a _ � Contractor r�.r/"✓"N r Date (n ❑ FINAL Z I am exempt under Sec BY B&P C for this reason • ,Plan check fee Signature Date PLUMBING PERMIT ISSUING FEE$ _ ❑ , TOTAL FEE SINGLE FAMILY Plan check applicant J HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law _— — for the following reason (Section 7031 5, Business and Professions Address Code) City (? Tel --�� 1 ITEM= F11, as owner of the property,will do the work and the structure s f ,-is not intended or offered for sale (Section 7044, Business - TOTAL'I t HL 41m85 and Professions Code) t;FiED; CONSTRUCTION LENDING AGENCY u t i I hereby affirm that there is a construction lending agency for the CHANGE ,til i performance of the work for which this permit is issued (Sec 3097, Civ C) Lender's Name 11 ,1 I t�M i;l I 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 regul/.,n Plum i g, and hereby authorize representatives of Cy to t r upon the a ove-mentioned property for ins c n pes SEE REVERSE FOR EXPLANATORY LANGUAGE 'S,Av6Ke df Permittee Date WORKER'S COMPENSATION DECLARATION _ 26DPW 9le9 76A6156A667A APPL�X66 �ATIO FOR PLUMBING PERMIT J ` I hereby affirm_that I have a certificate of consent to self insure, or-a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) , Policy No 3641-93 Company State Fund COUNTY OF LOS ANGELES DEPT.OFrPUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished BUILDING h ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) _ ADDRESS 10562 Live Oak Certified copy is filed with the county buildm ins ection department ABPP �,� NUMBER FIXTURE OR ITEM Q FEE '16/93 LOCALITY 3/ - Te _ Date Applicant Progress lye Plbg. WATER CLOSET - m le Cit �� CROSS ST Te Monte Ave. CERTIFICATE OF EXEMPTION FROM WORKERS' j BATH TUB COMPENSATION INSURANCE 1&0 ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK V" PAGE;�-4/-2— PARCEL/ permit is for one hundred dollars($100)or less.) LAVATORY OWNER Starts International Calif. Inc I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK �� ADDRESS 601 S. Figueroa St. #4650 become subject to the Workers'Compensation Laws DISWASHER / �,��7 CITYLos Angeles TEL NO Date Applicant CLOTHES WASHER v� CONTRACTOR NOTICE TOAPPLICANT�If, after making this Certificate of Pro ressive Plumbing Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 4257 Auction Ave. #F provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION 01TYBaldwin Park TEL NO WATER HEATER 962-2428 } I hereby affirm that I am licensed under provisions of Chapter 9 J B'� O STATE LIC (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS �� LICENSE NO 478794 CLASS C-36 U Professions Code,and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY 5 PER SYSTEM License Number 478794 Lic Class C-36 / Oa H ' D FINAL VALIDATION Pro ressive Plumb' 3/16/93 17-0 DATE /� Contractor g � l (n ❑ I am exempt under Sec � \ FINAL ZBY 5t= _ B&P C for this reason J Date Plan check fee ® a �f Signature PLUMBING PERMIT ISSUING FEE$ �� -7137 X10.65 ❑ TOTAL FEE SINGLE FAMILY Plan check applicant r 7 " TOTAL 3 J.0 ® 65 HOME OWNER-BUILDER DECLARATION Name CHECK L 1El 1 hereby affirm that 1 am exempt from the Contractor's License Law CHEF K for the following reason (Section 7031 5, Business and Professions Address Code) (HA WaE .00 ❑ City Tel No - 1, as owner of the property,wi/ll do the work and the structure is not intended or offered for sale (Section 7044, Business ® t� i f 1 %4_ �- and Professions Code) CONSTRUCTION LENDING AGENCY J 271: 1 AM :51 1 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 t 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 t is County to enter upon the above-mentioned property for insp on purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3/16/93 _ Sign lure o Permittee Date