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Home My Public Portal About8916 LONGDEN AVE_Plumbing__ WORKER$'COMPENSATION DECLARATION APPUCAMN FOR PLUMBING PERMT I hereby,affirm that I have Q. certificate of consent to self. 20-0026 DPW 6/87 inVure, or a certificate of Workers' Compensation Insurance, 76A667A 3 or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS • Policy No Company— Certified omonY Certified copy is hereby furnished BUILDING q ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �/I�/e h' T Certified copy is filed with the county uilding inspec- tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date ld 6 Applica WATER CLOSET v7? NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' —yd2 7 BATH TUB CROSS ST COMPENSATION INSURANCE , SHOWER �-� OWNER S (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY jp ADDRESS 467 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYTEL NO 2•r5'� so as.to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR QY•�S Date Applicant CLOTHES WASHER _ ADDRESS 6 NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY �cua TEL NO f1G�j�-2�3 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE F. ♦� ` LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION ,yDISTRICT NO PR SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 3 OUTLETS rSC./) , `O f (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER D and Professions Code,and m license is in full force and effect 5 PER SYSTEM Y FINAL VALIDATION a� License Number Lac Class DATE� � �� /,, �/� FINAL Contractor �ZsDate��J; ' BY Q ❑ 0 I am exempt under Sec W B&P C for this reason 0-1 Plan check fee DU) Date Z PLUMBING PERMIT ISSUING FEE$ �3 Signature TOTAL FEE 7 �� Plan check applicant c SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name AC•`T e i I hereby affirm that I am exempt from the Contractor's License Address 1r �i) Law for the following reason (Section 7031 5, Business and �� ••- Professions Code) City Tel No - • I ITEMS ❑ 1, as owner of the property, will do the work and the _, structure is not intended or offered for sale (Section D Ti+TAL .,=1 7,= 7044, Business and Professions Code) C{ - ECK 137 a_a1€ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE x1.111 the performance of the work for which this permit is issued (Sec 3097, Civ C ) 01300-00131 10i15/913 Lender's Name iJ 9 1 AN11'411 Lender's Address I certify that I have read this application and state that the D above information is correct I agree to comply with all County ordinances and State laws,regulating Plumbing, and hereby authorize representatives of thi ounty to enter upon the ab ntione pro ty f pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION /nl I�(�g UC/a 1'��la,(l FOR P (I ()(a!1 0 MIG f72fo7(,d T I hereby affirm that I have,a certificate of consent to self 20-0026 DPW 6/87 G�11�a /ry u u V FOR I!" ILVIIVU 11VV Il"L�U�S111711 insure, or a certificate of Workers`Compensation Insurance, 76A667A or a certified ccoopyy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No,ri✓a _ff pony� �J Certified copy is hereby furnished ❑� FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS Certified copy is filed with the count building inspec- ' tion department NUMBER FIXTURE OR ITEM @ FEE ) � LOCALITY Date �d S^^�7lpplica WATER CLOSET o� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' Z BATH TUB CROSS ST 141 COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS Al. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY n— O TEL NO<4-/9-2 i��2��/ so as to become subject to the Workers'Compensation Laws <4 / Com[ - Jv DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- _ CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be O STATE /� ��p LIC deemed revoked WATER HEATER LICENSE NO J AlT DCLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PR ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 3 OUTLETS 0-122 �y (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER O ��... and Professions Code,,and my licensee is in full force and effect 5 PER SYSTEM FINAL VALIDATION _Selp: License Number — g3s^d Lic Class ' �a DATE Z U• / Q y�Q FINAL Contractor cA-q 6e —mate -I/ BY X ❑ 0' I am exempt under Sec V B&P C for this reason LLL Plan check fee CO Date ly z' PLUMBING PERMIT ISSUING FEE$ Signature TOTAL_FEE SINGLE FAMILY Plan check applicant =� f ITEMS HOME OWNER-BUILDER DECLARATION Name 1Z37 ® 50 1 hereby affirm that I am exempt from the Contractor's License 7 Low for the following reason (Section 7031 5, Business and Address F I'i IF Professions Code) City Tel No' k, 5 - C;"GE ;,., eOi ❑ 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) �V 0000_00 i� 10/.15/90 CONSTRUCTION LENDING AGENCY _7 1 j �lii�4l7 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 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 e ordinances and State jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-ment)pned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE /d -s—Pb Signature of Permittee Date =gyp , pp WORKERS COMPENSATION DECLARATION 20-0026 DPW 9/89 p P®p BIS g TT ON FOR PLUMBING PERMIT 76A667A bkil fr•Av �16� I hereby affirm that I have a certifioate of corisent to self insure, f or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) + y �� 'Jr7-f p y�� COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Polic No Com an Certdied copy is hereby furnished BUILDING ❑ - - FOR APPLICANT.TO FILL IN(PRINT OR TYPE) ADDRESS -16,6 'Certified copy is filed with the county budding inspection department NUMBER FIXTURE OR ITEM FEE _ _ LOCALITY Date l V 9�Applica WATER CLOSET �a Q NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS'�~ CROSS ST COMPENSATION INSURANCE Z BATHTUB / ✓ MAPBOOKL PAGE Q�� PARCEL fL (This section need not be completed,If the work involved by the SHOWER permit Is for one hundred dollars($100)or less) n �D OWNER LAVATORY I certify that in the performance of the work for which this-permit A MAIL is issued, I shall not employ any person in any manner so as to SINK become subject to the Workers' Compensation Laws ADDRESS �-• / DISWASHER D CITY- t TEL NO' Date Applicant / CLOTHES WASHER CONTRACTOR } - 6t/041_,.f NOTICE,TO APPLICANT If, after making'this Certificate of �C VV Exemption,you should,become subject to`the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS SA S 4S Q/bo�_e provisions or this permit shall be deemed revoked -i„ , LAWN SPRINKLER SYSTEM O LICENSED CONTRACTORS DECLARATION / CITY TEL NO a I hereby,affirm that I am licensed under provisions of Chapter 9' WATER HEATER `, Q (commencing with Section 7000) of Division 3 of the Business'and GAS SYSTEM -3' OUTLETS LICENSE NO (4.DJ� CLASS LIC ` O =Professions Code,and my license is in full force and effect DISTRICT NO PRO ESSED BY Q OUTLETS OVER O _ 5 PER SYSTEM License Number <L Lic Class FINAL Z VALIDATION C'�ta-r WLU 7) _ DATE �j Contractor s --V-Dat.• to ElI am exempt under Sec BY AL r Z B&P C for this reason Plan check fee Date ' Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE 3=y JT SINGLE FAMILY Plan check applicant L / 1 HOME OWNER-BUILDER DECLARATION "Name Eit•�•I o s ' I hereby affirm that I am exempt from the Contractor's License Law i - for the following reason (Section 7031 5, Business and Professions Address .^�=°� X73 °1{ Code) t r 1 C v,* ` . City Tel No �C I,as owner of the property,will do the work and the structure F. f is not intended or offered for sale (Section 7044, Business , • �• I I HL• _- ��` �-'' ® — 0 and Professions Code) - ® J CHEf.K i CONSTRUCTION LENDING AGENCY Y c.HA14.,E n03 I hereby affirm that there is a construction lending agency for the f- performance of the work for which this permit is issued (Sec 3097, Civ C) ' 0000-000 1 10/1,5./% Lender's Name - ,?'t t i,!0 1 AM 11:'f!•1 J t7t a 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 propert for i pectin purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Ga