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HomeMy Public PortalAbout9524 LIVE OAK AVE_Plumbing__ ION DECLARAT - WORKER'S I have a certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I heroby•affirn5'Shat 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.]0-04R960 Company CNA Tri__ ( Q_ COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS© Certified copy is filed with the county building inspection .952A Live '0 lc Avenue department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple City Date 2-21-92 Applicar©wen Broin Plumbin, WATER CLOSET 91) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. 3 BATH TUB 3 6 ASSESSOR x i COMPENSATION INSURANCE (This section need not be completed if the work involved by the I SHOWER 14' 55 MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) 6 LAVATORY 87 30 OWNER Jlm Marshall I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toMAIL become subject to the Workers'Compensation Laws. 1 SINK .14155 ADDRESS 1. DISWASHER 14 .55 CITY Arcadia TEL N6.:3'55-:8569 Date ApplicantCLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of 1 CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTORs provisions of the Labor Code, you must forthwith comply with such ADDRESS . 4265 N.. Baldwin Avenue provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY El Monte TEL.NO. 443-0078 �• I hereby affirm that I am licensed under provisions of Chapter 9 1 WATER HEATER 14 55 (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Professions Code,and my license is in full force and effect. 1 GAS SYSTEM 7 OUTLETS 22 .121. LICENSE NO. CLASS — Q-1 6 0 OUTLETS OVER DISTRI i NO. P50.CESSED BY 5 PER SYSTEM v _ 231 741 3 Hose bibbs 43 65 v License Number Lic.Class C36-20-16 FINAL VALIDATION 1 ,p, Contractor Owen Bros. Plmb. Date 2- Laundry .tray 14 55 DATE 21-92 �� ❑ .._.. r'�'= F- I am exempt under Sec. FINALBY e B.BP.C.for this reason Plan check fee Date: Signature PLUMBING PERMIT ISSUING FEE$ .2 4• 75 OTAL FEE -367 06 El T Plan check applicant SINGLE FAMILY 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. No. y Y I,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 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 ordinances and State laws regulating Plumbing, and hereby authorize re a ntatives of this County to enter upon the above-mentioned pro rty f inspection purpo 2-21-92 SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature of Permittee Date