HomeMy Public PortalAbout5812 MUSCATEL AVE_Plumbing__ ION
WORKER have PEpS(jTate of consent to 20-0028DPW 9/89 APPLICATION FOR PLUMBING PERMIT
75A667A
I hereb�.�fr,;,�<rthat II have a certificate of consent to self insure,
or a cs'Ificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.)
Policy No. Company 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 5-,5Certified copy is filed with the couA building inspection
de artment. It NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date '- Applicant F 7, WATER CLOSET �O
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERSCROSS ST Q/1_ _
COMPENSATION INSURANCE t BATH TUB ASSESSOR
(This section need not be completed if the work involved by the SHOWER , 50
MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or less.) OWNER
I certify that in the performance of the work for which this permit LAVATORY
Is issued, I shall not employ any person in any manner so as toSINK ADDRESS,ESS,/ 3) �. 4
become subject to the Workers'Compensation Laws.
DISWASHER CITY TEL.NO.41 y b!'
1r
Date Applicant CLOTHES WASHER150 CONTRACTOR nn
NOTICE TO APPLICANT: If, after making this Certificate of JD fqj, jg4ee, i
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM p�
LICENSED CONTRACTORS DECLARATION 1 CITY �I'i °YJZGt TE . O. �O
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER d
(commencing with Section 7000)of Division 3 of the Business and / GAS SYSTEM OUTLETS IL CET SE NO. Ol5� CLASS 3 (p Q
Professions Code,and my license is in full force and effect. It
r 5OUTLETS OVER _2 PER SYSTEM �Fl
ICT .PRO SSE BY Q
License Number a?�/`�j 757 Lic.Class — ~
FINAL ) V
y v DATE li1�A VALIDATION W
a
Nei
Contractor •—""°' , cc
❑ FINAL
I am exempt under Sec. BY
B.&P.C.for this reason
Date: Plan check fee
Signature PLUMBING PERMIT ISSUING FEE$ 4 v
❑ TOTAL FEE
SINGLE FAMILY Plan check applicant 5
HOME OWNER-BUILDER DECLARATION Name F$t I o a
I hereby affirm that I am exempt from the Contractor's License Law y
for the following reason(Section 7031.5, Business and Professions Address t ti).17 R0.51"
Code):
City Tel.No. 1 ITEMS'
❑ I,as owner of the property,will do the work and the structur �
is not intended or offered for sale(Section 7044, Business , r TOTAL o 0
l•�
and Professions Code). CK 80.51'"1
CONSTRUCTION LENDING AGENCY CHANGE J30
I 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.) 6/29/9[)
Lender's Name 1572 j AM 8:41
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
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE