HomeMy Public PortalAbout6380 OAK AVE_Plumbing__ LvSRirm that
I have ATION DECLARATION 7 E 817 ) APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a' certificate of consent to self ce e+�(z-ao
insure,or a certificate of Workers'Compensation Insurance,or — 2
a certified copy
7thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
PolicyNo377630 CompanyState Fund
ID Certified copy is hereby furnished. TM;BE
R APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS
ZI Certified copy is filed with the county building inspection
fN FIXTURE OR ITEM � FEELOCALITYTem le Cit Califo .nia
Date plicantTruman Solis PlbgvWATER CLOSET
NEAREST
BATH TUB I� CROSS ST. 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWERMAIL
L` OWNER / �/n1_ '
(This section need not be completed if the work involved LAVATORY ADDRESS (V S /�D ' CL
by the permit is for one hundred dollars ($100) or less.) ItSINK 7L O
Temple Cit oCao . .286.945
v
I certify that in the performance of the work for which this DISHWASHER M
permit is issued, I shall not employ any person in any manner CONTRACTORTruy(lan SO11S Plb a Ince O
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS (~j
Date Applicant SWIMMING POOL RECEPTOR 26b Gln Avenue W
NOTICE TO APPLICANT: If, aftermaking this Certificate of CITYAltadena' CalifoTEL.NO.794-105 rLrL
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. 3.2400 CLASS C® 6
with comply with such provisions or this permit shall be '�
deemed revoked. DISTRICT NO PR ESSE'f)B
GAS SYSTEM —3 OUTLETS f�
LICENSED CONTRACTORS DECLARATION OUTLETS OVER 6-
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL 7 P �. VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect. ,
License Number 312400 Lic.Class- C-36 B1NAL
ContractorTruman SOligate 12_21°81
l
F1 I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code).
TOTAL FEE _4A
,J
Lic,or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address -4—
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code): c cy
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project
(Section 7044,Business and Professions Code). _
CONSTRUCTION LENDING AGENCY
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.). None
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
ab/ mentioned property for in ection purposes. Qr
Signature of Permittee Date