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Home My Public Portal About9933 OLIVE ST_Plumbing__ • -WORKERS'irmth ;COMP a certificate DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,-affirm that I have a certificate of consent to self in- �'�6 DPW 4/90 sure,or q certificate of Workers'Compensation Insurance,ora 76A667A certified copy therepf(Sec. 3800, Lab. C.) �, yIL JII Policy No, 33901 1-OQ:ompany Golden EaJZle COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS 9933 Olive department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY emple City DcIte Applicant WATER CLOSET(TOILET) :Iap 1;?b NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 3CROSS sT. Baldwin COMPENSATION INSURANCESHOWER y OWNER Owen Construction , QV (This section need not be completed if the work involved by ^ MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 4275 N. Baldwin Ave. I certify that in the performance of the work for which this per- SINK CITY E1 monte TEL. No.350-0345 mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER / CONTRACTOR Owen Bros. Plumbing, Inc. Date. Applicant CLOTHES WASHER 6 ADDRESS 4265 N. Baldwin Ave. NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITY E1 Monate TEL.N0.443-0078 ly with such provisions or this permit shall be deemed revok- STATE 231-741 LIC. C36-20-16 ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS /�O 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE >.License Number Lic. Class 231-741 C36-20-16 ��o a FINAL D C Contractor Owen Bros. Pluml�i,r�>; 9/30-97. BY y v Q I am exempt under Sec. H V B.BP.C. for this reason Plan check fee W ► a Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 5SINGLE FAMILY s HOME OWNER-BUILDER DECLARATION Plan check applicant AOGTA I hereby affirm that I am exempt from the Contractor's License Name 3303 289.10 Law for the following reason (Section 7031.5, Business and Professions Code): Address 1 ITEMS ❑ I, as owner of the property, will do the work and the City Tel. No. TOTAL 289 o 10 structure is not intended or offered for sale(Section 7044, O''EO09 e 10 Business and Professions Code). CONSTRUCTION LENDING AGENCY ► CHANGE .00 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.). 0000-0001 2/15/96 Lender's Name 4877 1 AMID"-31 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-m ioned property for inspection purposes. ,C / SEE REVERSE FOR EXPLANATORY LANGUAGE Sign e of Permittee at t WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hg'reby, affirm that I have a certificate of consent to self in- 20-0026 76A667A �4/90sure,ora certificate of Workers'Compensation Insurance,ora ce,040"" gqp (Sec. 3800, Lab. C Policy No—'l-W-174 Compan �4- � COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. BUILDING Certified copy is filed with the county building inspection FOR APPLICANT 70 FILL IN(PRINT OR TYPE) ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY i f WATER CLOSET(TOILET) G� Ddte — "� ApplicanteF �`' l _ �/ NEAREST CERTIFICATE OF EXEMPTIORKERS' BATH TUB CROSS S7. COMPENSATION I SHOWER OWNER L%firZ"✓Jv s% ' ' (This section need not be complerk involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER :::Ys �j c1 CONTRACTOR ��. 1110 t•1 Date rr `� ` Applicant T�`� CLOTHES WASHER / NOTICE TO APPLICANT: If, after making this Certikc ' x� ADDRESS tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR em P Y I P CITY J VSA p-qA. L. NO.'Ay�' Ift sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ` t ly with such provisions or this permit shall be deemed revok- STATE Gt LIC. I ed. WATER HEATER LICENSE NO. t CLASS LICENSED CONTRACTORS DECLARATION DISTRICT O. PROCES_-SED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commenting with Section 7000)of Division 3 of the Business OUTLETS OVER J 5 PER SYSTEM 'gyp._ and Professions Code, and my license is in full f e an ef��-/// FINAL riFATION fect. '.% HOSE BIB DATE 6�263303 43'.40 d License Number Lic. Class ��a p Contractor S SP f iK Date v BY AL cc 1 IT�I'� V I am exempt under Sec. TOTAL 4-3 .40 Q ' B.&P.C. for this reason CHECK 43'40 Lou Plan check fee pop. CHANGE 00 � Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Q SINGLE FAMILY 3 0000-0001 6/20/96 HO I/SINGLE DECLARATION Plan check applicant 7020 1 AN 9:54 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address D1, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). Poo 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.). 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 representatives of this County to enter upon the above- ntioned property for inspection pur oses. - .- SEE REVERSE FOR EXPLANATORY LANGUAGE Sig t re of Permittee Date