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Home My Public Portal About9939 OLIVE ST_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 26A667 DPW 4/90 76A667A n .sure or a certificate of Workers'Compensation Insurance,ora tilull cerfi�jed copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. 33901 1—OLQmpany Golden Eagle ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ® Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS 9939 Olive department. @ FEE LOCALITY Tem l e City Date 1-1-97 Applicant Owen Bros. Plumb WATER CLOSET(TOILET) NEAREST 2 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB .7 CROSS ST. Baldwin Ave, COMPENSATION INSURANCE SHOWER — OWNER Owen Development (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 4275 N. Baldwin Ave. I certify that in the performance of the work for which this per- SINK J CITY TEL.NO. mit is issued, I shall not employ any person in any manner so E1 Monte Ca 91731 as to become subject to the Workers'Compensation Laws. DISHWASHER 1 CONTRACTOR Own Bros. P1umbin Date. Applicant CLOTHES WASHER I Fn ! ADDRESS 4265 N.B aldwin Ave NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CIN E1 Monte TEL.NO. 443-0078 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE No.23 1—741 CLASS C36-20-16 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM '� OUTLETS1611 D 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER cam! c.; Z—t'�'�� and Professions Code, and my license is in full force and ef- 5 PER SYSTEM ®V FINAL eVALIDATION fect. HOSE BIB 3.2 DATE a License Number 231-741 Lic. Class C36-20-16 AOGTo� FINAL Contractor Owen Bro P1 ,bong 9-30-97 BYj Q3 289-iQ Q ❑ I am exempt under Sec. I ITEMS U B.BP.C. for this reason Plan check fee' TOTAL 289- 10 a Date: PLUMBING PERMIT ISSUING FEE$TOTAL FEE ► CHECK 789e 10 Signature b 3_3 CHARGE .00 O A V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name 2/I5/96 Law for the following reason (Section 7031.5, Business and 4876A1�110�30 Professions Code): Address ❑ I, 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). ► 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-mentione property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of FlerMittee Date .. ..WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20.0026 DPW 4/90 sure,or certificate of Workers'Compensation Insurance,or a 76A667A n cerci��ied c y th f(Sec. 3800, Lab. C. '�jL JII Folic�y�No•�I Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. /—/-�;17 BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS depar m t NUMBER FIXTURE OR ITEM @ FEE LOCALITY A e/ Ddte -' Applicant WATER CLOSET(TOILET) NEAREST GG C TIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR -� Date Applicant CLOTHES WASHER ADDRESS ��,� C( NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR 1 emption,you should become subject to the Workers'Compen- CITY C�L MAFY-Tk. 7 �.J sation provisions of the Lab -Co*le,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- / 0 STATE LIC. ed. WATER HEATER LICENSE NO. i J CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS OG� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and e- 5 PER SYSTEM FINAL VALIDATION fect. n r >tii y HOSE BIB DATE -' � License N mber Lir. Class `, + IL /all/1 FINAL ILV Contractor wDate 1' BY ACCTA Q I am exempt under Sec. 3303 43°40 V B.BP.C. for this reason Plan check fee ITE CL Date: L PLUMBING PERMIT ISSUING FEE$ t417 TOTAL 43 -40 z Signature TOTAL FEE CHECK 43°40 SINGLE FAMILY i CHANGE °00 HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Q000_d001 �� Professions Code): Address R I, as owner of the property, will do the work and the City Tel. No. ��?7 ACt ° 4 structure is not intended or offered for sale(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.). I 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-ppntioned pro erty for inspecH ur oses. � SEE REVERSE FOR EXPLANATORY LANGUAGE Sign Jure of Permittee Date