The URL can be used to link to this page

Home My Public Portal About5948 RENO AVE_Plumbing__ WORKERS'that I have DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,'afEirm that I have a certificate of consent to self in- 76A�667A �� fure,or a cbrtificate of Workers'Compensation Insurance,or a certifiVa. ed� py thereof Sec. 3800, Lab. C.) Va.�' �� Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county buildin p c on ADDRESS �� Wv-0-D S-r-• d5R% A t. NUMBER FIXTURE OR ITEM Cal FEE LOCALITY WATER CLOSET(TOILET) ` Dtlte Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKER ' 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($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER �A`` CONTRACTOR - Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY TEL.NO q(8 3�} sation provisions of the Labor Code,you must forthwith comp- r LAWN SPRINKLER SYSTEMS /� g ly with such provisions or this permit shall be deemed revok- STATE �r��ss� LIC. ed. WATER HEATER LICENSE NO. JJ CLASS LICENSED CONTRACTORS DECLARATION 7DISTR:1CTO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fed. 58_✓S55. C Z� HOSE BIB DATE —! Y License Number Lic. Class fZ Q�� FINAL CJ O V Contractor BYRC:t:T a 4 O I am exempt under Sec. 3303 B.BP.C. for this reason LU Plan check fee ► 1 ITEMS w Date: PLUMBING PERMIT ISSUING FEE$ a 7�' TOTAL 44 o JLC)� Signature TOTAL FEE CHECK 44.10 SINGLE FAMILY applicant Plan check HOME OWNER-BUILDER DECLARATION CHANGE .00 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 0000-0001 7f 9/96 ❑ I, as owner of the property, will do the work and the City Tel. No. 7319 1 AMII.0 5 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 t application and state that the above information is come I o gree to comply with all County ordinances an laws regulating Plumbing, and hereby auth�ve e q resents Tues this County t ent upon the rA - oned pr erty r inspection p rpos S. Ll ,� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitt I bate I WOR(&RS'COMPENSATION DECLARATION 4/90APPLICATION FOR PLUMBING PERMIT I.her bl;aff!IF that I have a certificate of consent to self in- �0 X26 PW Au fer or a certifficate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, lab. C.) I COUNTY OF LOS ANGELES DEPT. OF-PUBLIC WORKS Policy No.3510555 Company REPUBLIC INDMTY VCertified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) � BUILDING ertified copy is filed with the county building inspection ADDRESS 5948 RFS department. NUMBER FIXTURE OR ITEM ,@ FEE LOCALITY TEWIE CITY CA Ddte °� Applican WATER CLOSET(TOILET) �, o NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB rl CROSS ST. COMPENSATION INSURANCE SHOWER 0 OWNER NIK NIKOUI (This section need not be completed If the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS P.O. BOX 80788 ' I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK r(7 CITY SAN MARINO, CA 91118 X818-850-3262 as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR FRANK Date. Applicant ' CLOTHES WASHER ADDRESS 9860 LOWER AZUSA ROAD NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY EL METE, CA 9173,1 TEOW4W2548- sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. 397884 CLASS C/36 C/16 LICENSED CONTRACTORS DECLARATION ! 0) DISTRICT NO PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETSD� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM q 0 FINAL , - ON fect. HOSE BIB DATE LIDATI� !- License Numb�P.7884 LLc. Class C/36 C/16 �� rITEMS 4420411i a1AU A r lg FINAL V Contract9r• HARBOR & SONS, Mot2/31/96 BY o I am exempt under Sec. TOTAL -442.4 - B.&P.C. for this reasonPl ► 0. an check fee GyEGK Date: PLUMBING PERMIT ISSUING FEE'$ (� '42e 0 Signature TOTAL FEE �� SINGLE FAMILY IW-ft'tN4L HOME OWNER-BUILDER DECLARATION Plan check applicant eQQ 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 ❑ I, as owner of the property, will do the work and the City Tel. No. 100-0001 nu 1-5/95 structure is not intended or offered for sale(Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY ® 379$ 1 PH12-128 I hereby affirm that there is a construction lending agency'for S 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 770� e-mentio ed property for inspection purposes. �--G�. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of er ittee Date