HomeMy Public PortalAbout5511 ROBINHOOD AVE_Plumbing__ RKPRS�
�to COMPENSATION ar a �'JIfaaitc4toudptoolf " 'i°) APPLICATION FOR PLUMBING P E R M tT vkenCeloat
a certified copy thereof(Sec.3800,Lab.C.
COUNTY OF SOS ANGELES sulL,DING AND SAFETY
policy No. Company zvl
F] Certified copy Is hereby furdl bbd. FOR APPLICANT TO,FILL IN (PRINT OR TYPE) BUZLDIN Q 11 r� �.y.�t�� N�J
19 tertifl Y ecouhty bull 1nsP n NUMBER FIXTURE OR f11JN • Fly ADDR 1 sl MOW -
LQCALITY TE
WATER OL()SET
Dat plltan r NEAR T
CERTIFICATE OF EXEMPTION BATH TUB CROSS 8T.
FROM WORKERS'
COMPENSATION INSURANCE 'SHOWER MILOWNER
(This waDA' need hof be ieted if the work favolved LAVATORY MAIC
CITY by the. permit is for one hundred dollars ($100) or leu.) SINK CCITY IJ�
4� TEL.NO.
I corttfy that in the 2_
performance of the work fot which this DISHWASHEFj
permit is Issued, I shall not employ ap•y person in any manner CONTRACTOR
so as to become subject to the Workers' Compensation Laws.
CLOTHES WASHER
ADDRESS O
Date Applicant 8WIMMI•NQ POOL RECEPTCFR
NOTICE TO APPLICANT:If, after making this Certiflcat&of CI TEL.NO d Lal
Examption, you should-become subject to the Workers'. LAWN SPRINKLER SYSTEM -STATE LIC.
Compensation provisions of the Labor"a, yoit must forth- ^ {(?Q�?
WATER HEATER LLCENSE NO`��f'O /O C`L _
with comply with rpch p;ovitlona Or this perafft (hall be � DISTRICT NO. OCES8�D BY
dmMed rerokpd. GAS 8Y87r M OUTLETS
LICENSED CONTRACTORS DECLARATION OUTLET'S OVER 1J�
I hereby affirm that I am llcentad under provisions of Chapter 6 PEA SYSTEM
9 (commencing with Section 7000) of Dtvislon 3 of the Btnl- FINAL
nese and Professlom Code, and my 1lcense is in full force and DATE '(�� L
effect.
FrNAL f
License Numb., Lic.Class / BY
ContractorData AUAZO
I am exempt from the [icetutng r6qutrements as I am a Plan check fee �.
licensed amhtect or ■ registered pro(eadongl engineer PLUMBMGPERMIT ISSUING FEE$
! acting In my professional capacity (Section 7051, Bur
ineu and Professions Code). TOTAL FIEE
to 00
Llc.or Rei..No. bate Plan check app"Oarrt
HOME OWNER BUILDER DECLARATION Noma
I hereby affirm that I am exempt from the Contractor's Addraar
License Law for the fouowing reason. (Section_7031.5, I)usi- CFty Tal.No.
noes and Ptofeaslons Code):
QI, as owner of the pioperW. am excluatvely cohtracting
with licensed -ooritractora to construct the project
(Section 7044,Busineas and Professions Code). ;92 6 7.3 A
CONSTRUCTION LENDING AGENCY # 0 0 0 0 0.5
I baae{��eby affirm that there is a construction landing agency
for performance of the work for which thta permit Is FINAL
issue&'aSName 7.Civ.C.). �' ddd 2 0 0 D 0
INSPECTION o o a l a o o 6
Lender's Address
I Certify that I have read this application and state that the
above information V correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANG[IAGE
ordlnances and State laws regulat(ng Plumbing, and hereby
auth of this Coun to enter n th
■boy ention6d pro for ihs n
oT Permittee Da