HomeMy Public PortalAbout5552 ROBINHOOD AVE_Plumbing__ WORK!~R'B COMFF4SAT1ON DEC LA ATK)N 240028 DPW 6/M
J hereby.afllrm that I have a oertlfloatee consent to self Insure, 7arA APPLICATION FOR PLUMBING PERMIT JJ
or a oerdflcate of Worker's Cornpensation Insurance, or a cer{lfled
oopy thereof(Sec.3800 LO.C.) -
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
_
❑ No Comparry
Cwt itad copy is hereby tumwwd. FOR APPtJ(�ANr TO FILL IN PRINT OR TYPE) BU1LD[N(�
❑ Certified Dopy is fled with the county bufldhV Inapsc*)n ADDREBB
departrrrerrL NUMBER FIXTURE OR ITEM FEE LOCALITY
TC
Data Applicant WATER CLOSET NEAREST
CEFITIFFCATE OF E)=MPTFON FROM WGA} ' BATH TUB CROSS ST.
COMPENSATK)N INSURANCE PAGE MAP BOOK OUQ'v PAPo3- DI
ted
(fhhLeection need not be completf the work involved by the SHOWER
permtt Is for one hundred dollars($100)or Ism.) OWNER
I certtfy that In the performance,of the work for which this permit LAVATORY
MAIL
ie Issued, I-shall not employ any person In any manner so as to SINK '
become subJeat to the Worker' Compensation Laws. RE88
DISWASHER CITY AW
TES NO. _
'lly
Dole APp&oarrt CLOTHES WABHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become sub)ect to the Workers' ComponastJon SWIMMINQ POOL RECTOR ADDRF�
provision of the Labor Code, you must forthwtth comply with such
provisions or this permit shall be deemed revoked. LAWN SPRINKLER 8YSTEM
LiCENSM CONZRACTORS DEC)AIp
RATN CI1Y TEL NO.
I hereby affirm that I am licensed under provlslons of Chapter B WATER HEATER STATE
(oommenoing with Sectlon 7000) of Olvlslon 3 of the Business and ��NOGLLASS Vx
Profesek>ns Coee de,and my IicenIs In full force and effeot. OAS SYSTEM OUTLETS
OUTLETS OVER DISTFOCT NO. y PROCESSED BY T_6 SYSTEMA ��O Q
Lk»nse Warner IAC.Claes V
FINAL
DATE 5_ 5 VALIDATION a
Contractor DateFINAL
r-1I am exempt under Seo. BY J Z
B.dP.c.for Ws reason
Plan check feeSignatu '
PLUMBING PERMFr ISSUING FEE S 2(j
� 15
C
❑ TOTAL FEr a `�
Plan check applicant ACCT.T
SINGLE FAMILY
�� '�
HOME OWNER-Bl11LDER DE-CKNI LAFUTName �`5W U 1•�5
1 hereby affirm that I am exempt from the Contractors License Law 1T R�.tr+
for the following reason (Section 7031.6, Business and Professions Address 1 T U►S
Code):
City Tel.N0. TOTOL. 121 - 35'
I,as owner of the property,will do the work and the structure � r� 1. �
Is not Intended or offered for sale (Section 7044, Business `
and Professions Code). ' ,00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there la a construction lending agency for the
performance of the work for which this permit Is Issued (8ec. 3097, [w{—{ o1 3/24
195
CN.C.) p
7C/}2 AM11-.:r+/
Lender's Name
Lenders Address
I certify that I have read this application and state that thq above '
Informstlon Is oorrecL I agree to oompty with all County ordinances
and State Tawe regulating Plumbing, and hereby authorize
repreeentattvss of this County to enter upon the above-mentloned
pro r I specHon urpo*". SEE REVERSE FOR EXPLANATORY LANWAGE
/ / -
8iq»h,re-of Permittee ge3e