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Home My Public Portal About5617 SANTA ANITA AVE_Plumbing__ 4• � e N " iWORKER'SthatIhave a cNsaTION icate;ECLARATI to 7APws1a9 APPLICATION FOR'PLUMBING PERMIT I hereby affirm that I have a certificate of'consent to self Insure, or a Gertifieate 0 Workers Compensation Insurance,or a certified copy thereof(Sec.3800.Lab.C.) ' "° COUNTY OF LOS ANGELES, DEPT.OF PUBLIC WORKS-' DEPT.OF:PUBLIC WORKS DIV. Policy No. 99119,E Company Republic Indemnity t, ❑ 'Certified copy is.hereby furnished. r FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING + `5617 SANTEI ArTITA AVENUE Er Certified copy is filed with the county building Inspection department. F NUMBER FUTURE OR ITEM a FEELOCALITY (�+I�Date U2lI 04 APPlicanWATER CLOSET � ]ADDRESS NEAREST CROSS ST. f CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR COMPENSATION INSURANCE (This section need not be completed if the work-Involved by the SHOWER MAP_BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) �. LAVATORY �O OWNER MIEN MI WNSTRUCnCN I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS 1300 E. � STMT#20B become subject to the Workers'Compensation Laws. 15 DISWASHER IF CITY ATH MRRA TEL.NO. 308-1828 Date Applicant CLOTHES'wASHER ,CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of FRANK MMM & SONS, INC. Exemption,you should become subject.to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such , ADDRESS 9860 LOTAR AZUSA ROAD provisions or this permit shall be deemed revoked.. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO.444-2w > I hereby affirm that I am licensed under provisions of Chapter 9 s5WATER HEATER , IL (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. 397884 CLCASS C/36 C/16 V Professions Code,and my license is in full force and effect. OUTLETS.OVER DISTRICT NO. PROCESSED BY 5 PER SYSTEM n�` License Number 397884 LIc.Class C/36 C/16 •b b 3 U '+._ �d _ a .s FINAL FRANK MARRONE & SONS DATE —(� - V# ATION 1185�� CL Contractor Data 12/31/94cc ❑ I am exempt under Sec. FINAL _ _ ITEM ..._.._ Z _.._ TOW ._ .1185.15 B.&P.C.for this reason 1185 .1} Date: Plan check fee CHECK Signature PLUMBING PERMIT ISSUING FEE$ a"r� � - — -�vH�+IGE - ••••• • woo ❑ TOTAL FEE Flan check applicant I 1 . j/5 ~ 1 � �` SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name - , 1946 1 AM10:47 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): ❑ City Tel.No. I,as owner of the property,will do the work and the 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. 3087, Civ.C.): + Lender's Name 1 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-mentioned property for Ins p tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i ,1 Glnnatiim nt Parmittan Hata WORKER'S COMPENSATION DECLARATION 6DPW 9/89 7BA667A APPLICATION FOR PLUMBING PERMIT 75A65 I hereby affirm that I have a certificate of consent to self,insure, or a certificate of Worker's Compensation Insurance, or a cdrtified copy thereof(Sec.'3800 Lab.C.) A y4 (�U(^J � COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. • Company Cart.ifled copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /� Certified copy is filed with the county building inspection ADDRESS �lQ.I department. NUMBER FIXTURE.OR ITEM a FEE LOCALITY Date .Applicant WATER CLOSET NEAREST t lJ� 0 Q CROSS ST. 4+ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION.INSURANCE MAP ASSESSOR OK PAGE PARCEL (This section need not be completed if the work Involved by the SHOWER Q,, permit is for one hundred dollars'($100)or less.) OWNER ' S' e 9 na ' , V. l certify that In the performance of the work for which this permit LAVATORY Is issued, I shall not employ any person in any manner so as toSINK ADDRESS 9• AAt((< t ` become subject to the Workers'Compensation Laws. `f DISWASHER KDATE . T.L.NO. Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ;CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR O provisions of the Labor Code, you must forthwith•comply with suchPQ provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM •� LICENSED CONTRACTORS DECLARATION WATER HEATER' CITY T.&' 0-A- J r W LIC. NO.� t ,.f 1 I hereby affirm that I am licensed under provisions of Chapter 9 / IL (commencing with Section 7000)of'Division 3 of the Business and GAS SYSTEM OUTLETS . CLASS Professions Code,and my license is In full force and effect. TRICT NO. PROCESSED BY Q�} OUTLETS OVER License Number �d(, 1 Lic.Class 5 PER SYSTEM L . VALIDATION W Contractor .Date _ (� ❑ Z I am exempt under Secr:�- b B.&P:C.for this reason RCC�a Plan check fee 317 41.85 Date: Signature PLUMBING PERMIT ISSUING FEE'$ Q 1 ITEM=' TOTAL FEE TOTAL 41 -85 SINGLE FAMILY Plan check applicant EHEC 4 615 HOME OWNER-BUILDER DECLARATION Name -11 �,�� I hereby affirm that I am exempt from the Contractor's License Law C .1-13 for the following reason (Section 7031.5, Business and Professions Address Code): ❑ City Tel.No. I,as owner of the property,will do the work and the structure 00-000 _4r is not intended or offered for sale(Section 7044, Business ® o and Professions Code). -u 64 i PM 48 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 1 ` and State laws regulating Plumbing, and hereby authorize repress tatives of this County to enter upon the above-mentioned pr in ction purposes mSEE REVERSE FOR EXPLANATORY LANGUAGE ay Si nature of Permittee Date