HomeMy Public PortalAbout6333 TRELAWNEY AVE_Plumbing_10/16/1985_water line DEC
TION
WORKERS t I have
aceriN cafe of corse APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of convent to self 76A667A
ins e, or otter cafe of Workers Compensation Insurance, CE BV(REV 10/81)
or a certifi opy thereof (Sec 3800, Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Company
Certified copy is here urnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified co is filed w o ry ddmg mspec ��/ �� EL4wrv�Y
bond tit NUMBER FIXTURE OR ITEM ® FEE LOCAUTr7F",04,E C(7 7Y
Date App ant WATER CLOSET NEAREST
CERTIFICATE OF EX RKERS' BATH TUB CROSS ST 404EiT-IR
COMPENSATION INSURANCE OWNER
(This section need not be completed N the work Involved by SHOWER
the permit Is for orta hundred dollars($180)or lass ) MAIL
I
certify that in the performance of the work for which thisU4VATORv ADDRESS -
permit is issued I shall not employ any person in any manner SINK CITY . TEL`NO
so as to become subject to the Worker/Compensation Laws
DISHWASHER CONTRACTOR �.QA�! /[(Q S�I//CFI
Date Applicant CLOTHES WASHER ADDRESS 63
NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Worker CITY ,S I I�� A�.,s Y��
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM .J�P. ;A TEL No 4f�A, 7-A
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO 9,i A
LICENSED CONTRACTORS DECLARATION OrMI T Nq BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS o
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER15,
and Professions Code and my license is in full force and effect 5 PER SYSTEM
IN
ALIDATION C
License Number Uc Claes V
Q� FI K
Contractor Dote BY
❑ 1 am exempt under Sec
B 8P C f«this reason N
Plan check fee =
Dote - Pilo
PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name E-, 4S,40&A_-,4 1&4 72FQ dp ;2 31 7.6 A
I hereby affirm that I am exempt from the Contractor s License address 2S /C/(XJiI/TiO/7l� ///ELt/ ST
f« the following reason (Section 7031 5, Business and
Professions Code) City f7�L/j7EylJiQ L'4 Tel No x!3 # 0 5
❑ 1, as owner of the property will do the work and the 1 • • 1 6 5 0
structure is not intended or offered for sale (Section
7044 Business and Professions Code) , • • • 1 6 5 0 6
CONSTRUCTION LENDING AGENCY I Q 1 6—8 5
I hereby affirm that there is a construction lending agency f«
the performance of the work for which this permit is issued
(Sec 3097, Cw C )
Lenders Nome
Lender's Address
I certify that I have read this application and state that the 11110above informotion is correct I agree to comply with all County
4nrcrs,and Statelowsregulrntatives of thisned propertyforinspection pu / $EE REVERSE FOR EXPLANATORY LANGUAGE
iaee to