The URL can be used to link to this page

Home My Public Portal About5327 WELLAND AVE_Plumbing__ OWORKERS'COMPENSATION'DECLARATION APPLICATION FOR PLUMBING PERMIT ■' • 20 0026 DPW 4/90 I he 15 tgffirm that I hav@ a certificafe of consent to self in- 76A667A sure,or a'certificate of Workqrs'Compensation Insurance,or a n certified Gopy thereof(Sec. 3800, Lab. C.)' lul 994965 * Rep. Indemnity COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ,Policy No. Company Certified copy is hereby furnished. BUILDING a an venue FOR APPLICANT TO FILL IN(PRINT OR TYPE) 5327 Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS department. @ FEE -EEMPEE CITY, CA 6/24/92 WATER CLOSET(TOILET) . LOCALITY Ddte Applica � • NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' i BATH TUB CROSS ST. , COMPENSATION INSURANCE SHOWER OWNERMur-Sol, Inc. (This section need not be completed if the work involved by MAIL 132 La Porte the permit is for one hundred dollars.($100)or less.) LAVATORY /C7 ADDRESS I certify that in the performance of the work for which this per- SINK -CITY Arcadia TEL N08/447-0558 mit is issued, I shall not employ any person in any manner so WSJ as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Frank Marrone & Sons, Inc. Date Applicant CLOTHES WASHER ADDRESS 9860 Lower Azusa Rd. NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY El Monte TEL.NOB/444-2548 sation provisions of the Labor Code,you must forthwith compp- LAWN SPRINKLER SYSTEMS ly with such provisions or this-permit shall-be.deemed revok- STATE397884 LIC• C/36 ed. WATER HEATER - LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provis!ons.of Chapter GAS SYSTEM OUTLETS 53 9(commencing with Section 7000)of Division•3'of the Business OUTLETS OVER �— and Professions Code, and my license is in full force and ef- 5 PER SYSTEM W3FINAL VALIDATION fect. HOSE BIB 'fig DATE License Number 397884 Lic. Class C/36 C/16. � rR a NAL C F. Marrone & Sons 12/31/92 FINAL Contractor Date Q I am exempt under Sec. Cl B.&P.C. for this reason ��; `` :�; W Plan check fee ► E:1: r. - a W,, Date: 7-rPLUMBING PERMIT ISSUING FEE$ � '-' --"y="� 2 Signature "";�'•;i= TOTAL FEE SINGLE FAMILY i.Plan check applicant ;:,t HOME OWNER-BUILDER DECLARATION pp ant �� V '-iq j I Name i•iiF hereby affirm that I am exempt from the Contractor's License = •t` .ti Law for the following reason (Section 7031:5,,Business and %r Professions Code): Address ;f • I, as owner of the property, will do the work and the City Tel. No. , structure is not intended or offered for sale(Section 7044, Business and Professions Code). ► ami -ra:_i 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 t Lender's Address I certify that'[ 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 ab a-menti ned property for inspection purposes - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of rermittee fDaie j . f` `WORKERS'COMPENSATION'a c TION•DECL conse N DPW APPLICATION FOR PLUMBING PERMIT ° I hesg�y, iffirm',that I havw a certificate of consent to self in- 20-0026 67A �� iure,or a'certificate of Workers'Compensation Insurance,ora certified copy thereof(Sec. 3800, Lab. C.)' " cy No.994965 ' Company.Rep. Indemnity COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS oli Certified copy is hereby furnished. i. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 5327 We!.Lancl, Avenue Certified copy is filed with the county building inspection I ADDRESS department. NUMBER FIXTURE OR ITEM C FEE LOCALITY s CA Ddte 6/24/92 Applica , i WATER CLOSET(TOILET) 5 . �? 4 ` NEAREST CROSS ST. + CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB Mur-Sol COMPENSATION INSURANCE OWNER , Inc. i (This section need not be completed if the work involved by SHOWER MAIL 132 .La Porte the permit is for one hundred dollars($100)or less.) 11 LAVATORY ADDRESS I certify that in the performance of the work for which this per- I, SINK 7J CITY Arcadia �� Np8/447-0558 mit is issued, I shall not employ any person-in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Frank Marrone & Sons, Inc. Date Applicant CLOTHES WASHER .ADDRESS 9860 Lower Azusa Rd. NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY E1 Monte TEL.NO8/444-2548 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE 397884 LIC. C/36 ed. WATER HEATER - LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS.SYSTEM OUTLETS 9(commencing with Section 7000)of Division.3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM 83 FINAL VALIDATION fect. HOSE BIB DATE License Number 397884 Lic. Class C/36 C/16 _g n FINAL F. Marrone & Sons 12/31/92 BY C Contractor Date a I.am exempt under Sec. ` C B.BP.C. for this reason r• LL Plan check fee �''��''i°T a Date: -7PLUMBING PERMIT ISSUING FEE$ �„� -'u rte+ Signature p TOTAL FEE 7 SINGLE FAMILY 3^i --'8 HOME OWNER-BUILDER DECLARATION Plan check applicant- • - - -- '= =5-" I hereby affirm that I am exempt from the Contractor's License Name 1`F ='ly = Y.J-, Law for the following reason (Section 7031.5, Business and til 4�-r Professions Code): Address ❑ I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, ;I-; Lj- ,I;11 C '� 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 e 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 ab a-menti ned property for inspection pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE / Signature of Fermittee Date