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Home My Public Portal About8712 WENDON ST_Plumbing__ ORKERS'COMPENSATION DECLARATION 7 ) APPLICATION FOR PLUMBING PERMIT I herebyaffirm that I have a' certificate of consent to self cr.cr, 91er7(z-eo insure,oi%certificate of Workers'Compensation Insurance,or a certified copy-thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. oinpany '091,1, 4-1171�_ �;9��9 cam"/�,ff ❑ Certifie -o�y iI.Hereby rnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ' ADDRESS 19 Certified copy is filed with the c unty building ins ec NUMBER FIXTURE OR ITEM • FEE / Datep n WATER CLOSET LOCALITY Applicant NEAREST 10 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST a ^. COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL -. (This section need not be completed if the work involved ADDRESS b'/�f by the permit is for one hundred dollars ($100) or less.) a SINK CITY ' TEL.NO. 0 I certify that in the performance of the work for which this. DISHWASHER• C1 permit is issued, I shall not.employ any person in any manner ]CONTRACTOR ` lX so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER .� ` 0 ADDRESS Date Applicant SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT: If, after making this Certificate of CITY L�t� TEL.NO214 ��/ a Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM Compensation provisions of the Labor Code, you must forth- STATE LIC. with'comply with such provisions or this permit shall be WATER HEATER LICENSE NO CLASS — deemed revoked. GAS SYSTEM I OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5PER SYSTEM , 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code,and my license is in full force and DATE, effect. License Number FINAL Lic.-Class Contractor Date ❑ I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ Ci ` acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section,7031.5, Busi- City Tel.No. ness and Professions Code): 2 8 0, A ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project 0 0 0 0_0 5 (Section 7044,Business and Professions Code). , CONSTRUCTION LENDING AGENCY 0.- 1 2.5 0 I hereby affirm that there is a construction lending agency Q o a a12505 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). ' Lender's Name 0 1.29-8-2 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- entioned property f ' spection purposes. ignature of.Permittee Date WORKERS'COMPENSATION DECLARATION 7GA667A I )4ereby of firm that I have a' certificate of consent to self c6:617(z-a6) APPLICATION F®R PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a.certified co th of(Sec.3800,Lab.C.) �� ( � —• COUNTY OF LOS ANGELS BUILDING AND SAFETY 1 Company-��ar`'' ' ✓ + Certified copy is hereby furnished. � � BUrNE DING ''] FOR APPLICANT TO FILL IN (PRINT OR TYPE) / �V RESS J Certified copy is filed wi the c my uilding inspection NUMBER FIXTURE OR ITEM 0 FEE f Dated a LIT Applicant WATER CLOSET REST BATHTUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WO RS' COMPENSATION INSURANCE SHOWER OWNE f "Pj�fcl�- LAVATORY MAIL P7 7V } (This section need not be completed if the work involved ADDRESS (7 L (- by the permit,is for one hundred dollars ($100) or less.) SINK O CIT � 7— TEL.NO. U I•certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner 4ADDRESS O so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER U Date Applicant W SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate.of J 1 �--�' TEL.N%Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM ^ �j��(�/ LIC. Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE.NOo�- `�3 72� CLAVS with comply with such provisions or this permit shall be DISTRICT NO. P O SSED deemed revoked. GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER , I hereby affirm.that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi-' 2 FINAL ATIO nese and Professions Code, and my license is in full force and DATE e`er VALID effect. g[Jl6 FINAL License Numb ��11 Lic.Classi?� By ContractorCB� ` L Date u i I am exempt from the licensing requirements as I am a Plan check fee ` licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date, Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address 01 8.6. 1 A License Law for the following reason (Section 7031.5, Busi- City Tel.No. I ness and Professions Code): # 0 0 0 0 05 ! I,•as owner of the property, am exclusively contracting I with licensed contractors to construct the'. project 2 0 0 1 6 0 0 (Section 7044,Business and Professions Code). x001600: CONSTRUCTION LENDING AGENCY I-hereby affirm that there is a construction lending agency 1 1.0581 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances nd St laws regulating Plumbing, and hereby authori re esenta ives of this County to enter upon the above- entio a erty'for inspection purposes. f Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76A667 A P P L I C A T I®•N P®h PLUMBING PERMIT I hereby affirm that I have g certificate of consent to self r-91117112-80) insure,or a certificate of Workers'Compensation Insurance,or � a certified c y thereof(Sec.3800,Lab.C.)) COUNTY OF LOS ANGELES 1 / �/ BUILDING AND SAFETY Policy No. Z ompany X 4 Certified copy is hereby furnished. i FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING & ❑ ADDRESS 71A E, WeN00- Certified copy is filed with the ounty building ins tion NUMBER FIXTURE OR ITEM ® FEE d LOCALITY -Date Applicant //� WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. �` .COMPENSATION INSURANCE SHOWER OWNER % A- O s, MAIL LAVATORY (This section need not be completed if the work involved 1 ADDRESS by, the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. 0 I certify that in the performance of the work for which this DISHWASHER ` c V permit is issued, I shall not employ any person in any manner CONTRACTOR ' �I �� J tZ so as to become subject to the Workers'Compensation Laws. ADDRESS sI O r ] P CLOTHES WASHER 1 9 E. �0� LL Date Applicant I SWIMMING POOL RECEPTOR L NOTICE TO APPLICANT: If, after making this Certificate of CITY �. Q TEL.NO. Ill LAWN SPRINKLER SYSTEM Exemption, you should become subject to the Workers' STATE // �y[� LIC. N Compensation provisions of the Labor Code, you must forth- LICENSE NO. 6 !G CLASS 1Z with comply with such provisions or this permit shall be WATER HEATER deemed revoked. DISTRICT NO. PR CES,SED GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER S,a c1 I hereby affirm that.I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL / ness and Profession VALIDATION Code, and my license is in full force and DATE / "�°� � effect. FINAL License Number 0G 76�� Lic.Class 4/ BY �,�,,/�� Contractor � 1 Ltb4'Kspl-1-• Dat/L_8=_F_Z F1 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ,acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic:or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt: from the Contractor's Address License Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): 1 9 0.2 A I, as owner of the property, am exclusively contracting with licensed contractors to construct the project # o o o o o 5 (Section 7044,Business and Professions Code). 2- 1600 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0 - . 16005 for the performance of the work for which this permit is I issued(Sec.3097,Civ.C.). 11,09-81 Lender's Name Lender's Address 1 I certify that I have read this application and state that the above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the abov-14nentioned property J61 inspection purposes. Signature of Permittee Dafe