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Home My Public Portal About9619 WOODRUFF AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 'I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 lR"® �,e ®r 16 PLUMBING 1r V ONa 76A667A sure,or a certificate of Workers'Compensation insurance,or a �7 certified „�copy thereof(Sec. 3800, Lob. C.) Llu�l Policy N-o.g5y'Vj 79_-7 Company C_,0L_C0&e I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. BUILDING ; department. FEE I FOR APPLICANT TO,FILL IN(PRINT OR TYPE) W ❑ Certified copy is filed with the county building inspection j NUMBER FIXTURE OR ITEM ADDRESS a��fJ @ i LOCALITY �A7et C/ Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB CROSS ST. ,G - C/T COMPENSATION INSURANCE I SHOWER OWNER Jess- (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- Ir er- SINK CITY TEL.NO. ��` yt L�' mit is-issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR FAY 6Ut 6Fd U Date Applicant 'ayS La1.,W_l>r A CLOTHES WASHER �- NOTICE TO APPLICANT: If, after making this Certificate of Ex- I ADDRESS empfion,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITYUA/2•C,�I).4 (JAI ?/fib TEL.NO. ?9? sation provisions of the Labor Code,you must forthwith comp- � j” ly with such provisions L N S INKLER SYSTEMS or this permit shall be deemed revok- , STATE ,> LIC. / ed. WATER HEATER LICENSE NO. CLASS L LICENSED CONTRACTORS DECLARATION DISTRIQ WO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �/ 9(commencing with Section 7000)of Division 3 of the Business I OUTLETS OVER and Professions Code, and my license is in full force and of- 5 PER SYSTEM FINAL Lt TION fect. CuEt�7 —3/3 G y� HOSE BIB DATE t; 43.40.-,- License Number Lic. Class �J I CL 12 O Contractor.�YdAl Q9C-4 Date 5` c/ ! FINAL 0000' 3/1 3/ 4/96 0 I am exempt under Sec. e1099 1 :568' B.BP.C. for this reason Plan check fee ® a f� Date: PLUMBING PERMIT ISSUING FEE$ z Signature I �O SINGLE FAMILY TOTAL FEE HOME OWNER-BUILDER DECLARATION j Plan check applicant 5 I hereby affirm that I am exempt from the Contractor's License; NameAt0ToA Law for the following reason (Section 7031.5, Business and, Professions Code): I Address 3303 43.40 F1 I, as owner of the Property,*will do the work and the'l City Tel. No. $ ITEMS structure is not intended or offered for sale(Section 70441 ,5 Business and Professions Code). TOTAL 4- o 40 CONSTRUCTION LENDING AGENCY I ® CHECK 43.40 1 hereby affirm that there is a construction lending agency fot CHANGE .00 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). I Lender's Name I 0000-0001 3/ 4/96 Lender's Address 5100 1 AN 9:56 I certify that I have read this application and state that the above information is c rect. I agree to comply with all County ordinances and t ws regulating Plumbing' - hereby authorize repr7pperstyforinspection eof this County to enter upon the ab -m fio purposes. C/?_ 1* SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur Permittee Date TION WORKER'have a certificate OfConsen to I 76AS87 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A 1 hereby affirfi that I have a certificate o}consent to self Insure,l or a certificate of Worker's Compensation Insurance,or a certified .. - cropyifiereof(Sec.3800 Lab.C.) Policy hei 3510555 Company RFPi T E�fNT21' COUNTY O'F LOS ANGELES DEPT.OF,,PUBLICI WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Y P y . . ' ; Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 9619 WOODRUFF AVEiV[JE I�I Certified copy is filed wi the county building Inspection department. NUMBER FIXTURE OR REM FEE LOCALITY TRITE CITY Date 09/18/95 Appll i 3 WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 3 BATH TUB 3 CROSS ST. COMPENSATION INSURANCE ASSESSOR PEBOOK �lPAGEO/d/ PARCELD/A (This section need not be completed if the work Involved by thel SHOWER nwo permit Is for one hundred dollars($100)or less.) I LAVATORY OWNER J� ,TATATAT I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to SINK Q ADDRESS 357 W. WALNU become subject to the Workers'Compensation Laws. DISWASHERaa D CITY AR,MIS CA 91006 TEL. 447-4824• Date Applicant CLOTHES WASHER l CONTRACTO )1]K $r $ IN(;, NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such 9860 LOWER AZUSA )DAD provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION I CITY ELM=, CA 91731 TO_14548 8# —2 I hereby affirm that I am licensed under provisions of Chapter 9 ` WATER HEATER CL (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS STACET SE NO. 397884 CLASS ' C/36 C/16 Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY 397884 C/36 C/16 5 PER SYSTEM 0 License Number Lic.Class O IFINAL s DATE Ld Contractdr• MAR)M & SONS, INC.Date 12/31/96 In, cc " I am exempt under Sec. FINAL--i BY B.&P.C.for this reason Plan check fee • Date: ® I PLUMBING PERMIT ISSUING FEE$ Signature ElI TOTAL FEE SINGLE FAMILY I Plan check applicant HOME OWNER-BUILDER DECLARATION Name 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): e i ❑ I1 City Tel.No. ' I,as owner of the property,will do the work and the structuFe 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 fort e performance of the,work for which this permit is Issued(Sec.30l 7, Civ.C,.) Lender's Name I I 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 p operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE tgnature of Pertntttee Date