Loading...
HomeMy Public PortalAbout5708 OAK AVE_Plumbing_1/13/1982_WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a 7tified /copy 3 thereof (Sec. 0Lab. C . Policya;. CompanytO./�,,& ❑ Certified copy is hereby furnished. ©Certified copy is filed with the county building inspection Dateepart/� "Applicant F �^""�' A / CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the work involved by the permit is for one hundred dollars ($100) or less.) 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 become subject to the Workers' Compensation Laws. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. License Number Lie. Class Contractor Date '❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Bus- iness and Professions Code). Lie. or Reg. No. Date HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Bust - and Professions Code): I, as owner of the property, am exclusively contracting with licensed contractors to construct 'the project (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. 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 and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab e -mentioned property for inspection purposes. [gnat re of Permittee bat 76A667A CE firr(a-ae, APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES i - BUILDING AND SAFETY FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �K �,� )� NUMBER FIXTURE OR ITEM • FEE ADDRESS L� //�/ f LOCALITY WATER CLOSET •�/���/��. NEAREST BATH TUB CROSS ST. SHOWER OWNER LAVATORY MAIL ADDRESS' /7 _ a'Y' SINK CITY •/�qftp G)`T� TEL. NO. L�y /)jy7li DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY / TEL. NO. LAWN SPRINKLER SYSTEM STATE LIC. / WATER HEATER /t LICENSE NO. CLASS / GAS SYSTEMOUTLETS DISTRICl'NO. Py OUTLETS OVER SIV 5 PER SYSTEM FINAL GATE VALIDATION —'L --S'� FINA� BY 32 Plan check fee PLUMBING PERMIT ISSUING FEE $ (TOTAL FEE Q SU Plan check applicant Name Address City Tel. No. SEE REVERSE FOR EXPLANATORY LANGUAGE APPROVALS DATE INSPECTORS SIGNATURE INSPECTOR'S NOTES OWNER -BUILDER DECLARATION UNDER SLAB WORK / —2;;- ROUGH PLUMBING �I� LY V 1 hereby affirm that I am exempt Qom the'Contractors GAS PIPING" pn- .1^ V License Law for the following reason (Section 7031.5, Business and Professions Code): Any city or county GAS VENT i� y �^�' which requires a permit to construct, alter, improve, HOT WATER HEATER.. ..` _ demolish, or repair any structure, prior to its issuance, PLUMBING FIXTURES �O'�� also requires the applicant for such permit to file a he is licensed to Y Q signed statemeitt that pursuant the GAS-TESTI— `� provisions of the Contractor's License Law (Chapter 9 UTILITY CO. NOTIFIED I. ., (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt FINAL. '. L'Kfah ws ��o \ therefrom and the basis for the alleged exemption. Anv ., violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five Pun d dollars ($500).: INDUSTRIAL WASTE APPROVAL ` _ _ as owner of the property will do the work, and \ the structure Is not intended O offered for sale. ' (Sec. 7044, Business and Professions Code: The Con- tractor's License Law does riot apply to an owner of - property who builds or improves thereon, and who does such work himself provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of - - completion, the owner -builder will have the burden - of proving that he did not build or improve for the purpose of sale.) 1 am exempt under Sec. , B & P.C. for this reason INSPECTOR'S NOTES