HomeMy Public PortalAbout5708 OAK AVE_Plumbing_8/24/1994_WOthatI have
aceSATIONDECLARATION �6A6B7APW9/09 APPLICATION FOR PLUMBING PERMIT -�
I hereby affirm that I have a certificate of consent tc elf insure,
or a certificate of Worker's Compensation Insuja , or a certified
copy thereof (Sec. 3800 Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
Policy No. Co y
❑ Certified copy is y fumishad BUILDING
FOR APPLICANT TO FILL IN (PRINT OR TYPE) ADDRESS
❑ Certifis opy is tiled with the county building inspection t)YI1
de Ment. NUMBER FIXTURE OR ITEM ® FEE LOCALITY----
Applicant
OCALITY--Applicant WATER CLOSET AN f_
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
BATH TUB ASSESSOR
COMPENSATION INSURANCE I MAPSOOK� •(PAGE (PARCEL
(This section need not be completed If the work involved by the SHOWER
permit is for one hundred dollars ($100) or less.) I LAVATORY OWNER ( A
I certify that in the performance of the work for which this permit MAIL
is issued, I shall not employ any person a any manner so as to I - SINK r ADDRESS
became subj t to the Workers' Cempens do Laws.
DISWASHER I CITY q 1� TEL. NO.
Date Zy Applicant -r ln'C I CLOTHES WASHER CONTRACTOR Qr
NOTICE TIO APPLICANT: If, after -making this Certificate of
Exemption, you should become subject to the Workers' Compensation I SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL. NO. 4.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000) of Division 3 of the Business and STATE LIC. I 0
DIS
Professions Code, and my license is in full force and eft GAS SYSTEM OUTLETS LICENSE CLASS
OUTLETS OVER DISTRICT NO. PROCESSED By X
5 PER SYSTEM14,�O
License Number lass;/ (� ID� ~
/ FINAL/ U
DATE y, _ $-qJ VAI lUA710N wa
ConNa�ctor Pate ':
FIllyyy-----TIIV' FINAL _
I am exempt u r S— / �� BY IMP,
1 1 r�i';_.
B4P. r this reason {�'�IL ^�'
Plan check fee , _ '='
nate- -- -r
Signaler- PLUMBING PERMIT ISSUING FEE $ (j Z - �'�E�f`
❑ I ^ I TOTAL FEE04)r a' Q 4FIANG2E
Plan check applicant i t
SINGLE FAMILY n'rr-UI_,— ri
HOMEOWNER -BUILDER DECLARATION (Name _jt.__'i _%Q;y
I hereby affirm that I am exempt from the Contractor's License Law
for the:fellowing reason (Section 7031.5, Business and Professions I Address k_77Q II� iw' 1 i HI'I
Code
City�irn "V, i' Tel. No.
I, as owner of the property, will do the work and the structure / 7 /•
V is not intended or offered for sale (Section 7044, Business
and Professions Code). O ,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lentlin ency, for the
performance of the work for which this permit I 'sued (Sec. 3097, -
Civ. C.)
Lender's Name
Lender's Addre7
I certify that I have d this application and state that the above ,
information !scar ct. I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
representatiy s of this County to enter upon the above-mentioned
proper y fo�spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
[y/,/ �z u
Signature of Permittee bate
APPROVALS DATE INSPEOT s SIGNATURE
UNDER SLAB WORK I _
ROUGH PLUMBING J _
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL Enter oil Front I
INDUSTRIAL
WASTE APPROVAL
INSPECTOR'S NOTES
INSPECTOR'S NOTES
b
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for
the following reason (Section 70315. Business and Professions
Code): Any city or county which requires a permit to construct, alter,
improve, demolish. or repair any structure, prior to its issuancer also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) o1 Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031 5
by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars (8500)
[11. as owner of the property will do the work, and the structure
is not intended or offered for sale
(Sec. 7044, Business and Professions Code.' The Contractor's Li-
cense Law does not apply to an owner of property who builds or
improves !hereon, and who does such work himself provided that
such improvements are not intended or offered for sale. It, however,
the building or improvement is sold within one year of completion, the
owner-bmlder will have the burden of proving that he did not build or
improve for the purpose of sale.)
I am exempt under Ser
B & P.C. for this reason
Date
Owner