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Home My Public Portal About4929 BALDWIN AVE_Plumbing__ (2) 76A667-CE817-11-57 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER Sq, BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Sup't of Building LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS S NUMBER FIXTURE OR ITEM / ��_, C C WATER CLOSET OWNER MAIL J � r BATH TUB ADDRESS SHOWER CITY IIIf/ T�. NO. CJ CONTRACTOR ffaliey um U0. /✓ LAVATORY 442 W ee WOO F'1 . SINK ADDRESS ° y DISHWASHER CITY en Ora TEL. NO. Ed 5— 96 CONTRACTOR'S IbO847 STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRRIIC�T.�LD. GE P I 7„ON�E READY FOR INSPECTION WATER HEATER // o GAS SYSTEM INDUSTRIAL _WASTE APPROVAL INSPECTION RECORD sit z 'V 7 9 A 7-1 a / APPROVALS /r @ $1.00 PER ITEM 1 q DATE INSPECTOR S SIIGNATURE d OR FIXTURE $ UNDER SL-A-I,WORKa '1T,p,f? PERMIT 00 ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THI APPLICATION "— GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING + PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST {LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIMOERTY. e. SIGNATURE OFPERMITTE tVADATION INALROBERTA.WOOD. LISUPERVISING MECHANICAL ENG'R N.O. CASH 9'011' FEB 4 5 A 12_.0-0 M e WORKER'S COMPENSATION DECLARATION 6DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A66 I hereby affirm thaE I have a certificate of consent to self insure, 76A667A or a certificate of Worker's Compensation Insurance, or a certified copy therreof(Sec.3800 Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING `yV IAl 4,V67- ❑ Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM C FEE LOCALITY Date can WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS S . COMPENSATION INSURANCE BATH TUB ASSESSOR 1 (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGEeAI PARCELI�9t) permit is for one hundred dollars($100)or less.) OWNER 7 j I certify that in the performance of the work for which this permit LAVATORY [r is issued, I shall not employ any person in any manner so as to MAIL become subject to the Workers'Compensation Laws. SINK ADDRESS o� FA• i �� —�� CLOTHES WASHER DISWASHER CITY Dat q.�Applicant K. (� `f p� T NOTICE TO AP I ANT: If, after making this Certificate of CONTRACTOR KAk N Exemption, you should become subject to the Workers' CompensationSWIMMING POOL RECEPTOR . / provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM 4Z ry )31 LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER Il (commencing with Section 7000) of Division 3 of the Business and OUTLETS LICENSE NO. 0STATE LIC.CLASS _ O GAS SYSTEM Professions Code,and my license is in full force and effect. '3 y O. DISTRICT NPROCESSED BY OUTLETS OVER r, 5 PER SYSTEM O v. 2 J 44� �� F_ License Number Lia Class� �y Q FINAL m P"Datel_—_ DATE ?- VALIDATIONWContractor J (n ❑ FINAL Z I am exempt under Sec. BY B.&P.C.for this reason C ir �3-- :3L. Plan check fee __ I ,ir Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE ❑ Plan check applicant _ ` SINGLE FAMILY 4k0 HOME OWNER-BUILDER DECLARATION Name ;"I; ': f�! � 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): ❑ City Tel. No. I, as owner of the property, will do the work and the structure 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 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 ente on the above-mentioned propert for inspection urpos SEE REVERSE FOR EXPLANATORY LANGUAGE ture of Permittee Date