The URL can be used to link to this page

Home My Public Portal About5033 BALDWIN AVE_Plumbing__ (3) WORKER'S COMPENSATION certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that Ihave a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab. C.) Policy No ✓z Company /4�/-� c�L-- COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �q Certified copy is filed with the county building inspection ADDRESS � ��✓�� i/1/� deparrtment. N NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 1 ` —� Applicant !T//6 T OPC) 'J`4 _ WATER CLOSET NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY MAIL � is issued, I shall not employ any person in any manner so as to SINK ADDRESS �03 3 /`//��G��y�%✓ become subject to the Workers' Compensation Laws. DISWASHER CITYTEL.NO. { L" Date Applicant CLOTHES WASHER CONTRACTOR % s L NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR 16// provisions of the Labor Code, you must forthwith comply with such ADDRESS 5 0 provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY /�j j� TEL.NO. .�3` 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. O / (� Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS �� LICENSE NO. CLASS OUTLETS OVER DISTRICT NO. �O PROCESSED BY IZ License Number `�' ZZ� Lic.Class�"� 5 PER SYSTEM -<—on I� Cfv.+ ✓C� FINAL (y( DATE �� L!�� VALIDATION a Contractor�1 `1�1 t� ✓' � Date L~ U) F1I am exempt under Sec. FINAL _ $ ti`• 't{ a a BAP.C.for this reason =._I -7 'i�i Plan check fee ► lr Date: Signature PLUMBING PERMIT ISSUING FEE$ Z� ITEM_ ❑ TOTAL FEE TITHE 40 . 65 L[ SINGLE FAMILY Plan check applicant t_Hh K 40 a 65 HOME OWNER-BUILDER DECLARATION Name CHANGE .130 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_–' i; ' ! r`3 I, as owner of the property,will do the work and the structure `10 � [I;I'�`1 '"/''4j 9 is not intended or offered for sale (Section 7044, Business .7::C 1 AN11.*4 and Professions Code). –V}_ a CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agehcy for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.) Lender's Name nr✓� 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 prop tr Ffoi i pectin u oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date f 78A 8+7+,C E#817 10 82 APPLICATION FOR PLUMBG PERMIT COUNTY OF LOS ANGELES J D 3 0 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MM JOHN A LAMBIE COUNTY ENGINEER ADDRESS WILLIAM A JENSEN SUP T OF BUILDING r LOCALITY FOR APPLICANT TO FILL IN NEAREST caoss sr NUMBER FIXTURE OR ITEM EACH FEE c OWNER WATER CLOSET $125 '3(' MAIL / BATH TUB 125 ADDRESS SHOWER 125 CITY TEL NO LAVATORY 125 CONTRALTO � SINE125 ADDRESS DISHWASHER 125 CITY 6reTEL N _ JCONTRACTOR S STATEr LAUNDRY fUB 1 25 REGISTRATION NO �� COUNTY ❑ CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PROCE DrBY WATER HEATER 1 50 Q g AL GAS SYSTEM OUTLETS 150 7 WASTE AP OVAL O OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD A V 09 Ono ~ z elk WPPROT/LS D1ATE INSPECT?' N URE PERMIT $ 2 00 UNDER WORK ROUGH PLUMBING TOTAL FEE O GAS PIPING J I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ... I �drSi/JQ( PLUMBING x I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AMM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABO V DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL 4�/��/� e/-1MCdi'N �LIDATION ROBERT A'WOOD M o CASH SUPERVISING MECHANICAL ENG R'� ;IJO2566- r1AR2 ! 5 D 1 500` ION WOthat I have a certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a certificate of consent to self insure, of a certim te'of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) &III &D �I�iyy �JGIa22 7Q& �5 COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. P�N pang l � , -..a.�: 7 Ta rif . Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 03 [ A) Certified copy is filed with the building inspection /department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY 61-9 C( Date ( Applicant I WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKER BATH TUB ( CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work inv ed by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER d� , I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to MAIL SINK ADDRESS become subject to the Workers'Compensation Laws. A t' DISWASHER CITY �j P� /• TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of `v Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS �0 provisions of the Labor Code, you must forthwith comply with such rT provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO ,1:t � �- I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and STATE LIC. 0 Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS OUTLETS OVER DISTRICTND PROCESSED BY 5 PER SY TEM License Nu er Z- ic.Class C 3� 0, • JQ/ FINAL DATE. VALIDATION Contractor ate `� AC1ins CO) FINAL I am exempt under Sec. BYLLQ#, 1-�o`.3 .&P. .far this reason Date: q ITE Fy.- Plan check fee t 1 t I t ,.. m Signature PLUMBING PERMIT ISSUING FEE$ T1#IAL 1 -15 65�S , TOTAL FEE / CHECK 115.65 ❑ Plan check applicant CHANGE �#1 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law �rrnll�#_� � r,ti�r for the following reason (Section 7031.5, Business and Professions Code): t►Address S� vJ tt . . El 1, Tel. No. �FZj 3 # u 1 Aft .`I3 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 ect. I agree to comply with all County ordinances and State s regulating Plumbing, and hereby authorize represen t' s o 5iz nter upon the above-mentioned P r in a z SEE REVERSE FOR EXPLANATORY LANGUAGE 5 r�3 ign ture of Permittee,4 Date