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HomeMy Public PortalAbout5421 BALDWIN AVE_Plumbing__ (2) 76A667-CE#817 5.61 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING L 13, / JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS DN-7 WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL J BATH TUB ADDRESS CITY TEL NO. SHOWER LAVATORY CONTRACTOR a-f, Plumbing l SINK ADDRESS Z 3')a 3 .>O. Cranshaw Blvd* DISHWASHER CITY 7 I'" TEL. NO. 03 93691 CONTRACTOR'S = 1 A ❑ LAUNDRY TUB REGISTRATION NO. 7 -3 6 COUNTY CLOTHES WASHERDISTR NO. GROUP ZON PR SSED BY WATER HEATER / . GY GAS SYSTEM INDUSTRIAL 0 WASTE APPROVAL t7 INSPECTION RECORD cG 0 F- U W a v>, Z a $1.00 PER ITEM z„ OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 4PPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE GAS TEST DESCRIBED RESIDENTIAL PR TY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTE FINAL �f VALIDATION ROBERT A. WOOD CK M.0. CASH SUPERVISING MECHANICAL ENG'R WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT fir,Yyher 01 affirm that I have a certificate of consent to self 76A667A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No—Company ��µ 13. Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY `(—ZZ 8 R A') CW /2- WATER CLOSET a �C e Date plicant g NEARESTCERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSSST ©L�l V COMPENSATION INSURANCE OWNER L SHOWER (This section need not be completed if the work involved by MAIL A^ LJ the permit is for one hundred dollars ($100)or less ) 2 LAVATORY d D ADDRESS 1'V� I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY TEL NO Zg7-7 Z l� so as to become subject to the Workers Compensation Laws DISHWASHER ^^ CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS Z_Z J�3 Lo D 1 U NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers CITY L � TEL NO �1 y 4� Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE 42- LIC deemed revoked I WATER HEATER CLASS LICENSE NO LICENSED CONTRACTORS DECLARATION DISTRICT NO 7DCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS S (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER i and Professions Code and my license is in full force and effect 5 PER SYSTEM ' FINAL � VA DATION License Number ,4--Z3Z [ Lic Class DATE — Cf 0 C) Contractor.7 J IEEE L I-AfF Dote 7-Z^ BYr ❑ 1 am exempt under Sec U B 8P C for this reason 1.1 Plan check fee 0-1 DatePLUMBING PERMIT ISSUING FEE$ d �4 6 9 3 A Z Signature TOTAL FEE # o 0 0 0 0 5 Plan check applicant I o o 6 Q,5 0 SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name o o o 6 4,5 0 C5: I hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5 Business and 0 522-86 Professions Code) I City Tel No ❑ I as owner of the property will do the work and the structure isnot intended or offered for sale (Section 7044 Business and Professions Code) polo 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 w 1 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 jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mention propepv for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature oill.Permittee Date