HomeMy Public PortalAbout6158 AVON AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION
I hereby,•affirm,that I have a certificate of consent to self in- 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT
!sure, or Ai certificate of Workers'Compensation Insurance,or a CE 817 A
s
� ;� „ •p P CE 817(REV. 8/86) ,
'!erfified copy thereof (Sec. 3800, Lab. C.)• �
Po
y,No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS �✓F,
NUMBER FIXTURE OR ITEM
de!plartment. , �7 gyp CLI_
�� @ FEE LOCALITY
Date �1/_'-�i pplicant �sC l/� CLI_ WATER CLOSET(TOILET) NEAREST
CERTIFICATE OXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER p
(This section need•not be completed if the work involved by MAIL /
the permit is for one hundred dollars (5100)or less.) LAVATORY ADDRESS (7 PJUJC
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so SINK CITY / w TEL. NO.2"p-t'-
as to become subject to the Workers'Compensation Laws. DISHWASHER .a55��++
- CONTRACTOR -
Date Applicant CLOTHES WASHER �— ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption, you should become subject to the Workers'Compen- ,
CITY ) TEL. NO.
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be-deemed revok- STATE UC. p
ed. WATER HEATER LICENSE NO. CLASS Ick
LICENSED CONTRACTORS DECLARATION �STRIC N ES D Y
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ✓�j
9(commencing.with Section 7000)of Division'3 of the Business OUTLETS OVER j
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect. DATE O
License Number C7 (� y Lic. Class V
FINAL
Contractor 0 ( C-kt Date •- �' BY O
P-
I am exempt under Se C)
B.&P.C. for this reas n Plan check fee , U
ate'. PLUMBING PERMIT ISSUING FEE $
Signature
TOTAL FEE
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
.t
1 hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and ACCT.*
Professions Code): Address
J07 enc
I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044, 1 ITEMS
Business and Professions Code). , TOTAL5$e 50
CONSTRUCTION LENDING AGENCY, CHECK c .� l
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.). ..... .. CHMIE. ...
Lender's Name 00Oy-W01 10/.2'4/8?
Lender's Address 6L1V�w1J 1 Al'l11:14
I certify that I have read this application and state that the
above infor ation is correct. I agree to comply with all County Pooordinances n e laws regulating Plumbing, and hereby
a rize r pres nt 'ves of this County to enter upon the
ove-men n pro rty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o Per Date
COUNTY OF Los ANGEL" APPLICATION FOR PERMT
Department of BUILDING
Engin
DIVISION OF BUILDING & SAFETY
WILLIAM 1 FOX. CONS" E891110 ► PLUMBING I
FOR APPLICANT TO FILL IN IC;T
•'LUMBERA&L RECCII/[O !Y R[AOY rOR DAT[ 'lB�l[D
_ � FIRST INI.7ECTION
ADOR��! ~jTT Z _
}-� /1 suILDINo
TEL. No ADDR[88 165T aw
'
COUNTY
LOCALITY
� M NO 'PIR �
PERMIT FEES CA a"6r
tiuMwtw I rvPE or re7CRIwc on KLM Te MAIL[R _
MAI
WAT[a CL08ET(TOILET) If 0.50 �1D ` ADORN 12 Z ._.�,
IIAT`t T.,II �Y 0.50 S_ CITY .�,�la„r� /R. y TLL.. NO U7 '7
_ I BHCrw[R
0601 1 1 HERESY ACKNOWLEDGE THAT I HAVE RVfl T f8
I LAVATORY (WA8H BABIN) O 0.50 �� APPLICATION AND BTATr TH•T THE ABOVC 12 C=WVCCT
ANO AOR[[ TO COMPLY WITH ALL COUNTY O"IOLAMCC8
411
KITCHEN BINK O 0.50 AND RTATL LAWtt R[OULATINO PLUMBING
1 C[RTIrY THAT 1 POMEWS THE ABOVE VALAO LrM a
'LAJNORY TUB ON TRAY A 0.50 I ANa[�[a COUNT* LICchat GR 1 AM THE LEaM. a Wigcw a
Or THE RENICENTIAL PROPERTY OEBCRtAED ABQK.
OAS BYBT, . OUTLETS O 250 I I r I
810 P[RMITT[[_To� • `
WATER H_[ATCR
Bt'a BINK 0501 INSPECTIOS�RECORD
i rLOOR •INK • 0 am ;
I rLnns DOA04 O.SO ,, +Y
I DISHWASHER _C.SO
'DRINKING rOUNTAIN 0.50 i
I URINAL O 50 ,
I HOUBC BCWCR 0.50 I
—aCtLl•wro is d
I
APPROVALS
c..Tc wree+o+R .rinB
1 i Rti�taiati Ititttw�lt� 1 I
i
o•a vww
accapoc&
I
1"I I �-
t
T Ants
N PIT 1
_ ,.ot�+e,l�
TOTAL. Rt 1• �. �0 L? m �
1
Us
Ts
rv.
DEPARTMENT OF BUILDING APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES PLUMBING 1
NAiUIZL Or IlNSIALLAII N Ell-STRICT No GROUP NO PERMIT/No.
UGH
PLUMBING FIXTURES COMPLETE 2-
POOL
~
NEATER CESSPOOL -- LEFTICKI READY FOR RECEIV D BY DAT[ ISSUED
FIRST INSPECTION JF _
OAS I MSCELLANEOU4
'f'I.1( 1' I ALL1'01MONO NI Y
NAME r �� 2U 1� IDOR[SS V
C _
W � 1
_ � A'D�DRESSS �'"��I.�,� LOCALITY
JCt / i� 1 L i� TEL NO wnai a�
l 7v
STATE � COUNTY
6 �
LICE SSE NO REO NO [ NAME P17 J.4a
4
LOCATION OF SEPTIC TANK,OP. CESSP001 z MAIL -
3 ADDRESS
NORTH 0 b //��
CITY /Yti TEL NO
CORRECTIONS
3: C
0,-�- -i
DESCRIPTION OF WORK _
> j- �u'�►t�"T^'�/t-�"r.�l...Aat►+r Wr1+ 'a"�r:.'�:M���9}tTAr.w.rwOR I'� -.to J r.tr ..... .�a �.,.......r .��W�--..r � at.4. `�.,ate
t 1
ROWER —DISHWASHER
LAVATORY REFRIGERATOR '
Y
KITCHEN SINK WATER SOFTENER ~
FLOOR SINK BAND TRAP
t
SLOP SINK FLOOR DRAIN +1a
i WASH TRAY URINAL APPROVALS
S
WATER CLOSET DRINKING FOUNTAIN
GATE ,w�►ccron • wwS
WATER HEATER >K DCHTAL LAVATORY ROUGH PLUMBGA ING _
�ETCR_ OUTL SODA FCUNTAIN OAS PIPING t
m I--- I nA, VENT
CESSPOOL [/[1 �� e+�t•
r_TOTAL NUMBER OF FIXTURES—
SEPTIC
�x EPYIC TANK SEPTIC TANK
.l—CSFWER
iPERMIT FEE 1OU UTILITY CO NOTIFIED
TOTAL FEE FINAL 4 •� a"�'� da
T �
M1�
2.
1
DEPARTMENT OF BUILDING APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES PLUMBING
AI IZl OI I9bTl1rLLAIION DIST ICT No I GRouP No PERMIT No
PLOUGHUM BI YO IFIXTURES I_ COMPLETE / �—
HEATER r CESSPOOL 'S EPTIC TAN READY FOR RECEIVE�ey nATE I6GUED
I ��,_ FIRST JNSrPCTIOlI
/ 1 V ' �-
OAS MISCELLANEOUS
55
APPLIC; b P ILI, INH 1 A Z L ED PORTION ONLY
C ` NAM r,?r j� P P 4 a 442 //1 ADDR
m !
ADDRESS
_2 �L 14'e4?'lw_s LOCALITYlEARE
v
CITY / ?�f & TEL N_O C� CROSS ST
T
STATE �,,/��,/ COUNTY /tL ���� r
LICE NSE�Q/�+�j/J REG NG Lf� /J W NAME 2,%
LOCATION OF SEPTIC TANK, OR CESSPOOL Z XIAIL
ADDRESS
NORTH O
I CITY TEL NO
CORRECTIONS
i
� I
SOUTH I I
�� ,,, f7r i�Jti• vr[n*T n}, if (11 .f �,.J1.a < >��7�►�i �C. akti• �"1 *+w.�..,. w..,�, I .� '�4'i "4
w-ti`3'0.�f'-C"'ti"'r t rt(rla+..i.v-��.�:.ti+rroCt. �.CL( .►..�....tC� �
BATH TUB FURNACE
�_I�
MOWER DISHWASHER
AJATORY REFRIGERATOR i
_T KITCHEN SINK WATER SOFTENER i
i IFLOOR SINK KANO TRAP
9 SLOP SINK FLOOR DRAIN
(_WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN D.,TE INS►[CTOR s NAM[
_Y ATER�HHEEATER DENTAL LAVATORY Rnllt.w PLIIURIN(i
® TER ' GAS .O^1 FOUNTAIN
_r_OUTL GAS PIPING
6A8 VENT
L�f CESSPOOL ff,%�'" ;t`/� l Yf• I ����
TOTAL NUMBER OF FIXTURE t
SEPTIC TANK
SEPTIC TANK >
LSSPOOL SEWER
_
IPERMIT FEE 1 TILITV CO NOTIFIED \
TOTAL FEE �� FINAL. xA�
11
1..111 T 1 R1. 4
_ f
Vt
DEPARTMENT OF BUILDING APPLICATION FOR PERMIT
L COUNTY OF LOS ANGELES PLUMBING
NAIURE OF R461ALLATION DISTRICT NO GROUP1 No I PERMIT NOj
a PLUMBING FIXTURES COMPLICTIt �� jI �7 r-� I�7 J I
s I ✓�—( READY FOR R[C[I [Dr DATE IS[U[D
H[ATiR / CESSPOOL [FTICTRN FIRST INSPXCTION h/� /
� S F7 !
A MMT f9Mt rftV'b'�J'�,Y1�� r' RTIO N ONLY , _ /'- ' •��
Joe —ZZ ff!/D!Y ¢r/
pf
t NAME ADCR
e
ADDRESS :7- ri LOCALITY / 2.,yjv Z ef
I
CITY a TEL �[AR[HT �� / .✓/
I STAT[ d /` �r COUNTY
LIC[NBE NO ��7 �/ REO NO � y NAM[ /`,r� f/L
LOCATION OF SEPTIC TANK.,OR CE9SPOOL � MADR[�1IL
AD
NORTH
I CITY TEL NO
CORRECTIONS I
1 I �
r�
J
<
Z
SOUTH t
DF9CRIPTION OF WORK ifir
HOWER DISHWASHER '
LAVATORY ■[FRIG[RATOR
Z XITCH[N SINK WATLR SOFTENER
M OCR SINK SAND TRAP
aLOP BINK ^OOR DRAIN
WASH TRAY URINAL APPROVALS �yt
i 1
WAT[R CLOSET DRINKING FOUNTAIN
DAT-_ IM8F[CT0111 MAY!
7p _WATER H[AT[R DSNTAL LAVATORY RouaH PtIr_IDIYO I r !
.QOA rvvn.. n OAS F P NO Ill r11 7/I f lel 1 t { Jf
OAS VLNT
t
CESSPOOL
TOTAL NUMS[R OF rIX"URrs LA-1
6[RIC TANK
�
SEPTIC TANK f wn
SrWKR
PERMIT FEE 100 UTILirt CO NOTIrIllp
TOTAt, FEE ' FINAL �' r