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Home My Public Portal About6262 AVON AVE_Plumbing__ WORKERS COMPENSATION DECLARATION CF-8 ,APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consefit to sel' ce e1;1i>(z soi insure of a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGE ES ti BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ❑ (�o�LQv� Certified copy is Bled with the county building inspection NUMBER FIXTURE OR ITEM • FEE ADDRESS vop, A" department LOCALITY /e—m P Cl Date Applicant ' WATER CLOSET NEAREST JJ BATH TUB CROSS ST hOYI en CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SHOWER OWNER v _r) GoRRIS n (This section need not be completed if the work involved jZ. LAVATORY MAIL ADDRESS LO lo� tJ Aodn 4v,-- a. by the permit is for one hundred dollars ($100) or less) SINKO CITY Sow GQbrie1 TEL NO 97- () I certify that in the performance of the work for which this DISHWASHER permit is issued I shall not employ any person in any manner CONTRACTOR O so as to become subject to the Workers Compensation Laws CLOTHES WASHER U ADDRESS Date Applicant SWIMMING POOL RECEPTOR Ul NOTICE TO APPLICANT If after making this Certificate of CITY TEL NO Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE LIC Z Compensation provisions of the Labor Code you must forth / LICENSE NO CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked ' / GAS SYSTEM OUTLETS r Dj�_ C SSED LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi FINAL VALIDATION ness and Professions Code and my license is in full force and DATE effect FINAL License Number Lic Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051 Bus mess and Professions Code) i TOTAL FEE Lic or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name k_r &0p gle, 2 2"7 3.3 A I hereby affirm that I am exempt from the Contractors Address i'V \)Otl W Q # o o o o o 5 License Law for the following reason (Section 7031 5 Busi cltyGgn �jYbr ' Tel No `J—a3SJ ness and Professions Code) 2'o o 4 0 5 0 MI as owner of the property am exclusively contracting with licensed contractors to construct the project �7 J �n ° 0 040505 (Section 7044 Business and Professions Code) vC` �1 2 5'—8 2 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioqed pr pert for in ect purposes Sign ture of Permittee Date APPLICATION FOR PERMIT ,RT&MENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING WM J FOX C 41EP CNGIN[ER NATURMF INSTALLATION DISTRICT NO GROUP IAYE /P�ER�MIT No rBING FIXTURES COMPLETE P/ BY READY FOR Opt Iss m ATTR CESSPOOL SEPTIC TANK ` FIRST INSPECTION ^ y MISCELLAN[OVs ~ APPLICANT FML IN HEAVILY OUTLINED PORTION ONLY ` Joe /� t' NAMG _ C // r�yivv+�!/Z� ADDRESS n -1 f? A/ �itl�►►.-.-. ? 9- I � AODR[sS LOCALITY J NEAREST c'1TY TEL NO�2-22LS CR08s BT coLNTY VERT NO 70 EXPIREtQa,4,3 � NAME / j� %TION OF SEPTIC TANK, OR CES.SPOOT MA'L = Snc_r::S NORTH CITY TEL No 1 AM THE LEfIAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICC OF WLIFICATION rLU/1MtR 1 AM THE LEGAL OWNER OF THE PROPE�T`r D[SCRI I ABOVE ii HI w 11 1 _owNrR - - r 3 ` CORRECTIONS Rti_ i'3, i !r "r., a ♦" f'*y► C ;J�.,,.,, �.r by .L. � .:J-..r.-' Sw e�,�.c.t-r +1� ? -,7r} ._'^ uT rpt e.�i�L�..r..r 1'.La«...►'r...Y�,Ks4-\Y+�A IA- V. •,.F '7P'r' SOUTH r , r DESCRIP'T'ION OF FORK `� ' f z _OATH Tua FURNACE ' 3 v Ix _S►IOK:A DISHWASHER O r• yK _LiVAT^4Y r'S7'R'.^. t1tTtlw {}T34 ,KITCHEN SINK WATER SOFTENER » � FLOOR SINK QAND TRAP ! _—SLOP SINK trr OOR DRAIN 9 _ APPROVAIS -WASH TRAY URINAL r w.u�as�e j _WATER CLOSET DRINKING FOUNTAIN DATE /NSPIMTOR S NAI49 t _WATER HEATER DENTAL LAVATORY SPUGH PLUMAINCI i _MITER 'd GAS SODA FOUNTAIN GAS PIPING I i:kv .r OUTL GAS VEMT v � 1 C![SSPOOL --TOTAL NUMBER OF FIXTURRS ice"• SEPTIC TANK ~~`w SEWER --t't&GPO0L==9rF`TfC TANK St, UTILITY CO NOTIFIRD k T- - L FCE N +� :aM APPLICATION FOR PERMIT a�wy iEPARnIENT OF BUILDING AND SAFETY } COUNTY OF IAS ANGELES - ''"` PLUMMING 'NM J, FOX, CHItP[NOINt[R NATURE OF INSTALLATION DISTRICT NO GROUPI ZONE PERMIT Npo. ; A ROUGH 7 �� p � PLUMBING FIXTUR COM Rt�,E1VED it 11 READY FOR 10DATE IiSUCO Y HtATt CES&POOL SEPTIC TANK FIRST INSPECTION i l— aAs MIOCVLLANCOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY ' Jos 1 HANt ADDRtfs it B ADOR[OB LOCALITY N[AR re !T l C►TY [L NO CROS! eT COUNTY ,, < < • CVnT NO OCATION OF SEPTIC TANK, OR CESSPOOL � AIL NORTH r Cm TEL No I AM THE LEGAL POSSESSOR OR THE ABOVE LOS ANGELS& COUNTY f ERTIFICAT[ Of QUALIFICATION r, 125ld&:-4 ►tuteo�R 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBEO ABOVE M Y CORREC'T'IONS SOUTH g DESCRIPTION OF FORK < , Awa" Tui FURTtACE *� rurmw� �..BHOWF_p DISHWASHER d ~ _LAVATORY __..__RCorp fin"ATQq ... _______KITCHEN &INK WATER &OFTENER ^ MINK f<< pAND TRAP &INK ` -..w=i &&AtN ._._WP SH TRAY URINAL "r APPROVALS �. 1 _WATER CLOSET DRINKING FOUNTAIN DATE to MAMt�- R ,WATER HEATER VtNTAI_,,L4VATORY ROUGH PLUMBING fi _-_METER OUTALS 600A FOUNTAIN CA$ PIPING ~ GAS VENT M CESSPOOL TOTAL NUMBCi. OF IrJCTUREG CEPTIC TANK r - — ,VS5P0 L *[PTIC TANK- i " •tWER UTILITYCO NOTIFIED TOTAL F'EE ,r'�r9 Lh ,: s Ai.4 F/NAL �3}et.rl�r'u t� r BE M�N