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Home My Public Portal About4916 1/2 BALDWIN AVE_Plumbing__ 76A607-CE817 10 60 � Cif APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGUMM BUILDING AND SAFETY DMSION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS WILLIAM A JENSEN �TO T OF BUILDING LOCALITY FOR APPLICANT FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAII. BATH TUB ADDRESS SHOWER CITY TEL NO CONTRACTOR LAVATORY SINS ADDRESS J z— DISHWASHER CITY TEL NO CONTRACTOR S LAUNDRY TUB a REGISTRATION NO �� COUNTY CLOTHES WASHER DISTRICT NO _ GROUP I ZONE PR SED BY WATER HEATER s GAS SYSTEM INDUSTRIAi WASTE APPROVAL >, ,gyp INSPECTION RECORD Q. ' W r a l � $1 00 PER ITEM O O8 FIXTURE $ I d 00 APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 1 2100 UNDER SLAB WORK 11(7 Ir,7 TOTAL FEE 1 -2- d d ROUGH PLUMBING GAS PIPINGI(1 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER �J �+ '�' Z•//� ,/ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /4, LICENSED AS REQUIRED BY LOS GAS TEST CALIFORNIAOR ANGELES COUNTY AND STATE OF �/r� . 'IIS . / A THAT 1 AM THE LEGAL OWNER OF THE ABOVE ,d� DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE _ J OF PERMITTE FINAL VALIDATION ROBERT A WOOD cK M O CASH SUPERVISING MECHANICAL ENG R tP3,(5 5 7 9% Jnr 2 5 A 1200 I I 76A607-CE817 10 60 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVLSION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS WILLIAM A JENSEN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEST CROSS ST NUMBER FIXTURE OR ITEM OWNER / WATER CLOSET MALL BATH TUB ADDRESS CITY TEL NO SHOWER CONTRACTOR LAVATORY SINK ADDRESS S^� DISHWASHER CITY e<452TEL NO TS LAUNDRY TUB REGISTRATION NO 7 COUNTY CLOTHES WASHER DISTRICT NO / GROUP ZONE PRA�EBBED BY WATER HEATER K GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD d � -21W , o i N Z Q $100 PER ITEM OR FIXTURE $ (% APPROVALS J/ADATE INSPECTOR SISIGNATURE PERMIT $ 2100 UNDER SLAB WORK I/p-A a TOTAL FEE HROUGH PLUMBING O0 GAS PIPING U� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT 1 /71.)WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING iHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED A. ,BY LOS ANGELES COUNTY AND STATE OF GAS TEST W CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE n DESCRIBED RESIDENTIAL PROPERTI- UTILITY CO NOTIFIED G�6p-- .1/f SIGNATURE OF PERMITTEE VALIDATION ROBERT A WOOD cK M O CASH SUPERVISING MECHANICAL ENG R �2 W � ` 1 WORKER S COMPENSATION DECLARATION - 20 0026 76A667A PW9/89 APPLICATION FOR PLUMBING PERMIT I hem byraffirm that I have a certificate of consent to self insure or a certificate of Worker s Compensation Insurance or a certified I/ copy thereof(Sec 3800 Lab C) - - Policy No 3 Company I��l / COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Certified copy is hereby furnished _ R y FOR APPLICANT TO FILL IN(PRINT OR TYPE) ABUILDING DDRESS L Certified copy is fled with the county 2builng msp tion W AJ department NUMBER FIXTURE OR ITEM ® FEE 1 LOCALITY � Date L C Applicant WATER CLOSET NEAREST / M �� Z�� CERTIFICATE OF EXEMP ON FRO ORKERS CROSS ST BATH TUB ASSESSOR j I COMPENSAT N INSURANCE PAGE PARCEL ^(This section/need not be completed if the work involved by the SHOWER MAP BOOK permit is for one hundred dollars($100)or less) OWNER r I certify that in the performance of the work for which this permit LAVATORY is issued I shall not employ any person in any manner so as toMAIL _ O t� become subject to the Workers Compensation Laws SINK ADDRESS �0 �of D DISWASHER CITY-Tv� �� G TEL NO � Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of CONTRACTOR P1 Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such ADDRESS d provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NOr- / } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER / a (commencing with Section icons of infullDivision 3 of the Business and STATE LIC GAS SYSTEM OUTLETS O LICENSE NO .�S CLASS C^ O V Professions Code and my license is m full force and effect , OUTLETS OVER DISTRICT NO' PROCESSED BY Q 5 PER SYSTEM O License Number j L O Lic Class � H _ FINAL Vc a TION a DATE Contractor Date a CO) ��f/�t� I exempt er Sec gy AL +�+�t�+�i ITEMS *3.40? B&P C for this reason t - 1 ITEI tSS Date Plan check fee 73-, �, � � �-g 8 TOTAL �---oTAL � . 40 PLUMBING PERMIT ISSUING FEE$ Signature CHEtY. r43e40 ❑ Plan check�appllcant TOTAL FEE (NANGIE ` dQ SINGLE FAMILY > HOME OWNER BUILDER DECLARATION Name S 4/29/96 ] I hereby affirm that I am exempt from the Contractors License Law `� -ham - - 0000-0001 pr for the Code) following reason (Section 7031 5 Business and Professions Address (� -60741 rll =00 ❑ f City - Tel No 3 — 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) f � l CONSTRUCTION LENDING AGENCY f r J 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) _ t 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 o this Cou to enter upon the above mentioned property s ctio pu o es - SEE REVERSE FOR EXPLANATORY LANGUAGE 1 SXfiature cloMyeirmitte i Date