HomeMy Public PortalAbout4929 BALDWIN AVE_Plumbing__ 76A667-CE817-11-57
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Sq,
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS S
NUMBER FIXTURE OR ITEM
/ ��_, C C
WATER CLOSET OWNER
MAIL J �
r BATH TUB ADDRESS
SHOWER CITY IIIf/ T�. NO. CJ
CONTRACTOR ffaliey um U0.
/✓ LAVATORY 442 W
ee WOO F'1 .
SINK ADDRESS °
y DISHWASHER CITY en Ora TEL. NO. Ed 5— 96
CONTRACTOR'S IbO847 STATE ❑
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRRIIC�T.�LD. GE P I 7„ON�E READY FOR INSPECTION
WATER HEATER //
o GAS SYSTEM INDUSTRIAL
_WASTE APPROVAL
INSPECTION RECORD
sit z
'V 7 9 A 7-1
a /
APPROVALS
/r @ $1.00 PER ITEM 1
q DATE INSPECTOR S SIIGNATURE
d OR FIXTURE $ UNDER SL-A-I,WORKa '1T,p,f?
PERMIT 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI APPLICATION "— GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING +
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST {LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIMOERTY. e.
SIGNATURE
OFPERMITTE
tVADATION
INALROBERTA.WOOD.
LISUPERVISING MECHANICAL ENG'R
N.O. CASH
9'011' FEB 4 5 A 12_.0-0 M
e WORKER'S COMPENSATION DECLARATION 6DPW 9/89 APPLICATION FOR PLUMBING PERMIT
76A66
I hereby affirm thaE I have a certificate of consent to self insure, 76A667A
or a certificate of Worker's Compensation Insurance, or a certified
copy therreof(Sec.3800 Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING `yV
IAl 4,V67-
❑ Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM C FEE LOCALITY
Date can WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS S .
COMPENSATION INSURANCE BATH TUB ASSESSOR 1
(This section need not be completed if the work involved by the SHOWER MAP BOOK PAGEeAI PARCELI�9t)
permit is for one hundred dollars($100)or less.) OWNER 7 j
I certify that in the performance of the work for which this permit LAVATORY [r
is issued, I shall not employ any person in any manner so as to MAIL
become subject to the Workers'Compensation Laws. SINK ADDRESS o� FA•
i ���� �—��� CLOTHES WASHER DISWASHER CITY
Dat q.�Applicant K. (� `f p�
T
NOTICE TO AP I ANT: If, after making this Certificate of CONTRACTOR KAk N
Exemption, you should become subject to the Workers' CompensationSWIMMING POOL RECEPTOR . /
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM 4Z ry )31
LICENSED CONTRACTORS DECLARATION CITY TEL.NO.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER Il
(commencing with Section 7000) of Division 3 of the Business and OUTLETS LICENSE NO. 0STATE LIC.CLASS _ O
GAS SYSTEM
Professions Code,and my license is in full force and effect.
'3 y
O.
DISTRICT NPROCESSED BY
OUTLETS OVER r,
5 PER SYSTEM O
v. 2 J 44� �� F_
License Number Lia Class� �y Q
FINAL
m P"Datel_—_ DATE ?- VALIDATIONWContractor J (n
❑ FINAL Z
I am exempt under Sec. BY
B.&P.C.for this reason C
ir
�3-- :3L. Plan check fee __ I ,ir
Signature
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
❑
Plan check applicant
_
`
SINGLE FAMILY 4k0
HOME OWNER-BUILDER DECLARATION Name ;"I; ': f�!
�
I 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, 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 correct. I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
representatives of this County to ente on the above-mentioned
propert for inspection urpos SEE REVERSE FOR EXPLANATORY LANGUAGE
ture of Permittee Date