HomeMy Public PortalAbout9158 BIDWELL ST_Plumbing__ Wz'n` ,_ /�SATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby afflr that I ve a certificate of consent to self 76A667A
Insure, or a certificate of Workers' Compensation Insurayce, CE 817(REV. 10181) u
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company '
Certified copy Is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILIN
DG
Certified copy Is filed with the county building Inspec- ADI7RF55 t
Hari department. NUMBER FIXTURE OR ITEM O FEE LOCALITY
�a,� WATER CLOSET
Date 1" Appll4ant /�f/4 "�� NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS
PIO
COMPENSATION INSURANCE %+OWER OWNER�'1�j/i
(This Nction need not becompleted If the work ImroIved by
tFre permit Is for one hundred dollars le
($100)or es.) LAVATORY MAIL
ADDRESS
I certify that In thb performance of the work for which this 1
permit Is Issued, I shall not employ any person In any manner SINK CITY TEL NO.
so as,ta become subject to the Workers'Compensation Laws. DISH`WASHiER
CONTRACT
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL QECFPTOR
OF TEL
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY
with comply with such provisions or this permit shall be STA r U t ,�
deemed revoked. WATER HEATER LICENSE NO J S
LICENSED CONTRACTORS DECLARATION DIST 4k7 NO BY
I hereby affirm that I am Ilcer»ed under provisions of Chapter 9 GAS SYSTEM OUTLETS /(
(commencIN with Sectlon 700D) of Division 3 of the Business OUTLETS OVER (J
and Professions Code,and my license Is to full force and effect. 5 PER SYSTEM FI
rr �/ �,, � jj�� DA�� V IDATION
License Number yOf VLlc. Classes Q
F I (>.
Contractor to LX
D °
I am exempt under Sec. 0
U
B.BP.C. for this reason
Plan check fee
Date:
PLUMBING PERMIT ISSUING FEE$ Z
S I9 nota re
TOTAL FEE 6
Plan check appllcarit
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name 6 2 Q S A
I.hereby affirm that I am exempt from the Contractor's License Address
Low for the following reason (Section 7031.5, Business and #.000 2
Profeulons Code): I City Tel. No.
1, at owner of the property, will dp the work and the ( o 0 1 S
El
structure Is not Intended or offered for sale (Section o o o 1 6 5 0 5
70.", Business and Profeulons Code).
CONSTRUCTION LENDING AGENCY ( 23o-86
I hereby affirm that there to a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3097, Cly. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the ,
above Information Is orr . I agree to comply with all County
ordinances and St I regLilating Plumbing, and hereby
authorize Neer a of this C er—Upbl the
above-mentlo spectlon purpo es.
f
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature Permittee
76A 6E'?_c E6e1 T' D/Qa _
1
APPLICATION FOR PLUMBING PERMIT
iRT �OS
GLot to
DEPARTMENT OF
JUA. AtJ�ION
[[R IJ
l
TcRom
5`-' Bidwell
WILLIAM A.JENSEN, &LrWT OF WUILDINOTbmple CFOR APPLICANT To FELL R1
NUMBER F7 R[OR ITEM EACH F[[
3 wawa ci.os>rr ass 75 T.
OwRn J. B. Weber Dev, Co
mAm
1 BATH Tn 1.0 25 A ppm 26 T a City Blvd,
2 sHown im 50 czrr Temple Ci TEL NO.
LAVATO*T l n 75 coarmcrORVall Plumbing Co. of Glend
1 snrR iss 25 APDRESR 442 W. Fleetwood. Place
1 DMErWAEHER I ti 25 crTr Kendora TEL mo. $d 51293
LAUNDRY TVD im not No. 209.431 COUNTY 8
1 CLOTHES WAdHEI 1.26 Dlrr�!14T N GR Ur [ F RM[D BY
1 WATER HEATER im 0 ✓
1 GAS STSTEJ[ OUTLM Iso 5q amueruAL
WASTE APPROVAL
1 OUTLETS OVER a PER ST&Efc ao 30 nra%=Ox RECORD u
_ ( ix
IV Wa
I
Z
A"OVALB TT4 I R•.MIGNA
PERMIT s 2 00 UNDER BLAB WORK
ROUGH PLUMBING y
TOTAL FEE 3o GAS PIPING
AH
I HI RLIY CKNOWL[D4" TA} 1 }{AVX R=AD THIS "FLICATION ��VENTAHD fTAT[ THAT THR A10V[ IN CO KNECr AND AORa TO COMPLY
WrrH ALL COUNTY O DINANCICS AIRD STAT[ LAWS W6ULAT INa
FLUMNINO. HOT WATER,HEATER
I HneraY CICRTIFY THAT 1 AM FROF[RLY RLaI.Ti1tD AND/oR PLUMBR
PLUMBING FIXTURB
LlCarS>m AS R=OUIRm WY L045ANIQLKS COUNTY AND STATIC OF GAS TEST
t DL
CALIFORNIA ON THAT I AM THL LKOAL OWNIR OF,AND IMTLMD TO
RICSIDTHR ASOVL M�(
n..rD MA DCMTLAL FROF[IfrY. UTILITY CO. NOTIFIED
■IQNATURE
OF F[RM ITTI[
FINAL t
A MATION ROBERT A. WOOD C
cic M.O. ASH SUPERVISING MECHANICAL ENO'R
LrLos427�0 FEB 9 5 D 20.30-