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Home My Public Portal About9162 BROADWAY_Plumbing__ C6e17 9163 • eF, ^ P APPLICATION L FOR UMBING PERMIT • COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER / BUILDING AND SAFETY DIVISION BUILDING b JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSE[ 3125 2S MAIL BATH TUB 1,25 7 s ADDRESS _SHOWER 1.25 CITY TEL. NO. LAVATORY 1.Y5 / Z•S CON7RACT0 SINK 1,25 7 ADDRESS DISHWASHER 1.25 CITY TEL. NO Q LAUNDRY TUB 125 CONTRACTOR'S _ STATE ❑ REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 I Z.S DISTRICT NO. GROUP ZONE I t!q, MESSED BY WATER HEATER- - - - 1.50 _ .G J 12- I v C�-E+•at�' GAS SYSTEM OUTLETS 1.50 INDUSTRIAL - a' WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD IJ 17-A—e 1/ IN o Ll / a z Aa APPROVALS �C D' TE INSPECTOR'SfIGNATURE. PERMIT S 2 00 UNDER SLAB WORK r v ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS'V ENT ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING, I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - PLUMBING FIXTURES L VV LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST I,06 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED 1/ Y!'� SIGNATURE OF PERMITTE FINAL /C//�7" /�+J/A• V LIDATION ROBERT A•WOOD cK. / M,O. CASH SUPERVISING MECHANICAL ENG'R LACO2 3 1 5AUG 6 5 D 1 125 WORKERS' cI have ATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that have o'certificate of consent to self 76AE67A -. insure, or a certificate'of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof ec. 3000, L b. C.) n C (_ Ct COUNTY OF LOS ANGELES l ,L BUILDING AND SAFETY OcY Company l Certified copy is hereby furnished. EJ Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM C FEE LOCAU /'f Date q licant WATER CLOSET l�. PP tv NEAREST CERTIFICATE.OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER - (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL �7 ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ✓ SINK CITY TEL. N so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR r Date Applicant ✓ CLOTHES WASHER ADDRESS NOTICE APPLICANT: If, after making this Certificate of 1 Exemption,n, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO.LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall beSTATE - C. deemed revoked. WATER HEATER LICENSE NO. / C it LICENSED CONTRACTORS DECLARATION DISTRICT NO. fROCESSEQ PY I hereby off irm that I am licensed under provisiohs�of Chapter 9 GAS SYSTEM OUTLETS _ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER - - and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALVALIDATION 0 (License NumbeC, (t'/9 V��J' Lic. Class DATE VV 1\ ad FINAL Contractor .E.( / Date BY F_ ❑ I am exempt under Sec. / .Z �O ut B.BP.C. for this reason Plan check fee D '<3 7 Q 8 A z Dote. PLUMBING PERMIT ISSUING FEE$ D Ci Signature ( 0 0 0 0 0 5 TOTACFEE L ' Plan check applicant 2 ?to 2 8 50 SINGLE FAMILY Q HOME OWNER-BUILDER DECLARATION Nome I hereby affirm that I am exempt from the Contractor's License Address 01823-84 Law for the following reason (Section 7031.5, Business and Professions 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 D 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.). u Lender's Name Lender's_Address I cerlify that I hove read this application and state that the D 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 enter upon the above-mentioned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION PP ICA TION FOR PLUMBING ®0 p ppp BIN PERMIT 1 hereby.affirm that I have a certificate of consent to self 76A667A P91�I�IL P9 0 OCI FOR Ir IL ILY�V9 ACI`L9 Ir lG ll'17H9 0 insure, or a certificateof Workers' Compensation.Insurance, CE B17(REV. 10/81) �° oro certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES �' BUILDING AND SAFETY �{P�olicy No./C F6�lL`XCompany Elf; rd0yr Jfn-- IvL�. , 1 Certified copy is hereby furnished. EJ Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 5—. tion Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURMITEWM@ EELOCAD7VDate Applican { WATER CLOSETAREST Ir— CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB - CROSSSLCOMPENSATION INSURANCE SHOWEROWNER(This section need'not be completed if the work-involved by Rthe permit Is for one hundred dollars ($100)or less.) f LA1161- lckrl� VATORYADDRESS �y I certify that in the performance of the work for which this - J �r permit is issued, I shall not employ any person in any manner SINK CITU so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR �v U Co ✓� Date Applicant - CLOTHES WASHER 7 NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' . Compensation provisions of the Labor Code, you must forth- (M �WJJ with comply with such provisions or this permitshallbe — STATE LIC. LAWN SPRINKLER SYSTEM CITY TEL.NO�J deemed revoked. WATER HEATER LICENSE NO. l CLASS '..i LICENSED CONTRACTORS DECLARATION DISTRICT NO. P OCESSED BY . I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM _ OUTLETS (commencing with.Section 7000) of Division 3 of the Business OUTLETS OVER J 'O and Professions Code, �and �lm�yy license is in full force and effect. 5 PER SYSTEM FINAL CL VALIDATION V License Number [L� 3SL`{-('z"( Lic. Class /�' DATE �D ,f FINAL / O Contractor Date �2BY U " 1— U El am exempt under Sec. ( 1� [�v Is. B.BP.C. for this reason Plan check feeD a Date: Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant SINGLE FAMILY s.3 \7.1{J A HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License # o o\o a rj Law for the following reason (Section 7031.5, Business andAddress ! r Professions Code): City T.I. No. 2 0 5 B 55 Q ❑ 1, as owner of the property, will do the work and the o o structure is not intended or offered for sale (Section _ D r `j g"S = °' 7044, Business and Professions Code). Q r�.D 2-84 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 Nome Lender's Address o a o tb I certify that I have read this application and state that thee o (A above information is correct. 1 agree to comply with all County �M o J ordinances and State laws regulating Plumbing, and hereby Ivor o authorize representatives of this County to enter upon the I .CDs o J above-mentioned property for inspection purposes. Cpm On SEE REVERSE FOR EXPLANATORY LANGUAGE BCH �ature 1germltlee 'Date WORKERS COMPENSATION DEGLARATION APPLICATION FOR PLUMBING PERMIT I hereby affim{ that I hove"o certificate o4.cons en �o self in- pA7ADPW 4/87 � , lyre,or a rettificate of Workers'Compensoho surance,or h CE el](REV. 8/86) certified.copy thereof (Sec.,3800, Lab. C. COUNTY OF LOS ANGELES - DEPT. OF PUBLIC WORKS Policy No. Compo � Certified copy is'hereb" urnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING I�./'� BROADWAY A -/-/( z Certified copy is d with the county building inspection ' ADDRESS /L D(-` Y V A department. NUMnBER -FI%TORE OR.ITEM @ FEE LOCALITY Date Applicant ` WATER CLOSET(TOBET) -.PL NdE O NEAREST �/1 } CERTIFICATE OF EXEMPTION FROM WORKERS' 2 BATH TUB - LAC E - O CROSS Si.ROS�I {�•�� CJ,��I r COMPENSATION INSURANCE - SHOWER -+- OWNER -MR ,__ SU E - - - . -. f-. (This section need not 6e completed if the work involved by I � MAIL �/� ��L the permit is for'one hundred dollars ($100) or less.) - LAVATORY PMC O 'gDDRE55 {�1 L I.certify that in the performance of the work-for which this - SINK - mit is issued, I shall not employ any personin y net - 6 CITY TEL NO. as to become sublect I the Workers'Cornpe at' n La Q - ` t / DISHWASHER 'CONTRACTOR K ( M V`L ON� Date Applicant - CLOTHES WASHER D ADDRE O � O NOTICE TO APPLICANT: If, after m irg this Certi at Ez- SWIMMING POOL RECEPTOR - emption,,you should become subject to the Work ompen- CITY � 1 T .TEL. N sotion provisions of the Labor Cade, you must forthwith camp- - LAWNSPRINKLER SYSTEM L. l 1' ly with such provisionsor this permit shall be deemed revok- - STATE /' c LIC: ed: - WATER HEATER LICENSE NO. 6 S CLASS G ,UCENSED_CONTRACTOR5.DECLARATION _ - - DI TRI T N OCES r, licensed under provisions of Chapter GAS SYSTEM- - ` - - I hereby affirm that I ami' OUTLETS - D _ - 9'(commencing'with Section 7000)of Division 3 of the Business OUTLETS OVER Ped Professions Code,.and my license is in full force and ef- 5 PER SYSTEM FINA VALIDATION a � , 6�/^//I G 3 / DATE O License Number 4// Lic. Classy - Kim VVV{y� FINAL X1 I Contractor Date I( �4. - ." - BYiA O r 1 am exempt under Sec. - .. W W •B.BP.C. for this reason - Plan check fee D ` - Date_ PLUMBING PERMIT ISSUING FEE$ Signature . _ O .. - TOTAL FEE - - ' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant - C 1 hereby affirm that I am exempt from the Contractor's License Nome - • Law for the following reason (Section 7031.5, Business and _ AGGT.s 1 Professions Code): Address _ 'F� Cit Tel. No. .. - 3307 70.5d) I; as owner of the property, will do work"and the Y structure is not intended or offere r sole(Section 7044, - . 1` ITEMS Business and Professions Cod •'•-D TOTAL - . 70 .50 CON51RUCTIO ENDING AGENCY - 1hereby affirm that th is o construction"IendTng agency for - r. CHECK JO.SCI the performance o mVwork for which this permit is issued CHANGE .I1Q (Sec. 3097, Civ. .). 'Lender's me f [TJ 00-0001 11/30/S, Lend'er's Address • 7167 1 AM11%3 I certify that 1 have read this application and state that the - above information is correct. I agree.to comply with'all County ordinances and State laws regulatingPlumbing, and hereby authorize represent County to enter upon the(///�I _ shove-mention ns ecfion purp�l ossa s. ^✓ . . " SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur4Vof Permit te Date- -