HomeMy Public PortalAbout9451 BROADWAY_Plumbing__ ;GAs1
n ssI' N 'PAPPLICATIO �FORLUMBING PERMIT w
oes_
DIVISION OF BUILDING AND SAFETY' 4
Department of County, Engineer
'County of Los Angeles ..
WM.J. FOX.COUNTY ENGINEER BUILOING�Y III _t, /
ADDR ESS "j /'/F'l P NVQ—"�- G�CJ Jy
CASSATT D. GRIFFIN, SUPT of BUILOINO
I LOCALITY`14/1T�iV •4� _V�'y 7�
_ FOR'_APPLICANT TO FILL NEAREST
IS • �
� (y ��V
f& /L -K ' CNO.
y
GROUP N/ ZONE RFA.Y FOR IVSPECTIan
MAIC
INDUSTRIAL
.CITY .TEL. NO. WASTE APPROVAL
PLUMBER —)s./L�/Y< LJ . {
INSPECTION RECORD
ADORESS�,/-( W.'//� �Lf" e(� � Li iLT�r �i G
C TVY(_aG.��1 I/. �� /t TEL. NO. , _
LICENSE NOf/ /,
NUMBER TYPE OF FIXTURE OH ITEM FEE -
7 WATER CLOSET (TOILET') e 8
BATH TUB -
SHOWER
LAVATORY (WASH BASIN I
KITCHEN SINK
DISHWASHER '
LAUNDRY TUB OR TRAY
CLOTHES WASHER -
. r I
t
x
TOTAL NO. r.o.eo APPROVALS
DATE INSPECTORS SIGNATURE
GAS SYSTEM OUTLETS n 1.00
WORK
WATER HEATER '. a 1.00 UNDER SL'A B.
ROUGH PLUMBING
'PERMIT 5 7 00
- { r GAS PIPING
TOTAL FEE �•T 60' GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY, ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
IHEREBY CERTIFY THAT 1 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 RESIDENTIAL PROPE"'�
SIGNATURE <,�./�✓1.'/ I
-OF PERMITTEE I• l/ VVVFINAL'
.WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R. A. WOOD. CHIEF PLBG. INSPECTOR
76A667-CE4817 10-67 1f L
G,c '"
',APPLICATION FOR PLUMBING PERMIT
COUNTY'_OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER J%
BUILDING AND SAFETY DIVISION BUILDING 7 L �lo,nG �
JOHN A. LAMBIE• COUNTY ENGINEER ADDRESS �l (-)A
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY (�4/-
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE %
L J
I WATER CLOSET 1.50 5_ OWNER MAIL
BATHTUB 1.50 ADDRESS I"1/✓1
SHOWER 1.50 CITY A 2( TEL. NO.
/ O /CONTRACTOR /
LAVATORY L50 S j2 o e
SINK 1.50 ADDRESS Soy, - 1Yic.-lC
DISHWASHER 1.50 CITY /pwtSTATE `, "1� TEL. NO. �L
�Zq
/ CLOTHES WASHER L50 ( S LIC
LICENSE NO. �a,J �J�U,� CLASS ` -3�
SWIMMING POOL RECEPTOR 1.50
DISTRICT NO. , GROUP _ ZONE I PROCESSED BY
1— }
LAWN SPRINKLER SYSTEM 2.00 O
WATER HEATER 1.50 INDUSTRIAL 0.J
_ WASTE APPROVAL
GAS SYSTEM ( OUTLETS 1.50 ( �9 SPEC ION RECORD U
OUTLETS OVER LLI
5 PER SYSTEM .JU 1N �, C, 0. /) h
Z
I^.. _
Plan check fee 25% of above. See reverse.
PLUMBING PER111T ISSUING FF,E S 110 APPROVALS DATE IS ECTOR'gSGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING 77-1
Address GAS PIPING
GAS VENT
City Te). No. HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST eye
PLUMBING. /
1 HERESY CERTIFY THAT 1?AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED /LOS ANGELES C NTY ANO STATE OF
CALIFORNIA OR THAT I M�THE LEGAL OW R'OF A D INTEND TO
RESIDE IN.THE ASOVE EE RIBEO RESIDENT A PR Tv. FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG-R._
OF PERMITTE PERINIIT VALIDATION CK. M.O. CASH '
PLAN CHECK VALIDATION CK. M.O. CASH
LAC07262�S N0u13 5 D 8.00 :v
,. APPLICATION FOR PLUMBING PERMIT
SUI,, I AND SAFETY DIV S ON
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING r
NUMBER FIXTURE OR ITEM ® FEE ADDRESS - (: a�✓
WATER CLOSET LOCALITY
BATH TUB NEAREST
CROSS ST.
SHOWER OWNER r S
LAVATORY MAIL / /q
ADDRESS �'\
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR �'
G
CLOTHES WASHER
ADDRESS Z 5`Q �L�J._
SWIMMING POOL RECEPTOR
CITY L TEL.NO�
LAWN SPRINKLER SYSTEM
STATE LIC. 7
WATER HEATER LICENSE NO. CLASS
GASSYSTEM OUTLETS DISTRICT ROUP Z E OCESSE B31Y
OUTLETS OVER (f�y ( ` /
5 PER SYSTEM INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORD
S—Z2-7�6 v t> yN Ae'j Sul 7'e oM N
J 3 Y �i =
Plan check fee
PLUMBING PERMIT ISSUING FEE 8
TOTAL FEE '
Plan check applicant
APPROVALS DATE INSPECTORS SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUM BING. HOT WATER HEATER -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY L05 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST -
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE �)
OF PERMITTEE FINAL IZJ 7d
PLAN EHKK\VAiID'A '10 J �''�VI rclGi,Iv'.,O—CASH— PERMIT VALIDATION cK: M.G. cnsH
.G.
POLICY HOLDER; 1j�"ti1Y 22 5 D 3 4.0 p &
POLICY NUMBER i✓fGj%SGc�� 7ii3 - _ . -
I
• 764661. +
CE 8I7TREV.67781
Its
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN IPRINT OR TV PEI BUILDING
ADDRESS N
NUMBER FIXTURE OR ITEM ® FEE
/ WATER CLOSET LOCALITY
lei
NEAREST
BATHTUB CROSSST. '
SHOWER OWNER -ht
p�v3'
LAVATORY 3 MALL '
ADDRESS
SINK CITY - TEL.NO.
DISHWASHER CONTRACTOR
r Y- V46,AlG-
CLOTHES WASHER ADDRESS 2—
SWIMMING
SWIMMING POOL RECEPTOR
CITY � TEL.NO 1`-iaz63
LAWN SPRINKLER SYSTEM
STATELIC.
WATER HEATER LICENSE NO. IF CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S MkNATURE
OUTLETS OV ER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING ,��• y
GAS PIPING i
O
GAS VENT V
as
HOT WATER HEATER FOF
PLUMBING FIXTURES W
GAS TEST 1N
Plan check fee UTILITY CO.NOTIFIED Z
PLUMBING PERMIT ISSUING FEE S 7
TOTAL FEE FINAL
Plan check applic t
PLAN CHECK VALIDATION
Name
Address
City Tel.No.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY.WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION p '1 q l
1 HEREBY CERTIFY THAT I A PROPERLY REGISTERED AND/OR LICENSED AS 2Oµ I• 1 A
REQUIRED BY LOS ANGELES Co. PND STATE OF CA IFOflN1A OR THAT I AM THE
LEGAL OWNER OF,PND fN0 ESIOE IN THE EMS RESIDENTIAL
PROPERTY.
# O O O D 6 5
t
SIGNATURE 2 6 6 U O O
OFPERMITTEE /5/p7p BYQ �' '
DI_RIQNO._ P CES�L�'+`�`"�V O o -1 —6005 8
5� I% 8 09.27-78
INDUSTRIAL
WASTE APPROVAL
i �76=687 -CE#817 2-62
APPLICATION FOR PLUM ING PERMIT
OS ANLES
DEPARTI ENTOUNTOF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER 11 ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN 'NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE J
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 135 'ADDRESS
CITY NO.
SHOWER 1.25
LAVATORY 135 CONTRACTOR
SINE 1.25 ADDRESS rl ",�Azf e6,
DISHWASHER 1.25 CITY C y J
CTOWS STATE
LAUNDRY TUB 1.25 •R GINSTRAT ON NO. O 4 �O COUNTY ❑
CLOTHES WASHER 1.25 DISTRIC NO. GROUP ZONE PR ESSED BY
WATER HEATER 1.50 ��} _
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 ER SYSTEM .90 - INSPECTION RECORD >
d
s
Z �
O
U
6
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING �I
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION /
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH BALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HERERY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS.TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.AND END To J T -
RESIDE N. THE ABOVE DESCRIBED RESIDENT PROPER UTILITY CO. NOTIFIED /
SIGNATURE
OF PERMITTEE
FINAL
VALIDATION ROBERT ROBERT A.'WOOD
cK.
M.0. CASH SUPERVISING MECHANICAL ENG'R'
LH1,08 4 1 7"� DED14 5- D 3.25~ Q
'B"ss' °°B" 7'5' APPLICATION FOR PERMIT '
DEPARTMENT OF BUILDING AND SAFETY P"L 0 N�J
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
TR :C GROUP ZO .
FOR PPLICAN11T TO FILL IN �. � / / —/
PLUMB � V
� RECEIV BY READY FOR ATE ISSUED
FIRST INSPECTION
ADDRESS �•'S- 7 ,-O/
BUILD NO Zx
CITY / / /� No. ADDRESS � /�)
CDUNTY 7 (' LOCALITY .en� Tw -
LIC NBE NO. / E%PIKES S NEAREST c <Z ,-
PERMIT FEES CROSS ST. ✓/n/ A CP��/Y ( Y,
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) a C.SO s3,/ ,/O ADDRESS
BATH TUB ® 0.50 CITY TEL No.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) /@ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK Q 0.50 Q, AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY a 0.50 Q ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
DAB SYSTEM-OUTLETS 0.50 U� SIGNATURE OF
WATER HEATER 0.50
SLOP BINK ® 0.50 INSPECTION COICD
FLOOR BINK ® 0.50 /<
FLOOR DRAIN ® 0.50
DISHWASHER ® 0.50
v
DRINKING FOUNTAIN ® 0:90
URINAL ® 0.50 - L/-� z Z'- 'r+'
Q
HOUSE SEWER ® 0.80 « _A[ Ai/O Qr G+QGdS Z
-
MISCELLANEOUS - l7
' O
APPROVALS
DATE INBP_ECTCR•9 NAME
ROUGH PLUMBING i
�GAS PIPING
GAS VENT
CESSPOOL ® 1.001 CESSPOOL
-
SEPTIO TANKI SEPTIC TANK
_ 'DRAIN'( `) PIT ( ) 100 SEWER
PERMIT11.00 •GAS TEST
• ^ ^ UTIALLITY CO.NOTIFIED
TOTAL FEE B G'/J✓/ //„(/P hc�//Z4/9 '
FIN �J'(I
/
couNrr of LOS ANGELES APPLICATION FOR PERMIT
Depaof County Engineer P L U f3 0 H �J
DIVISIOISIO OF N OF BUILDING & SAFETY
WILLIAM J. FOX. County Engineer
FOR APPLICANT TO FILL INDIST NO. GROUP I ZONE PER .
5 7/ I )-
PLUMBER
) -
PLUMBER - �' (,2/ J.-G[•C�Y✓3/�`L'YLCL) REGEIV¢D BY READY FOR DATE ISI
` i I FIRST INSPECTION /7 5* 1
ADDRESS �� :5 I � � � ;� _t r �_Ll' ,L
'nnI � 1 BUILDI NO
� !]
CITY ,-QJM1]-L,'1 LLL0TEL No. "'-L 6 I ! �� ADO RE'S % Jam/ /d/�' �1.(•"(<.IT.I�I_4i Ye_i
COUNTY �� J ' LOCALITY •'Q "
LICENSE NO. -/ EXPIRES
NEAREST
PERMIT FEES CROSS ST.
I
NUMBER TYPE OG FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ 0.50 1p U ADDRESS
BATH TUB @ 0.50 ) CITY TEL N0.
"7 SHOWER @ O.SO ) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
J, LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID,LOS
LAUNDRY TUB OR TRAY @ 0.50 ANO ELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
GAS "BVSTEM-�Z—OUTLETS 0.50
OF THE RESIDENTIAL PROPERTDESCRIBED ABOVE.
@ Q Y
SIGNATURE OF
,WATER HEATER @ 0.50 / /) l PERMITTE
SLOP BINK @ O.so INSPECTION RECORD
FLOOR SINK @ 0.50 _
FLOOR DRAIN @ 0.50 I /_ /J t/ Z/
U
DISHWASHER @ 0.50 TO �-eU E� _ �T—UP 4-
DRINKING FOUNTAIN @ 0.50 '�7 1`C p^/
URINAL @ 0.50 FJ g S 14,0
HOUSE SEWER @ 0.50 �M
MISCELLANEOUS �� v ❑
'vyv��.�`—.-Gt
i
Ge-
APPROVALS
ee�� DATE' INSPECTOR'S NAME
ROUGH PLUMBING - 'S/ s4 44144,L._
GAB PIPING
GAB VENT
CESSPOOL @ 7,00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 7.00 GAS TEST
TOTAL FEE
UTILITY CO.NOTIFIEDY��✓��/
C'3 !'
OO !c FINAL
.^,
76@06' DES#17 6-52 l% r
r
rm thfit I have a certificate
DECLARATION 76A667 DPW 9I89 APPLICATION FOR PLUMBING PERMIT
I hereby affirm ih�t I have a certificate of consent to self insure, ]BA667A
or a cer4ficale of Worker's Compensation Insurance, or a certified
copy(hereof(Sec.3800 Lab.C.) - p
Policy No��� /Oy Company �'n'-� COUNTY OF LOS AINGELES DEPT.OF PUBLIC WORKS, DEPT. OF PUBLIC WORKS DIV.
El Certified copy is hereby furnished.
Fl Certified
APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certifietl copy is filed with the count building inspection ADDRESS
NUMBER FIXTURE OR ITEM @ FEE LOCALITY �_ L
Date /� ✓ApplicanQ WATERCLOSET SQ NEAREST �G•r
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE B�GG'� � ASSESSOR
(This section need not be completed if the work involved by the 3 9HBvy "� i l MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) - +cry��^•J S OWNER
LAVATORY r <:
I certify that in the performance of the work for which this permit O
is issued. I shall not employ any person in any manner so as to SINK MAIL
become subject to the Workers'Compensation Laws. ADDRESS
DISWASHER CITY 'TEL.NO.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR �L
provisions of the Labor Code. you must forthwith comply with such ADDRESS Q -,
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM - �/
LICENSED CONTRACTORS DECLARATION C .z!/S7 TEL.NO�f�� }
1-hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �j�( �+li a
(commencing with Section 7000 of Division 3 of the Business and j GAS SYSTEM OUTLETS /.r7/ SCE SE NO.TATE LIC. V
Professions Code,and my license is in full force and effect. d"1 CLASS�3 t
OUTLETS OVER p / DISTRICT NO. EROCESSED BY
7 / 5 PER SYSTEM �•r13"tq.+ •O•/ J - O
License Number y� / �l / / T/ Lic.Class (.4 `-� �/ �- a./
FINAL 4 U
Contract `,e'� /� 7v2 f DATE a1 •.-pI I ' 1 7 V.�J DATIONI� - 829.bQ a
❑ I am exempt under Sec. "' �� 7 FINAL 1 Y /1'1fi.n.a— 1 ITEMS
B.&P.C.for this reason _ TOTAL tit T - 6 y
Plan check fee CHECK
_ � . ' I2,201.613
Date:
Signature PLUMBING PERMIT ISSUING FEE$ a/�X �' i12/ CHANE .L�I
❑ TOTAL FEE �o2�ro0 �.$':/ r
SINGLE FAMILY
Plan check applicant �- 11 3
IJQI]l]-I]I]Ll j 1/22/93
HOME OWNER-BUILDER DECLARATION Name _ `�
I hereby affirm that 1 am exempt from the Contractor's License Law •� /-p(-Q 7�sU 1 FIMii;w
for the following reason (Section 7031.5, Business and Professions Address 1
Code): 1 1
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 1 -. .• y
and Professions Code). D
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
1 certify that I have read this application and state that the above D
information is correct. I agree to comply with all County ordinances
and State taws regulating Plumbing, and hereby authorize - -
representatives of this County to enter upon the above-mentioned
property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
_ WORKERS' COMPENSATION DECLARATION APP I.P`•.11®I!.!i FOR PLUMBING AAA�DI11A?� f�R'RMIT
I her.apy affirm that I have a certificate of consent to self 20-0026 DPW 6/87 P'i lr IL 'b �tl FOR r IL�YtlHS® Il rl`L9 If"L.IK9H7 Y
insure, or a certificate of Workers" Compensation Insurance, 76A667A
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No.112946897 Company CNA Tns . Co-
F-1
O
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
13 Certified copy is filed with the county building inspec- ADDRESS 5512 Cloverly
tion department. NUMBER FIXTURE OR ITEM @ FEE
Locnury Temple Cit
Date 7-16-92 Applicant Owen Bros . Plbg. WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER D.W. McNeil CO. , Inc.
(This section need not be completed if the work Involved by
the permit is for one hundred dollars ($100) or less.) LAVATORY MAIL ADDRESS 5350 Alhambra Ave.
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 Los Angeles TEL. NO. 225-5694
so as to become subject to the Workers Compensation Laws. DISHWASHER
CONTRACTOR Owen Bros. Plumbing, Inc.
Data Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS 4265 N. Baldwin Ave.
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY El Monte TEL. NO. 443-0078
with�com with such revisions or this LAWN SPRINKLER SYSTEM
comply p permit shall beSTATE
deemed revoked. WATER HEATER LICENSE NO, 231 741 CLASSC36-20-16
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER e G
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL• CSG VALIDATION d
License Number 231 741 tic Class 036-20-16 ) g DATE 2 1/-/J 0.
Owen Bros. Plbg. 7-16-92 n - 5 By
C
Contractor Dote _
I am exempt under Sec. UV
B.BP.C. for this reasoni
Plan check fee t n N
Dote: Z
• PLUMBING PERMIT ISSUING FEE S
Signature - -
' c TOTAL FEE D
• Plan check applicant._
SINGLE FAMILY -
HOME OWNER-BUILDER DECLARATION Name 5
I hereby affirm that I am exempt from the Contractor's License -.
Law for the following reason (Section 7031.5, Business and Address
Professions Code): City _ Tel. No.
El
- ftti.g_I
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section t
7044, Business and Professions Cade). 40
CONSTRUCTION LENDING AGENCY !,t r-^.!!
I hereby offirm that there is construction lending agency for. L� =;1!
the performance of the work for which this permit is issued -
(Sec. 3097, Civ. C.). .1_f_f
• Lender's Name
Lender's Address 7j itjifl�=t�
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County .
k
nces and State laws regulating Plumbing, and hereby
z rese nedSEE REVERSE FOR EXPLANATORY LANGUAGE
�re of Permittee Date
WORKER'S COMPENSATION DECLARATION 20.0026 DPW 9169 I I
u
I hereby affirm that I have a certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PERMIT
or a certificate of Worker's Compensation Insurance, or a certified -
copy thereof(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.
UILDING
I2� '+ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS q ,4 �(�T(Q(,(i
Imo' enirtcopy is filed with the county building inspection
d _
epanment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �
Dale Applicant WATER CLOSET 4C I OL
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. LD
. COMPENSATION INSURANCEASSESSOR.
(This section need not be completed if the work involved by the SHOWER - MAP BOOK 0 1 PAGE PARCEL
permit is,for one hundred dollars(4100)or less.) OWNER A J
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 to SINK MAIL
become subject to the Workers'Compensation Laws. - - - ADDRESS
DISWASHER CITY TEL.NO.
Date Applicant CLOTHES WASHER `
NOTICE TO APPLICANT: If, alter making this Certificate of NTRACTOR•�1/'.n—. %ri! 4 ,f
Exemption,you should became subject to the Workers'Compensation SWIMMING POOL RECEPTOR `��'CCC���CCC.CCC" V i
provisions of the,Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION 0LLGTEL.NO. •T' '
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER N+c�c_r<.--v TATE (('' 0-
(commencing
(commencing with Section ]000) of Division 3 of the Business and SICENSE NO. � (O C'f CLASS �LIC. � O
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS
`{'\ OUTLETS OVER DISTRICT NO. PROCESSED BY
i to(, 1 Lit.Class l"r�t� 5 PER SYSTEM
License Number LO O 0
O U
_ p �yo(�( DATEFINA2—// /c 1/ VALIDATION W
�IGcrP �'� IFAS' DATE / IL
Contractor Dale rA
❑ I am exempt under Sec. 6Y AL _� Z
a
B.BP.C.for this reason
Data:
Plan check fee
Signature PLUMBING PERMIT ISSUING FEE S f
TOTAL FEE
❑ TOTAL 41- 35
SINGLE FAMILY Plan check applicant
CHE
HOMEOWNER UILDER exempt
DECLARATION Name - _
I herebyaffirm that I am exem t from the Contractor's License Law "•`�ttx`' �tlllt
for the ollowing reason (Section 7031.5, Business and Professions Address r"TTti1:L]�
Code):
❑ City Tel.No. .. -
I, as owner of the property,will do the work and the structure 1_i}1]11-1111!'1 li f 21., '
is not intended or offered for sale(Section 7044, Business
and Professions Code). D it{f[I i Ai�li%1i
CONSTRUCTION LENDING AGENCY
6 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 stale 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 enter upon the above-mentioned
pfope ty far inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Slgnatur f. Permittee Date