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HomeMy Public PortalAbout9024 CALLITA ST_Plumbing__ DEC TION WORKERS' that have COMPENSATION cafe of corse APPLICATION FOR PLUMBING PERMIT. 1� I hereby affirm. that I have a certificate of consent to self 76g667q . J� ns✓re, or a c'ertifimte of Workers' Compensation Insurance, CE 817(REV. 10/81).' or a certified copy t-h•�ereof (sec. 3800, b. G) COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑ohcy No{O J-Compan - Certified copy is hereby furnished ) FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ •FEE LOCALITY � Date 1 l�Applicant L �Ii WATER CLOSET _ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS" BATH TUB CROSS ST. COMPENSATION INSURANCE - OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less:) 'LAVATORY MAIL _ ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in ah'y'manner SINK CITY TEL. NO066 so as to.became subject to the Workers'Compensation Laws. DISHWASHER _ CONTRACTOR Date Applicant CLOTHES WASHER - NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should became subject to the Workers' SWIMMING POOL RECEPTOR , Compensation provisions of the Labor Code, you must forth- CITY TEL. NO .9 LAWN SPRINKLER SYSTEM / with complywith such provisions or this permit shall be S7ATE /y LIC. deemed revoked. WATER HEATER LICENSE NO. n C1155 LICENSED CONTRACTORS DECLARATION DISTRICT.NO. PROCESSED BY I hereby off irm-that,I am licensed under provisions of,Chopter,9 __ _ _ _ GAS SYSTEM _ OUTLET_5., _ ." - .T _ -- - - _.-- .. n (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER T 02 l G and Professions Code, and my license is in full force and effect. 5 PER SYSTEM N EL / r VALIDATION O7/ License Numberi:X Lic. ClassDAUT - CK q I� FINAL O Contractor Date BY L ❑ I am exempt under Sec. H B.BP.C. for this reason z Plan check fee D X, 7 23 y A Date: PLUMBING PERMIT ISSUING FEE$ © tff'c o o'o - 5 Signature TOTAL FEEo , 650 Plan check applicant SINGLE FAMILY - e e e 1 650'0 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that 1 am exempt from The Contractors License ;I 1.3 0—8 3 Law for the following reason (Section 7031.5, Business and Address Professions Cade): 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.). Lender's Name _ .. . .. Lender's-Address I certify that I have read this application and state that the D above information is correct. Iagree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorizerepresentatives of this County to enter upon the Y above- ntioned property inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signofure o ittee Date 76A867A ICE 8178) -4/]] APPLICATION FOR PLUMBING PERMIT BWLDING AND SAFETY ISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING C NUMBER FIXTURE OR ITEM - ® FEE ADDRESS 02 G i'�A WATER CLOSET LOCALITY. - BATH TUB NEAREST CROSS ST. -�Y✓1-P.-� SHOWER OWNER LAVATORY - MAIL ADDRESS 4 SINK CITY �N' Jh' TEL.NO.OJ%-86Z DISHWASHER CONTRACTOR CLOTHES WASHER 6W06 ADDRESS L✓TO SWIMMING POOL RECEPTOR --- , _ CITY TEL.NOz6LIC. _ LAWN SPRINKLER SYSTEM` STATE m CL SS WATER HEATER LICENSE NO. V GAS SYSTEM OUTLETS 3 DIS)�1�0 �6RQUP O`E ,2O BY OUTLETS OVER /IJ�Pr�p !Vv' O 5 PER SYSTEM INDUSTRIAL V WASTE APPROVAL INSPECTION RECORD H _ 7/11/7-T /-7- 7"YL,AI E y A � Z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTALFEE 3 Plan check applicant APPROVALS DATE .INSPECTOR'S SIGNATURE Name L4,%*, ,� UNDER SLAB WORK Address 8o ✓r N Vv\ ROUGH PLUMBING City Tel.No.2r$5-2ZEJ,/ GAS PIPING HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE A80VE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES /I HEOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS iEST,,35'.p LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. - UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL PLAN CHECK V IDATION CK. M.o. CASH PERMIT VALIDATION cK. M.o. CASH 6 0 4�tdrit 24 5 D 1 3.0 Q AMg WORKERS'COMPENSATION DECLARATION � \ APPLICATION FOR PLUMBING(DING PERMIT I hereby affirm that I have a certificate offonsent-Fa self J6Afi6JA(�..-„-.]� u _ uv L Mtl91D II CI�.r l�0'(OH9 II insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified ��copy tthQreof he (Sec. 3800 C, COUNTY OF LOS ANGELES �/�. BUILDING AND SAFETY Policy No.p7ompan - Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building ihspec- ADDRESS NUMBER. FIXTURE OR ITEM EEE i tion department. n ' NEAREST f e` EAREST . OCALITY Dale Appligonl Y IL'/� ✓LXY�_Lh/'•'7.LWATER CLOSES NEAREST IF CERTIFICATE'OF EXEMPTIONFROMWORKERS' l' BATHTUB CROSS ST. - COMPENSATION INSURANCE SHOWER OWNER" (This section need not be completedif the work involved by.' MAIL - - - the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I'certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner - SINK CITY TEL. NO. so as 10become subject to the Workers'Compensation LOWS. DISHWASHER �/� ''')� CONTRACTOR Dmelf.L:121,QLApplicant CLOTHES WASHER ADDRESS D,b NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject td the Workers' CITY TEL. NO Compensation-provisions of the Labor Code, you must forth- LAWN SPRINKLER.SYSTEM with comply with such provisions or this permit shall.be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS .LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSED BY .. �y I,hereby-offirm that.lam licensed underpro4isions of Chapter 9 - . __ GAS.SYSTEM_ - - OUTLETS _ _ - - _ _ _ -.-..-_!/�`C//J (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER -'n 1. and Professions Code, y42and -m7y license is in full force and effect. 5 PER SYSTEM FINAL S ��•�¢"- VALIDATION V DATE License Number V 201ic. Class y� //11 FINAL ( O �� Contractor FC .9 Ll'!`-! Date. Ly 7` BVD t"*•+J V W ❑ 7�'7 s I am exempt under Sec. w B.SP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature _ - TOTAL FEE iso Plan check applicant SINGLE FAMILY - -� HOME OWNER-BUILDER DECLARATION Name 6 0 J.31A I hereby affirm that I am exempt from the Contractor's License Address f.Y o o0 0 0 5 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. —' 2te . 5250 ❑ I, as owner of the property, will do the work and the e a o 5 2.,5 0 c=s structure is not intended or offered for sale (Section D _ 7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY _ '1 0 1 7•—83 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, Ci, C.), Lender's Name Lender's Address , I certify that I have 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- eNioned propertyhr inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P iHee Date " WORKERS'COMPENSADECLARATION I hereby.afflrm that I have a certificate of consent to self APPLICATION FOR PLUMBING caER IT 1 L/ insure, ar a certificate of Workers'Compensation Insurance, CE817(REV. I0/8I) or a certified.mpy thereof (Sec. 3800, Lab, C.) COUNTY OF LOS,ANGELES BUILDING AND SAFETY P❑ollcy NoCompan J Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESSo Certified copy is filed with the county,but frig inspec- tion.department. NUMBER FIXTURE OR ITEM FEE " LOCALITY 7 WATER CLOSET Dote/.2-0-0)Appl icant NEAREST " CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. - COMPENSATION INSURANCE OWNER .. ., .- (This section need not be completed.if the work involved by' � - SHOWER - - MAIL . the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in,the performance of the work far which this permit is issued, I shall not employ any person in any manner SINK CITY N m so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM - - with comply with such provisions or this .permit shall be STATE LIC. deemed revoked. x WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby:affirm,that1.am licensed under provisions.of-Chapter9 -- -- -- .GAS SYSTEM., —_ _OUTLETS= -.__- - __ /�- - - -- commencin with Section 7000 of Division 3 of the Business 'A `� T r > ( 9 ) OUTLETS OVER - and Professions Code, and my license is in full force d effect. 5 PER SYSTEM FINAL tt G� DATE v - VALIDATION O License Numbe;?7 Lic Class U fyy FINAL / O Contractor BPeata ate_L BY U ❑ W I am exempt under Sec. � N B.BP.C. for this reason zPlan check fee D - Date: PLUMBING PERMIT IS FEE$ Lj Signature _ _ - TOTAL FEE 2 S� Plan check applicant ?. 7 6 J ) A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name #]'0 0 0 0 0 5. 1 hereby affirm that I am exempt from the Contractors License Address Low for the following reason (Section 7031.5, Business and 2 a e 2 2 50 Professions Code): City Tel. No. o•o o 'Z 2 J 05 ❑ 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 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Ci, C.). Lender's Name Lender's Address •I certify that I have 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 Io enter upon the - - above-m9fifloned property for 'n pec ion purposes. /� SEE REVERSE FOR EXPLANATORY LANGUAGE _ 3 Signa ure of Pe ee - Date /