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Home My Public Portal About5932 CAMELLIA AVE_Plumbing__ woPKERs'coMPENsAT1ON DKLARAT1ON APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a cbrttficate of consent to self 76A667A Insure, or a certlflcate of Workers' Compensation Ihsur6nce, a 817(REV.10/81) '`]' oracert fled copy thereof (Set. 380Q, Lap. C-) COUNTY OF LOS APIOELES J � BUILDING AND Wrry Policy Company ❑ Certified copy is hereby fumfghed. FOR APRKANr TQ FILL IN(PkINT OR TYPE) BUILDING Certified copy Is filed with the county building Inspec- ADDRM tion department. NUMBER FIXTURE OR rrEM Q FEE LOCALITY Daip J App11 WATER O.OSET ��,�►7 NEAREST CERTIFICATE OF DffAAPTION FROM W15-MRS' BATH TUB CROSS ST. ��r✓�r�' COMPENSATION INSURANCE SHQWER 1 OWNER (This section nNd not be eomplefed if th6*ark Invollv4d by tis}permit to for Qne hundred dojlan{$100)br lee.) LAVATORY MAIL3� I certify that In the performance of the work for which this � permit Is issued,f shall not employ any persorr In any manner SINK crry Ti No. � so as to beeome subject to the Workers Compensation La,Vs. DISI-IWASHER CONTRACTOR Date Applicant CLOTHES WASHER r NOTICE TO APPLICANT: lf, after making this CwtlNcate of POOL ADDRESS7 Exemption, you should become sublect to the Workers', SWIAMNG Compensfrtlon provisions of The Labor Code, you must froth- G1T� TEL NO'S�F-�� with comply with sgch provisions or this permlt $hall be LAWN SPRINIa�SYSTFJ4l STATE LF__ deemed revQkpd. WATER HEATER LICENSE NO. / / CLASS LICENSED CONTRACTORS DC-CLARATION DISTRICT NO. ore I heby affirm that I am IIcansed under provtslons bf Chapter 9 GAS SYSTEM OU RZS (commencing with Sectlon 7006) of Division S•of the Business and Professlor4r Code,and mV lfcgnse.is In full force and effect. 5 PER SYSTEM DAAFINAL � W1LlDAT)ON 0 3 - License Number 3 � i Ic. CIQss-df� p� ^/'�� FINAL Contractor�� y_ .�►�`� Dgte BY ❑ d I am exprupt urpder Sec._ h B.&P.C. for this reasoZ n Plan check fee Date. PLUMBING PERMIT ISSUING FEE$ Slghatur � ^, ' TOTAL FEE Plan check applicant �045R SlrlClf FAMILY #too • a e ° 6 HOME OWNER-BUILDER DECLARATION Name / I hereby affirm that I am exempifrom the Contractor'sLlcense Law for rho following reason (Section 7031.5, Business and 4— 2'-,-.1 ,b 50 Professions code): t!clty Tel. No,. 6,5 0 ❑ 1, as owner of the property, will do the work and thio structure Is not Intended or Offerid for sale {Sectlorr , 07, 1 5�-8 3 71 4", Buslnep ani Professions Code}. CONSTRUCTION LENbING AW CY r hereby affirm that there Is a construction lending agency fro the performance of the work fol which this permit is Issued (Sec. 3447, Clv. C-). Lenders Narno Lendeh's k¢dress I certify that I have read this application and state that the , above Information Is correct. I agree to comply with all County ordihances and State laws regulating Plumbing, and fi"by authorize representatives Qf this County to enter upon the above•-mentioned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnaturp Itt Date 7"667 APPLICATION FOR PLUMBING PERMIT BUIMING AND SAFETY DMSION Dep'ameat of Co=tr EngfnNr CommtT of Los Angaiye1JILDING JOHN A.LAMBIE,COUNTY ETNGINEER 'DDRB CAHBATT D.GRI"IN,BL7"t of BUILDMo LOCALITY FOR APPLICAM TO FILL IN NE.ARMST C OHS Err, La Tuimo OWNER D18TR 0. GROUP ZONE I ncADT FOR usfKGT)0■ MAIL ADDRESS 5932 Cen011ia. AVO• ..L INDUSTRIAL CITY WAST APPROVAL PLUMBER DUCE PLUMBING & HEATING INSpYGTION RECORD ADDRESS 3232 N. San Gabriol Blvd. CITY b ol Tei_ No. AT-04931 LICeNBE NO. 104970 NUYa[R I r"K OF rDrruni OR ITOI ME WATER LOSET (TOILET) 1.00 BATH TUB ® fl.00 SHOWER Q 1.00 LAVATORY (WASH ASIN) 1.00 KITCHEN SINK 0 V.O-O DIHHWAH ER 1.00 LAUNb Y TUB OR TRAY (2 $1.00 CLOTHFA WASHER 41.00 WATEEfZ HEATER 1.00 1 OAS HYHT - I.00 APPROVALS DA'Z'E INSPECTOR'S SIQlIATURE UiIDER SLAB WORK PERUrT x 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE Q GAS VENT i HEREBY ACI CrIFLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPLT HOT W TSR HEA WITH ALL COUNTY OGpINANCES AND ¢TAT$ LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I /1)i PROPERLY REGISTERED A11D/OR EAB TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN THE ABOVE UTILITY CO.NOTIFI® DESCRIBED RESI ENTI P 0 SIGNATURIS OF PERMITTEE FINAL ROBERT A.WOOD, JOHN A. LAMBIE,COUNtY GINmE.R VALIDATIO q 5UI+ERVLBING MECHANICAL ENG'R az. ■.o. w X1£3 3 2.00