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Home My Public Portal About4934 DOREEN AVE_Plumbing__ TenasT ` OBS_I7I0 .55 . _ APPLICATION FOR PLUMBING PERMIT 1 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING 7 JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT.TO FILL IN NEAREST NEARECROSS ST. OWNER DISTRO. GROUP ZONE I`r READY FCR IXSPELTION MAIL ( ADDRESS INDUSTRIALPOD CITY 1 TEL, NO. WASTE APPROVAL B PLUMER INSPECTION RECORD ADDRESS CITY TEL. NO. LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 BATH TUB @ $1.00 SHOWER - @ $1.00 ' LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK ,@ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY. @ $1.00 _ CLOTHES WASHER @ 51.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK I PERMIT $ i 00 ROUGH PLUMBING GAS PIPING TOTAL FEE GAS VENT I HERESY ACKNOWLEDGE THAT ( HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING, I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LI CE NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE UTILITY CO.NOTIFIED 4 DESCRIBED RESIDENT[ PROPERTY SRE .L OF PERMITTEE OFPER `1 FINAL' JOHN A. LAMBIE. COUNTY ENGINEER. VALIDATIO ROBERTA. WOOD, CHIEF PLBG. INSPECTOR CK. tl. 0. CAS L. 00 5 0 , JUL 22 3 J .- 0 � WORKER& COMPENSATION DECLARATION APPLICATION ,FOR PLUMBING PERMIT ,thereby, affirm.Thai I ho e o.certificate of consent to self,m 20-0026 DPW alai` . sure,or a certiflccte of Workers'CompensationCE'BInsurance or a CE'81 M7A7 REV g/g6) cerif�ed copylthereof (Sec 3800 Lab C-) .'. * , Policy No. OUNTY OF LOS ANGELES'_ - - .DEPT. OF PUBLIC WORKS Company C- - ` F71,, 'Certified copy is hereby furnished ` FOR APPLICANT'TO FILL IN (PRINT OR TYPE) BUILDING.. t ' ❑ Certified copy is filed with the county building inspection ' ADDRESS �,•� 6f�e /1✓Q. , X 'd NUMBER FIXTURE ITEM., @ FEE - - -.. - ,. . ' . LOCALITY Date > - •. Applicant .. - NEAREST WATER CLOSET(TOILET) - 7 t ,CERTIFICATE OF'EXEMPTION-F,ROM11 WORKERS'•. r BATHTUB' + - OWNERCOMPENSATION'INSURANCE 'SHOWER' B '(This section need not be completed-If-the work,involved,by MAIL ,he permit is for one:hendred dollars ($100)or less:) , LAVATORY. ADDRESS.' - certify that Tri the performance of the workfor which rh is�pei- - - - m t is issued, I shall not employ any person n-any manner so_ _ SINK.' - - - . :, .:CITY�f` - , TEI Nyqv Q�Q - - - as.to,becomI subject to the Workers Compensabon DISHWASHER CONTRACT ` ..LI • OR 'l�7�-PTC/ Date-- - Applicant ^ ;CLOTHES WASHER - NOTICE TO APPLICANT If; after making This CerLt cote'ofADDRESS .E.- SWIMMING POOL.RECEPTOR emptmn,you should become sableci to the`Workeis'Compen- 'CITY- TEL. NO: sationprovisions of the Lobor.Code .you mast forthwith`comp- •LAWN SPRINKLER SYSTEM ly,with such provisions`or this permit shall be`deemed:revak- _ STATE _ - - .LIC- `ed' - _ :.WATER HEATER - LICENSE NO. :CLASS - I, LICENSED CONTRACTORS DECLARATION-. DISTRICT NO OCESSED BY I hereby affirm ihat•,l am licensed under provisions of.Chapter GAS SYSTEM OU7LET5 0 - —r/! 9(commencing with Section 7000)of Division 3 of the Business -OUTLETS OVER and Professions Code and my-license is in full force;and'ef 5 PERSYSTEM .FINAL y ,t - - DATE License Number Lic. Class '-// VALIDATION a FIN Contractor` •` •' Date' .'' , . { § V BY AL G I'am eaempi.under Sec - M - W B.&P.C.for this reason - • cN . Plan heck-fee z Date:' PLUMBING PERMIT ISSUING FEE'$ c Signature` • - - . . ,. - s SINGLE FAMILY - TOTAL FEE Plan check a hmnt - HOME OWNER BUILDER DECLARATION '�, � 'applicant ., . . •... ,. - - .+=`•, _ I,fiereby,affirm that,l am-exempt the Contractor's License IJame - - - Law,for the following reason;(Section 7031:5 Business and aM !.0 -r• rF Professions Code): Addressl le S O t FrP {t- _lT I, as owner of the prw operty, will Bothe ork"arid the Cify. ,$ No. Structure'is notimeoded or offered for scile'(Sectmn 7044; - - - , - ;F?t: >L . Businessand ProfessionsCode)..- -' +- � - . . - _ . _ ;s i CONSTRUCTION LENDING;AGENCY 1 -s CK .:i�l hereby affirm..that there is•a construction lending agency for - _ 5 - +'Di' ` 1 The.performance of the work for which 11iis.permit Is issued ,43F (Sec. 3097, Civ.C.). Lender's Name, I. 1 Lender's Address _ . '. . - : - - L 1.. 1 1 I certify that I have.read this application and state.that the sl - - ' above information is correct 1 agree to comply with all County ordinances and,State laws regulating Plumbing, and hereby t-- aii oiiie representatives of this County to.enter upon the - +. ve-m entio a property for insp coon purposes: - - ' - -- -SEE REVERSE FOR EXPLANATORY LANGUAGE $' nature o. Pe_ nit ee � '. Date. _� WORKER'S have certificate COMPENSATION DECLARATION 76A666DPW 9/89 APPLICATION FOR PLUMBING PERMIT g 0-0026 I hereby affirm that I have a certificate of consent to self insure, 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. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE)❑ ADDRESS Certified copy is filed with the county building inspection -- department. NUMBER FIXTURE OR ITEM Ca' FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toMAIL become subject to the Workers'Compensation Laws. SINK ADDRESS DISWASHER CITY _ TEL.NO. Date Applicant ,^ CLOTHES WASHER NOTICE TO APPLICANT: If, after making this CeHificate of CONTRACTOR Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM } LICENSED CONTRACTORS DECLARATION CITY TEL.NO. a. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC. O (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. CLASS Professions Code,and my license is in full force and effect. W OUTLETS OVER DISTRICT NO. PROCESSED BY J 5 PER SYSTEM (y License Number Lic.Class } DATE VALIDATION 4 Contractor Date cc ❑ IO FINAL I am exempt antler Sec. FBY d B.BP.C.for this reason W Plan check fee V Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address 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 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, Ci, C.) Lender's Name Lender's Address Jcertify that I have read this application and state that the above , formation is correct. I agree to comply with all County ordinancestl State laws regulating Plumbing, antl hereby authorize presentatives of this County to enter upon the above-mentioned operty for inspection purposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE ..:atrg."t'widaf�^ c; PAftni'lte:z GYai�t ' • WORKER'Shave a cNSAicate of consent to 76A667OPW9la9 APPLICATION FOR PLUMBING PERMIT - 11 0-0026 I feraby affirm that I have a-certificate of consent to self insure, or a certificate of Worker'sComrpensaticn Insurance, or a certified copy theieof(Sec.3800 Lab. C.) - - COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company _ - ❑1 Certified,copy is hereby furnished. - - .- ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) _ BUILDING Certified copy is filed with the county building inspection- , ADDRESS r D oP ee A/ L, department. . NUMBER FIXTURE OR ITEM ® FEE LOCALITY l -/ Dale ApplicantWATER'CLOSET NEAREST / `•C� CERTIFICATE OF EXEMPTION.FROM WORKERS' BATH TUB CROSS ST. _ COMPENSATION INSURANCE ASSESSOR ' (This section need not be completed if the work Involved by the SHOWER - MAP BOOK PAGE PARCEL permit is for one hundred dollars(5700)or less.) OWNER ' I certify that in the performance of the work for which-this permit LAVATORY- is issued, I shall not employ any person in any man ner so as SINK L ADDRESS MAIL J�C'E v become�.surf e t to the Workers' Co alion Low DISWASHER CITY TEL.NO. Date APPlibant CLOTHES WASHER NOTIC TO PPLICANT: If, of making this rtificate of- CONTRACTOR ,�� eS U/• ]i/P ' Exemption,you should become Subject to the Workers'Compensation SWIMMING POOL RECEPTOR f ,[ ( ( provisions of the Labor Code, you.must forthwith comply with such ADDRESS �s $ i( � df` 7- provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYJ O 0 ,I,' TEL.N0.3y V= ) a hereby affirm thaf am licensed under provisions of Chapter 9 WATER HEATER - v� (commencing with Section ]000) of Division 3 of the Business and STATE yl LIC. O Professions Code, and my license is in full torte and effect. GAS SYSTEM OUTLETS LICENSE NO. C/ r619, CLASS �-- V OUTLETS OVER DISTRICT NO. PROCESSED BY O Irl /y 5 PER SYSTEM ��n p License Number�`v`�a" 3�— Lic.Class Lam — _ - FINAL fir•Ili .v W � DATE VATION Contractor D µ Date ❑ am exempt under Sec. NFINAL T'EyS By Z &BP.C.for this reason a T Plan check fee D .. .... . ._ _.. i:HECK 4.l.c.^ / Signature PLUMBING PERMIT ISSUING FEE.$ L�O CHANGE f ._('I - ❑ TOTALFEE `/ NH.�]E SINGPlan check applicant HOME OWNER-BUILDER DE DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law SIL_II_, 1 AN u >:..t for the following reason (Section 7031.5, Business and Professions. Address 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 7044, Business and Professions Cade). r 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 I 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 St a laws regulating Plumbing, and.hereby authorize rep sent lives of this C my to enter u n the abo -mentioned, pro arty r inspection u os - SEE REVERSE FOR EXPLANATORY LANGUAGE SW dLu1 U natulre of Permittees Dalle -