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Home My Public Portal About9068 EMPEROR AVE_Plumbing__ 11 WORKERS COMPENSATION DECLARATION 20-0026DPW,4/87 APPLICATION FOR PLUMBING PERMIT � erebyt„pffirm that I have a certificate of consent to self m- 76A667A u sure, Grqtic+hficate of Workers'Compensation Insurance,or a CE 817(REV 8/86) ,obrCd dopy thereof (Sec 3800, Lab �C ) • t �r COUNTY OF LOS'ANGELES DEPT-OF PUBLIC WORKS Policy No O mpany a e n G/ `* y Certified copy is hereby furnished �' - ' FOR APPLICANT TO FILL IN (PRINT OR TYPE) tBUILDING Certified copy is filed with the county building inspection DDRESS• d ( iC�%L7cl portment + NUMBER r ' FIXTURE,OR ITEM_ @' FEE OCALITY ��`'� �J � - WATER CLOSET(TOILET) ti r Date �^Applicant� _ NEAREST CERTIFICATE OF EXEMPTIO FROM WORKERS' BATH TUB ' CROSS ST _ COMPENSATION INSURANCESHOWER'. - OWNER ,(This section need`not be completed if;the work involved by MAIL ' "' / ° the permit is for one.hundred'dollars ($100)or less ) ',LAVATORY " ADDRESS w I certify'that in the performance of the work for'which this peri mit is issued, I shall not employ any person +k. n any. monner so _ SINK ' CITY ? TEL NO as to become'subject to the Workers'Compensation Laws DISHWASHER ' CONTRACTOR Date B Applicant � _ CLOTHES WASHER b ADDRESS ' NOTICE TO APPLICANT If, after making this'Gertificate of Ex- SWIMMING POOL RECEPTOR emption;you should become subject to the'Workers'Compen- r CITY rj TELNO sation provisions of,the Labor Code, you must forthwith comp'- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall-tie deemed revok- STATE L C ` ed " A, ` ", F 1 11 WATER HEATER LICENSE NO Q CLASS -LICENSED CONTRACTORS DECLARATION I ` , DISTRICT NO PRO! SSED BY I hereby affirm that I am Iice nsed'under provisionp s'of,Chater GAS SY,STEM•" OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER" fed Pro""fessionsrCode, and my license is in full force and ef- 5 PER SYSTEM FINAL,? VALI TION DATE d License Number Lic-,Class ' • V- ' FIN Contractor , ate .�Z BY D t r' i • w - lamexempt under Sec W w W B&P C for this reason { Plan check°fee ► a T r . Y,•� • ,. , a a Date PLUMBING PERMIT ISSUING FEE$ SigratureTOTAL FEE' 2999.-6A SINGLE FAMILY +" HOME OWNER-BUILDER DECLARATION Plan check applicant ; ' ' # e ?,o 0 0 5 I hereby affirm that I`am exempt from the Contractor's License Name t a �;'o 0 2 8 5ro0 Lawrfor the followmg'rea`son (Section 7031'5, Business and , Professions Code) Address y o o'o = 28,50 I,*as owner of the property", will do the,work and'the City Tel No structure is not intended or offered for sale(Section 7044, 2 7�,8 8 r Business and Professions Code) 1' s s, CONSTRUCTION LENDING AGENCY p '- I`hereby affirm that there is a construction lending agency for " the performance of the work for,which`thisipermit is issued (Sec 3097;CGv C ) " Lender's Name Lender's Address 1' I cerhfy,thot I have read-this application andIstate that the r above mformahon is correct,)agree to comply witFi all County t ► ordinances and State jaws regulating Plumbing, and hereby " autl orize representatives of this County to enter upon the above-me oned property for'mspechon purposes � REVERSE FOR EXPLANATORY LANGUAGE �ir� SEE - S alure of Permittee Date - a , D B S 17 25M BETS 7-47 APPLICATION FOR PERBM DEPARTYJ NT OF BUILDING AND SAFETY 7 CdUNTY OF LOS ANGELES WM J. FOX, CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DIST+RI GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE J �,7 HEATER_1_1 CESSPOOL —I SEPTIC TANKRE D Y READY FOR DATE ISSU D FIRST INSPECTION AS MISCELLANEOUS — ' APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY � K T JOB E NAME � i ADDRESS m ADDRESS / tJ4 �� -� LOCALITYNEAREST Z 7 d CITY I .TEL No. CROSS ST. COUNTY r CERT NO EXPIRES of NAME It v LOCATION OF SEPTIC TANK, OR CESSPOOL MAIL �y 3 - ADDRESS NORTH O ( i CITY " ,�-f5i5� TEL NO. t AM THE LEGAL POBBIESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK a z_ 1 BATH TUB FURNACE 17 ROWER DISHWASHER 0 O LAVATORY 4"REFRIGERATOR t� KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN t WASH TRAY URINAL APPROVALS WATER CLOSET - DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER—GAS SODA FOUNTAIN OUTL GAS PIPING GAS VENT I I CESSPOOL TOTAL NUMBER OF FIXTURES �\ SEPTIC TANK .CESSPOOL BEPTICTANK e'CJ WER I I $ UTILITY CO NOTIFIED TOTAL FEE l FINAL t � 9 8 25M SET-5 11-46 + APPLICATION FOR PERBUT DERARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELESL � � L 1 Wm J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP -ZONE PERMIT NO. ROUGH FIXTURES COMPLETE HEATER _� 4 �1✓ �� "`�- HEATER CESSPOOL SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION r AS MISCELLANEOU G"1- APPLICANT FILL IN HEAVILY"OUTLINED PORTION ONLY JOB L , NAME J ADDRESS ,J Id m ADDRESS /> > /✓ LOCALITY , D U V NEAREST .J CITY TEL No. CROSS ST. A. COUNTY CERT No EXPIRES � NAME LOCATION OF SEPTIC TANK, OR CESSPOOL 3 MAIL ADDRESS NORTH O �^ y�^O CITY TEL No 1,eC 7 I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFIC TE OF QUALIFICATION. -� PwMeert 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED � ABOVE. J �. WNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z / BATH TUB FURNACE / IY SHOWER DISHWASHER cl LAVATORY REFRIGERATOR / —KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS /9 WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S HAMM /,WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I 3o METER !0*1 GAS SODA FOUNTAIN OUTL GAS PIPING 1y GAS VENT 1 CESSPOOL e� TOTAL NUMBER OF FIXTURES �) /„! SEPTIC TANK 7- - -CESSPOOIEPTICTANJK SEWER A UTILITY CO NOTIFIED n {1I TOTAL FEE FINAL I 76A667-CE817-8-58 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUII.DING AND SAFETY DIVISION DR SS 9068 E. Emperor St rOHN A. LAMBIE. Count F Engineer cASSATT D. GRIFFIN,Sunt of Building LocALITY Jemplp City FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS 9068 E. L'mperor _ SHOWER CITY Tem1ple C JtV TEL. NO. LAVATORY CONTRACTOR Swan Pools Inc. Smx ADDRESS 13336 Ventura DISHWASHER cITYEncino TEL. NO. St84460 CONTRACTOR'S - STATE ElLAUNDRY TUB REGISTRATION NO COUNTY CLOTHES WASHER DISTR O [eOUP, Z/O)N/EJ ROCESSED Y WATER HEATER t1G /�'/ ( r , GAS SYSTEM INDUSTRIAL WASTE APPROVAL 114SPECTION RECORD / w ter supply to pool APPROVALS @ $1 00 PER ITEM —DATE INSPECTOR'S SIGNATURE ek OR FIXTURE $ UNDER SLAB WORK PERMIT $ 2100 ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP KATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT I 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 RESIDENTIA OPERTY SIGNATURE FINAL �� OF PERMITTE ROBERT A WOOD OF ]1,-3#4_ Ventura N. Green VALIDATION SUPERVISING MECHANICAL ENG R Green, m O CASH ' 'COO 0 4 S L JUL 24. 5 A 4 0 0 �Yr��/