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Home My Public Portal About9081 EMPEROR AVE_Plumbing__ 6 DES177 I2 54 APPLICATION LIVATIO Y FOR PLUMBING ■ E ■ 9MIT DBS - DIVISION OF BUILDING AND SAFETY -' ` T Deporhment of County Engineer County of Los Angeles WM J FOX, COUNTY ENGINEER BUILDING ADDRESS CASSATT D GRIFFIN, SUP T OF BUILDING .12��yX _ LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST OWNER.) DISTRIC NO ,I GR'YU READY FOR INSPECTION, MAIL O /1 ADDRESS J // / INDUSTRIAL CITY TEL NO b' v/ WASTE APPROVAL PLUMBERy" INSPECTION RECORD ADDRESS �7 CITY - `` TEL No6k,0-:3277 Z fir( LCR�//�,I, 7-0(J LICENSE NO / CJ F_ y G✓V NUMBER TYPE OF FIXTURE OR ITEM FEE / O WATER CLOSET (TOILET) $ � _Vfrp7-,5 BATH TUB (y SHOWER eG. LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY �.� � ,,,, AA-' )'4 4 V CLOTHES WASHER UY ��>�'R !lf A-� ,fit.✓ �-7:l•�7 TOTAL NO @ o so APPROVALS dill-<& DATE INSPECTOR S SIGNATURE GAS SYSTEM OUTLETS @ 100 J ' � UNDER SLAB WORK WATER HEATER @ 1 00 G ROUGH PLUMBING V PERMIT $ I 1 00 GAS PIPING TOTAL FEE d 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 REGWLATING PLUMBING FIXTURES PLUMBING GAS TEST 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED l CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI L PROPERTY' SIGNATURE i 0� OF PERMITTEES FINAL b'��a • .d WILLIAM J. FOX, COUNTY ENGIN VALIDATION � _ico fes/ 0 /d_ SEP 1 3 9 4 0 5 Q ID 1 PUTY f0 lll/// �J/ r v WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that 1 have a' certificate of consent to self cE e1 7 (z-so) APPLICATION FOR PLUMBING PERMIT insure, or a certificdie of,LVorkers'Co ensation Insurance or a cer �fi�' c�ereof ec. 800,L � Cc � COUNTY OF LOS ANGELES BUILDING AND SAFETY Pocy No. mp n Vdepa�ftment. 09 fied copy ishereby furnished. � rMBE R APPLICANT TO FILL IN (PRINT OR TYPE) BUILDINGfied copy.is filed with the county build ng inspection FIXTURE OR ITEM • FEE ADDRESS_� LOCALITY j WATER CLOSET C Date Applicant NEARESTBATH TUB CROSS ST.CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE SHOWER .Z OWNER fie . (This section need not be completed if the work involved LAVATORY MAILADDRESS by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL. NO. I certify that in the performance of the work for which this DISHWASHER U permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER Jp c 0 ADDRESS 6� l � Date Applicant SWIMMING POOL RECEPTOR n U NOTICE TO APPLICANT: If, after making this Certificate of CITY /?e TEL.NO �% LU Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE Q LIC. to Compensation provisions of the Labor Code, you must forth- LICENSE NO.� �( CLAS 'g— with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P ESSED LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section'7000) of Division 3 of the Busi- FINALS -. ness and Professions Code, and my license is in full force and DATE VALIDATION effect. Lic.Class FINAL BY License Number 3 ^� o Contractor ! ate V2 0 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ n 0 O acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE /t� ? 0 0 0 0 0 C>' Lic.or Reg.No. Date Plan check applicant 2 25,00 HOME OWNER-BUILDER DECLARATION Name e- /v/ R S. J- rely. o o ° 2 5.0 G iS I hereby affirm that I am exempt from the Contractor's Address !Z0lIPefl? 8 2'5._E 1 License Law for the following reason (Section.7031.5, Busi- CityTeI.No. ness and Professions Code): I, as owner of the property, am exclusively contracting with 'licensed contractors to construct the project (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,Civ.C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned prope y for inspection purposes. '?ZA f� Signature of Permitte Date _ '✓ORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of'Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified cop;, thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company J&6A? 4,11 CnSf; Certified copy is hereby furnished. F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building in c- ADDRESS "; tion department. Q _ NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY Date Applicant 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 Zzm the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS � fl- I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY 'o TEL. NO. so as to become subject to the Workers'gompenscition La DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOT! E T APPLICANT: If, after making this Certificat ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR _ CITY - _ TEL. NO. ' Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM AS U `° with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISr I f rT6 PROCESSED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /j (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER V and Professions Code,and m license is in full force and effect. 5 PER SYSTEM 3 Y FINALD.DATE —26VA DATION License Number��fig'/, Lic. Class _ ��-- FINA : Contractor�/(l�/�G�- C�if '�Oate 1� BY I am exempt under Sec. � B.BP.C. for this reason te. Plan check fee pool. ;21 8 a 2 A r PLUMBING PERMIT ISSUING FEE$ Signature - -- # o o o o 0 5 TOTAL FEE S� Plan check applicant ( ° ° 1 6 5 Q SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o o 0 1 6 5 0 5 ! hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 0A Q 4—8 5 Professions Code): City Tel. No. ❑ 1, 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 wliich 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 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date