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HomeMy Public PortalAbout10671 FAIRVIEW AVE_Plumbing__ i cY! COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY 1 WILLIAM J FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. PLUMBER VALLEY BOULEVARD PLUMBING C0: RECEIVED,By FIRSTpDY FOR INSPECTION DATE ISSUED r'g ADDRESS 8300 EAST VALLEY BLVD. BUILDING � � A CITY ROSBAEADt TEL No AT 2-2719COUNTY ADDRESS /E LICENSE NO cS EXPIRES 6-30- LOCALITY NEAREST PERMIT FEES CROSS ST NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ Oso 111 ADDRESS BATH TUB O 50 CITY TEL No SHOWER 050 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 1 LAVATORY (WASH BASIN) (9 050 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK Q 050 AND STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0 0 50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIB�D ABOVE GAS SYSTEM-3—OUTLETS 0 13 SO ATURE OF WATER HEATER 0 O 50 BIONPERM IITTE I: SLOP SINK D SO INSPECTION RECOR FLOOR SINK 0 O 50 FLOOR DRAIN @ 0.50 DISHWASHER Q O SO DRINKING FOUNTAIN 050 URINAL O 50 -J Q HOUSE SEWER 0 O SO Z MISCELLANEOUS LD M O APPROVALS .. DATE IN/SPECTCR,b NAME ROUGH PLUMBING ,.,,(L.1'� �'� / 0— GAS GAS PIPING '�jj A GAS VENT J CESSPOOL J OO CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT t 00 SEWER J►y�d PERMIT i Do GAS TEST r A Y d 1 .� •e! Q UTILITY CO NOTIFIED tJ TOTAL FEE U Q ,`o Io1� FINAL 76A667 DBS$#17 6-52 I , , WORKER SCOMPENSATION ate DECLARATof consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT f I hereb� affirm that I have a certificate of consent to self insure 76A667A or a certificate of Worker s Compensation Insurance or a certified / copy thereof(Sec 3800 Lab C) Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV _ ❑— Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection ( ADDRESS f ��If t• r—A-i 9 -i, HN5j�j department NUMBER FIXTURE OR ITEM @ FEE '-fLOCALITY Date Applicant ' WATER CLOSET v NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST 17Pi{— 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($100)or less) LAVATORY OWNER � �./ ,n IN-, -g pr-- I certify that.in the performance of the work for which this permit MAIL MI `rwJ Y' is issued I shall not employ any person in any manner so as to SINK ADDRESS �'©1 J I c become subject to the Workers Compensation Laws ' -A f 1,CT YO— J �- DISWASHER CITY-7g:I d iT�J/�—G•1_ /I n/ TEL NOTA"2,qZ Date Applicant CLOTHES WASHER 1 � V J ' TT ` NOTICE TO APPLICANT If after making this Certificate of CONTRACTOR ' Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwithicomply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER j1 (commencing with Section 7000) of Division i3 of the Business and STATE LIC O Professions Code and my license is in full force and effect GAS SYSTEM OUTLETS LICENSE NO CLASS U OUTLETS OVER DISTRICT NO O PROCESSED BY cc a ' 5 PER SYSTEM D ` O License Number Lic Class H FINAL U DATE ( VALIDATION W Contractor Date ❑ I,am exempt under Sec FINAL Z BY B&P C for this reason Date Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE _I SINGLE FAMILY Plan check applicant _ HOME OWNER BUILDER DECLARATION Name I hereby affirm'that I am exempt from the Contractors License Lawani r,(1 for the following reason (Section 7031 5 Business and Professions Address. �` °"" Code) ' 1 T i rs Ll --- City Tel No I as owner of the property will do the work and the structure i I_I AL 20-1 - 519 is not intended or offered for sale (Section 7044 ,Business 6 and Professions Code) ' r"�j�Lf i3(° 11 and 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) - - F I E_11tiR_5—I'!tl II 12, i 90 Lender s Name .�q�� ;10 cr 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 WORKERS'COMPENSATION CE e»SATION DECLARATION 81 A ) APPLICATION FOR PLUMBING PERMIT I herebyaffirm that I have a certificate of consent to self ce (z-so insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) t 7(11 Q1 man C� Y Vr LT&MAV ELES�' y BUILDING AND SAFETY Policy No (& p y gcTV 7716 Certified copy is hereby furnished - FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ® ADDRESS 10671 E. , Fairhall Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE LOCALITY department WATER CLOSET _ _ - Temple Date-4/11- 9 ApplicantJ,�'-i-an-W-'a- c��l� NEAREST - + ` CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST El Monte Ave COMPENSATION INSURANCE SHOWER OWNER Edwin D MAIL (This section need not be completed if the woik involved LAVATORY ADDRESS 10671 E. Fairball St. by, .the permit is for one hundred dollars ($100) or less) } SINK CITYTi NO Z- CL 9165 I certify that in the performance of the work for which this DISHWASHER 1 U permit is issued, I shall not employ any person in any manner CONTRACTOizieneral Installation Co ir so as to become subject to the Workers' Compensation Laws CLOTHES WASHER 1 0 - ADDRESS Date Applicant SWIMMINCOOL RECEPTOR U NOTICE TO APPLICANT If, after making this Certificate of CITY Los A TEL 3-2941 a Exemption, you should become subject to the Workers' LAWN SPRINKiER SYSTEM STATE LIC to Compensation provisions of the Labor Code, you must forth WATER HEATER 6 00 LICENSE NO 1 C AS Z with comply with such provisions or this permit shall be deemed revoked GAS SYSTEM ETS DISTRICT NO PROCESSED BY , O LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi FINAL TIO ness and Professions Code, and my license is in full force and DATE VALI N�/�� — �O effect I , v 18q BY 513 ' License Number is Class C36 BY Contractor oViftte 41M9 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Bus PLUMBING PERMIT ISSUING FEE$ 1OJ50 iness and Professions Code) TOTAL FEE 16 50 ;2 0 7 7 6A Lic or Reg No Date Plan'check applicant # o 0 o o,o 5 HOME OWNER BUILDER DECLARATION Name Io -,,16.50 I hereby affirm that I am exempt from the Contractor's 5 Address 0 00165060 License Law for the following reason (Section 7031 5, Busi City Tel No ness and Professions Code) 0 927-88 F] 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 o tftTll County to enter upon the above-mentioned pr rt form ection purposes a Sigriftfure of Per Date WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I he affirm that I have a certificate of consent to self 20-0026 DPW 6/87 r insureor a certificate of Workers,Compensation Insurance 76A667A or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company Certified copy is hereby furnished / ❑ „ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building mspec- 57/ tion department NUMBER ADDRESS /D 4p FIXTURE OR ITEM @ FEE ; , LOCALITY DateApplicant Y °w` WATER CLOSET v NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE-'s , OWNER �LA) SHOWER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less ) LAVATORY r ' ADDRESS I'certify that in the performance of the work for which,thisA / ,/ permit is issued I shall not employ any person in any manner SINK r CITY, ) E�d z,& 0 1�y TEL NQg fq 4U4-2&'q(,, F so as to become subject to the Workers'Compensation Laws t c DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS , Exem tionyou should become subject to the Workers SWIMMING POOL RECEPTOR P Y I , CITY TEL NO 1 Compensation provisions of the Labor Code, you„must forth- LAWN SPRINKLER SYST � Iq with comply with such provisions' or this ermi{+'shall be �� STATE LIC deemed revoked p p L"' WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION I DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisLons of-Chapter 9 GAS SYSTEM OUTLETS, (commencing with Section 7000) of Division 3 of the,Business OUTLETS OVER o } and Professions Code and my license ism full force and effect S,PER SYSTEM FINAL VALIDATIOP! 0.ti ' DATE 0 License Number L,c Class 0 FINAL fControctor Date BY 0' ❑ I am exempt under Sec q �f B &P C for this reason r Plan check fee Date PLUMBING PERMIT ISSUING FEE$ O Signature TOTAL FEE JT qU Plan check applicant _ SINGLE FAMILY ,... _ HOME OWNER-BUILDER DECLARATION' Name Eb /pay 0, 4-MNtk1A 13a, ,lw, I - I hereby affirm that I am`exempt from the Con0actor s License _r_ Law for the following reason (Section 7031 5, Business and Address i f K (—ice, ST— -(r ' __� - Professions Code) City' �► Tel NMIS tlb I;as owner of the property will do the work and the - y ' structure is not intended or offered for sale (Section ® i I_ 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there,is a construction lending agency for y { _k4ty L the performance of the work for which this permit is issued (Sec 3097, Civ C10 ) Lender s Name - Lender s Address r r', - I certify that I have read this application and state that the r above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing and hereby authorize r presentatrves of this County to enter upon the t r x abov 11 ned roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE �4TqJ Signature of Permittee Date ' � w