Loading...
HomeMy Public PortalAbout10765 FAIRVIEW AVE_Plumbing__ ' Y 76A667-CES17$-59 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DIVISION ABUILDING DDRESS !� 76S F JOHN A LAMBIE County Engineer CASSATT D GRIFFIN Sup t of Building LOCALITY 40741. FOR APPLICANT TO FILL IN NEAREST L CROSS ST NUMBER FIXTURE OR ITEM OWNER 7 ( WATER CLOSET MAIL ADDRESS BATH TUB A0/ SHOWER CITY l.� TEL NO 2 LAVATORY CONTRACTOR 1 SINS ADDRESS 3 Cy, DISHWASHER CITY h/j AV" PAA TEL NO. CQ 7 3 7 9�r CONTRACTORS ? STATE LAUNDRY TUB REGISTRATION NO G—J 3 3��D COUNTY ❑ / CLOTHES WASHER DISTRIC� GROUP ZONE PR Y WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD Y ,GG e fS r $100 PER ITEM /O OR FIXTURE APPROVALS AT`E// INSPECTORS SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE I �� 00 ROUGH PLUMBING ��yp�GID GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE pp DESCRIBED RESIDENTIAL PJIPPERTY UTILITY CO NOTIFIED ///7 /�. .�i.Cd A- ------J) SIGNATURE / OF PERMITTE I FINAL Ij ', �F VALIDATION ROBERT A WOOD, Cs m 0 CASH SUPERVISING MECHANICAL ENG'R t UC.o 9 2 8 0-0 APR 14 5 A 1 2.0 0 WORKERS 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 copy thereof (Sec 3800 L b C ) COUNTY OF LOS ANGELES ` BUILDING AND SAFETY Policy No( 6325!n ompany `^'ld Certified copy is hereby furnished BUILDING / p FOR APPLICANT TO FILL IN(PRINT OR TYPE) f /� s Certified copy is filed with the county building inspec- ADDRESS O / e r tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant " i-irl WATER CLOSET NEAREST I CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER mr' ,,` � (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less ) LAVATORY /� ADDRESS 6'/ I r I certify that in the performance of the work for which this � , i permit is issued, I shall not employ any person in any manner SINK CITY - 0-1 , TEL NGyq -0&0� so as to become subject to the Workers Compensation Laws DISHWASHER 11 vt ' CONTRACTOR [�I Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of ADDRESS J(/6 � J �� Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY t /i�T�/�� TEL NO _�r�/� j with comply with such provisions or this permit shall be STATE /�/� LIC q deemed revoked WATER HEATER LICENSE NO ` /lJ CLASS � LICENSED CONTRACTORS DECLARATION DISTRICT NO ROCESS€D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O (commencing with Section 7000 of Division 3 of the Business ( 9 ) OUTLETS OVER � and Professions Code and my license is m full force 5 PER SYSTEM w a DATEL VALIDATION S r -- ? License Number Lic Class =wSc�J FINALb09 (Y rnma Contractor �� �'� �Date BY 0� V j❑ I am exempt under Sec �G pi CL I O N B&P C for this reason Plan check fee _ ► Z Date PLUMBING PERMIT ISSUING FEE$ (' � Signature TOTAL FEE Q j- SINGLE FAMILY Plan check applicant ' HOME OWNER-BUILDER DECLARATION Name - I hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5 Business and 3 9 p Professions Code) City Tel No ❑ I as owner of the property, will do the work and the 0 0 o 0 o 5 structureis not intended or offered for sale (Section ' 7044 Business and Professions Code) , 2 0 0 3 0 5 0 CONSTRUCTION LENDING AGENCY o 0 0 3 5 Q v I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 7, 26-83 (Sec 3097 Civ C ) Lender s Name Lender s Address I certify that I have read this application and state that the oil.above information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- entioned property for inspection pure ses 1 �� `� SEE REVERSE FOR EXPLANATORY LANGUAGE c / - re of Permittee f Date • / T WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING 19,ll� ING PERMIT "'T Hereby affirm that I have a certificate of consent to self 76A667A I� a �Y U NJAMIII� 1� GY��Yi insure or a certificate of Workers' Compensation Insurance CE 817 (REV 8/86) cul or a certified copy thereof (Sec 3800, Lab C ) Polcy NWC70028POJ, ,y CNA a COUNTY OF LOS ANGELES _ DEPT OF PUBLIC WORKS , Certified copy is hereby furnished © FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 10765 "E. Fairview Ave . Certified copy is filed with the un jdinspec- ADDRESS tion department NUMBER VFIXTUREORITEM @ FEE LOCALITY Temple City Dote 4/15[87 Appli4ant WATER CLOSET NEAREST^ CERTIFICATE OF EXEMPTIO FROM ORRS',, BATH TUB CROSS ST ; COMPENSATION I SURANCE SHOWER, OWNER >ggig Gonzales (This section need not be comple ed iF the work Involy by the permit is for one hundred dollars ($100)or less ) LAVATORY ' MAIL 10 7 6 5 E. Fa l r V l e W AV e . I certify that in the performance ADDRESS of the work for which this - permit is issued I shall not employ any person in any manner SINK CITY Temple City TEL NO 4`44-0606 so as to become subject to the Workers'Compensation Laws DISHWASHER ' CONTRACTOR Verco- Plumbing, Inc . Date Applicant CLOTHES WASHER ADDRESS '`NOTICE TO APPLICANT If, after making this Certificate of P. 0. BOX 6530 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL Np, Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM J 8 5-141 with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO 484333 CLASS C36 LICENSED CONTRACTORS DECLARATION . 0O 6 .100 . DISTRr_j NO R ESS BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS"SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER )t ^>° 0 and Professions Code and/fq license is in full force and effect 5 PER SYSTEM FINAL VA DATION v License N m 48 333 Lic Class C36 DATE / /87 FI Contract o Date '4 1 -c-! I � (j I a exempt un er Sec y B C fort is reasona Plan check fee —� �6967,A Date Signature PLUMBING PERMIT ISSU G FEE$ 10 , 50 - # o,o o o o 5 TOTAL FEE 16. 50 Plan check applicant - ( ° ° 1 65,0 SINGLE FAMILY ee y HOME OWNER-BUILDER DECLARATION Name Y' I hereby affirm that I am exempt from the Contractor's License Address ° Low for the following reason (Section 7031 5, Business and Professions Code) City Tel No IDI,'as owner of the property, will do the work and the w structure is not intended or offered for sale (Section 7044, Business and Professions,Code) CONSTRUCTION LENDING AGENCY rt = 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 isc rect I agree to comply with all County ' ordinances and Stat ws regulating Plumbing, and hereby ouch nze eprese tcjjfves of this County to enter upon the a v - e tione operty for inspection purposes - r SEE REVERSE FOR EXPLANATORY LANGUAGE ' 4/15/87 " -A nature of rmittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,Affirm that I have a certificate of consent to self in- 20 DPW 4/90 76A66767A sure,or a certificate of Workers Compensation Insurance,or a certified copy thereof (Sec 3800, Lab C ) ' Policy No Company COUNTY OF LOS ANGELES DEPT. OF}PUBLIC WORKSI 1,� "fl . Certified copy is hereby furnished _ - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING & Certrfie copy is tiled with the county building inspection ADDRESS department NUMBER FIXTURE OR ITEM FEE LOCALITY ' Date Applicant WATER CLOSET(TOILET) , NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS'_ BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER r TAZ (This section need not be completed if the work involved by MAIL h the permit is for one hundred dollars (:100)or less ) LAVATORY ADDRESS V {p I certify that in the performance of the work for whic this per SINK mit Is issued, I shall not employ an erson In an anner s CITY ^�V TEL NO as to become subject to the Wofkers' ompens Io Laws "i DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after mP in this Certificate of SWIMMING POOL RECEPTOR ADDRESS t�7v3LI �� emption,you should become sub ect t the Workers'Compen- CITY TEL NO �f Z sation provisions of the Labr ' e ou must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC , ed WATER HEATER LICENSE NO 7roU (� CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO �i PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS GiGv 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER I�O_ !/ L and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL ,I— VALIDATION fect 1 HOSE BIB DATE �-�� License NumberS 24wqo Lic Class 7 a } FINAL O Contractor L P• "eliefDate BY r I am exempt under Sec s p A{CTos � B&P C for this reason co Plan check fee ► 3230.3 76.80 a Date PLUMBING PERMIT ISSUING FEE$ 1 ITEMS Z Slgnat a TOTAL FEE TOTAL 6 o �0 SINGLE F M LY p HOM WNER-BUI ER ECLARATION Plan check applicant HEC r. 75,80 I hereby affl�m that am exe p am the Contractor's License Name CHANGE .00 Law for the folio Ing reason (Section 7031 5, Business and Professions C Address I as owner of the property will do the work and the City Tel No 0000-0001 71-'15/96 structure Is not Intended or offered for sale(Section 7044 - Business and Professions Code) 7671 1 PM 453 CONSTRUCTION LENDING AGENCY ► I hereby affirm that there Is a construction lending agency for the performance of the worklfor 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 ordinances and State I regu tI)ig Plumbing, and hereby out a represents a of t s ounty to enter upon the a ove er ned p p rty f s ectlon purposes C�6. SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnatu of ermlttee Dat