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Home My Public Portal About9180 FORTSON DR_Plumbing__ WORKER'S COMPENSATIONDECLARATION20-0046 DPW 9/89 APPLICATLON FOR PERMIT ��E GREEN I hereby affirm that.I have a certificate of consent to self Insure, 76A36aC„ or'a cgrtificate of=Worker's Compensatiori Insurance, or a certified HEATING -VENTILATING- AIR CONDITIONING copy thereof(Sec 3800 Lab.C.) Policy GC'iCJf7Company COUNTY OF LOS ANGELES DEPT•OF PUBLIC WORKS BUILDING'AND SAFETY DIV. ❑ ertfied copy is hereby furnished , Certified copy is filed with the county bull ii1[[[��g i tion FOR APPLICANT TO FILL IN ADDRESS department. (PRINT•OR TYPE ONLY) Date ApplicaLOCALITY C NO. TYPE OF APPLIANCE OR EQUIPMENT "• FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work involved by the ASSESSOR permit is for one hundred dollars($100)or less.),, AIR HANDLING UNIT,CFM MAP BOOK . �Z: PAGED�� PARC DISTRICT NO r PROCESSED BY - 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 to BOILER,BTU become,subject to the Workers'Compensation Laws. 'COMPRESSOR,BTU " APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant' VENTILATION SYSTEM ' NOTICE TO APPLICANT: If, after making this Certificate of ROUGH 2g Exemption,you should'become subject to the Workers'Compensation EVAPORATIVE COOLER e� FINAL provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed.revoked. FURNACE-. 'FAU 'GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER WALL Professions Code, and'my license is in full force and effect. License Number Ic.,Class '. ACCT.ir O Contra r ' Date - EJ c I am exempt under Sec Plan check fee i •I! IM B&P.C.for this reason PERMIT ISSUING-FEE 1 ITEM, Date TOTAL FEET i ITAL 50 -' 5510 W Signature :HECK 56.55, d • PLAN CHECK APPLICANT .� OWNER-BUILDER DECLARATION ' f.H�i{+f]E Z I hereby affirm that I am'exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business-and Professions Code) ADDRESS ❑- I, as owner of the property, or my employees with wages tJ��13t1- Uli1 C+,�+=ft•�? as their sole compensation, will do the work and the CITY TEL NO { ,-•`_ + � 8.1431 structure is not Intended or offered for sale (Section 7044, � �f •- Business and Professions Code).' OWNER ❑ 60 I, as owner of the property, am exclusively contracting MAIL = pp with licensed contractors to construct the project (Sec- ADDRESS Q� tion 7044, Business and Professions Code), CONSTRUCTION LENDING AGENCY CITY �G `EL'NO. I hereby affirm.that there is a construction lending agency for CONTRACTOR , I performance.)of.the work for'which this permit Is Issued �y,Le (Sec.3097, Civ.C.: fr ADDRESS Len'der's Name J CITY TEL.NO. Lender's Address STATE / / LIO 'O r I certify that I have read this application and state that the above'. LICENSE NO CLASS - information is correct. I agree to comply with all County ordinances and State laws rel g to ng construction,and hereby authorize representatives o Dun enter upon the above-mentioned proper c n pur os SEE REVERSE FOR EXPLANATORY LANGUAGE S NATURE OF APPLICA R ROSIOZ7V DATE } 76A667 (CE-817)-4/72 l / APPLICATION OR PL MBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: FNEAREST HARVEY T. BRANDT, COUNTY ENGINEER 7IIIIIIIIIIIIIIIIIIIIIFOR APPLICANT TO FILL IN (PRINT OR TYPE) NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 OWNER MAIL BATH TUB 1,75 ADDRESS SHOWER 1.75 CITYyj,),nnj, TEL. NO. S2 LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. _ V CLOTHES WASHER 1.75 STATE LIC LICENSE NO �ijJ k9 16 CLASS SWIMMING POOL RECEPTOR 1.75 DIST/ICT NO.� GROUP ON FR CESS BY 1[� LAWN SPRINKLER SYSTEM 1.75 pV1 WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL p} GAS SYSTEM OUTLETS 1.75 INSPECTI N REC D v OUTLETS OVER 30 5 PER SYSTEM 4;/7 3 /,, C� O F-- U W N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No GAS VENT ` I HEREBY ACKNOWLEDGE THAT HOT WATER HEATER 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V .. PLUMBING. GAS TEST I HEREBY CERTIFY THATLAM AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED j LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESID N IAL PROPERTY. FINAL SIGNATURE I�` DA OF PERMITTEE PERMIT VALIDATION CC. M.O. CASH PLAN CHECK VALIDATION CK. M.0. CASH LLo =L 8 JAN 2 4 5 D 4.7 501 DB.S. �ii3-IV°2TMETY: 5M SES 11-46 - APPLICATION FOR PERBQT 7 I.��PENT OF BUILDING AND -SAFM-. PLUMBING _ `'COUNTY OF' LOS ANGELES Wm.J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUPI ZONE PERMIT NO. ROUGH FIXTURES-0 COMPLETE _ HEATER CESSPOOL SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED . FIRST INSPECTION GAS- APPLICANT M19CELLANEOUB APPLICANT FILL IN IIEAVILY OUTLINED PORTION ONLY JOB i a. NAME �,�,drG..) �_,"� ri,, '�/-,'t1f'' ADDRESS �.� _ �- .�Y.r� �_�2' . a ADDRESS ;��,� � �. �! � � ?�� LOCALITY J NEAREST yp y CITY !rte^_ ,'•� �• i� TEL.NO.j CROSS ST. jibr�� 0 COUNTY CERT.No. /��S ,,. EXPIRES W NAME •LOCATION OF SEPTIC TANK, OR CESSPOOL Z 'MAIL NORTH O ADDRESS CITY TEL.No. I. AM THE LEGAL POSBESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION..-/ i PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE.'% OWNER CORRECTIONS ' SOUTH J DESCRIPTION OF WORK z / BATH TUB FURNACE L7 SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK _ WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN / WASH TRAY URINAL APPROVALS / WATER CLOSET DRINKING FOUNTAIN 1 DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING / METER___'�_-GAS_ SODA FOUNTAIN GAS PIPING OUTL GAS'VENT I I 'CESSPOOL I - I m b I I 'TOTAL NUMBER OF FIXTURES O� SEPTIC TANK CESSPOOI SEPTIC TANK SEWER I ��- UTILITY CO.NOTIFIED TOTAL FEE � -9�0� FINAL D.B.S.17 25M 5L�'R'2-47 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY. OF LOS ANGELES �L� ' � WM.J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE b 7 Z HEATER CESSPOOL I—I SEPTIC TANK RECEIVED BY `READY FOR DATE ISSUED //„/� ` FIRST INSPECTION 5/� 7/„r' AS- MISCELLANEOU �Ll APPPLICANT FALL IN HEAVILY OUTLINED PO�R/TI�O�N ONLY lk W .Ll JOB NAME ADDRESS i M ADDRESS / LOCALITY17, 'l J � �Jd NEAREST d CITY, f,a /_G� 4 TEL.N� �/O CROSS ST. CCo ERT.No. EXPIRES W NAME LOCATION OF:-SEPTIC TANK,.OR CESSPOOL = MAIL 3 ADDRESS / J NORTH O i CITY / TEL.NO.' I AM THE LEGAL POSSESSOR GF THE ABOVE LOS ANGELEB COUNTY CERTIFICA �QUAIICATION. ' PLUMBHGGR�_r_//LL//// / I AM THE LEGAL OWNER OF THE PROPERTY DEESC:RIBED ABOVE. 3 fl) OWNER 1 CORRECTIONS SOUTH DESCRIPTION OF WORK _Z BATH TUB FURNACE . Q. SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK SAND TRAP GLOP SINK FLOOR DRAIN WASH TRAY- URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INBPHCTOR'B NAMi WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I METER GAS SODA FOUNTAIN OUTL 6A9 PIPING I i GAS VENT I I CESSPOOL - /TOTAL NUMBER OF FIXTURES SEPTIC TANK — CESSPOOI SEPTIC TANK SEWER S TOTAL FEE UTILITY CO.NOTIFIED / FINAL -•� � WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A r I hereby affirm tfj,at 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 41 /-g Company C -?� slind _S Certified copy is hereby furnished. BUILDING El APPLICANT TO FILL IN(PRINT,OR TYPE) ADDRESS r Certified copy is filed with the count 'tdi inspe tion /department NUMBER FIXTURE OR ITEM @ FEE Date V_13 {p —�■ ~13 Apphca WATER CLOSET LOCALITY NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST COMPENSATION INSURANCE BATH TUB - ASSESSOR G / (This section need not be completed if the work involved.by the SHOWER MAP BOOK 59, 2 PAGE ��lO PARCEL permit is for one hundred dollars($100)or less.) – OWNER r f rG GC I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to SINK MAIL become subject to the Workers'Compensation Laws ADDRESS o�r DISWASHER CITY C� C TEL NO. Date Applicant CLOTHES WASHER NOTICE TO APPLICANT. If, after making this Certificate of CONTRACTOR ,rbI, �I Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR / provisions of the Labor Code, you must forthwith comply with such ADDRESS / ��S• ( �Q provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM I LICENSED CONTRACTORS DECLARATION: CITY f 1� TEL.N DV 9 mac/ a I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER / (commencing with Section 7000) of Division 3 of the Business'and STATE / LIC Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO �b CLASS (� OUTLETS OVER DISTRICT NO PROCESSED BY Q Q License Number Lic.Class 5 PER SYSTEM C�00 CC��GG U FINAL Q VALIDATION LV _� DATE 4� r� ` L� Q. Contract r Date (n FINAL - '� Z ❑• I am exempt under Sec. BY A.B BP.C.for this reason H' t I a Date Plan check fee pool, ?,_�i.' ;=e L c PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE OTpl5® c SINGLE FAMILY Plan check applicant H rf ':--1; r HOME OWNER-BUILDER DECLARATION Name -E-IH{3U I hereby affirm that I am exempt from the Contractor's License Law (C- for the following reason (Section 7031 5, Business and Professions Address. Code) El . City Tel. No. ili1ia]—%!'t,f _. I, as owner of the property,will do the work and the structure f is not intended or offered for sale (Section 7044, Business 04— f and Professions Code) CONSTRUCTION LENDING AGENCY r I hereby affirm that there is a construction !ending 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 ordinances and State laws re lata lumbing, and hereby authorize _ representatives of is o n to nter upon the above-mentioned pro or ti rose 1 SEE REVERSE FOR EXPLANATORY LANGUAGE. Signature of er Date , WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a certificate of consent to self insure, or a certifidate of Worker's Compensation Insurance, or a certified copy thereoi;(Sec.3800 Lab.C) Policy No. Company COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT..OF PUBLIC WORKS DIV. ❑o Certified copy is hereby furnished -FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified co is filed with the count building ADDRESS - department. DDRESS - copy• y g inspection department. NUMBER FIXTURE OR ITEM '] 4 Q 2 \ Q FEE LOCALITY ^ , fG Date I `J —Applicant v l� e WATER CLOSET NEAREST 07 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE ASSESSOR p�f (This section need not be completed if the work involved by the SHOWER MAP BOOK JPO /- PAGE Q�G PARCEL,-;2R,46 permit is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to MAIL become subject to the Workers'Compensation Laws SINK j _ ADDRESS - Date I _ •3 COrIL:A ��(,( DISWASHER - CITY C TEL.NQ�,r6—X�sjr Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certifi(laja of CONTRACTOR Exemption, you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS7' provisions or this permit shall be deemed revoked: LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO _ j } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and STATE LIC ` O GAS SYSTEM a OUTLETS LICENSE NO. CLASS / //�` (� Professions Code,and my license is in full force and effect. cv OUTLETS OVER DISTRICT NO PROCESSED BY 'y[ 5 PER SYSTEM License Number •��jLia Class (— G FINAL Q Contractor orb�� e G Date ZQ—` 1 DATE Q-1( _l VALIDATION CL F-1 FINAL am - FINAL Z exempt under Sec. BY B'&P.C.for this reason Date. -Plan check fee PLUMBING PERMIT ISSUING FEE$ S Signature �" ❑ For Co9` a74 a�(, TOTAL FEE IL _ � -_ Plan check applicant i•t M,*- SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name i I hereby affirm that I am exempt from the Contractor's License Law EITA 4 1 ® -c 1 for the following reason (Section 7031"5, Business and Professions Address _. -'' i��5 Code): ` ❑ City Tel. No. CHAI,fG E ,("D I,as owner of the property,will do the work and the structure :r�Hr'�I= is not intended or offered for sale (Section 7044, Business and Professions Code) , CONSTRUCTION LENDING AGENCY r;4" I hereby affirm that there is a construction lending agency for the I iil� performance of the work"for which this permit is Issued (Sec. 3097, Civ.C.) Lender's Name 0,qe— �. 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 j representatives of this County to enter upon the above-mentioned proper y for inspe tion r oses SEE REVERSE FOR EXPLANATORY LANGUAGE �� 7 `t3 Signature of Permitteef^�r Co,.,6�DatenCtQn�