HomeMy Public PortalAbout8613 GARIBALDI AVE_Plumbing__ 76AC07-CE#017 5-61• D 10734 .
APPLICATION FOR PLUMBING PERMIT
COUNTY O
DEPAE OFC
N S Q/
13 G�ib81C�
ON
WILLIAM A. JE SAX. SUPT OF Sunml ld
FOR APMCMfi TO FILL IN
NUMIIR F rmRX OR mlow
°Wffi V. Barker
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car � 1K).LAVAIXBEDOWE �oToa General Installation Co.
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mTa ADDEM 8588 West Blvd.
DM WAMM car Los Angeles �, PL 3.2541
Laumm rm C&M C-36 151839 787
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1vaM Seams
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APPROVALS DATI INSPICTOR'lFAIMLATURIL
PERMIT 4 Y '00 UNDER SLAB WORK
TOTAL FSS ROUGH PLUMBING
GAS PIPING
1 HIRQY AaKNOWL D" THAT 1 HAV= RAD THIS AP71UQATION
AND /TATs THAT THX AlKM M 001R![[,'T AND A!» TO COMPLY GAS VENT
wmi ALL COUNTY.OSDINAKCICS AKD STAT= LAMS SZtULATING
FLUMm1m4. HOT WATER HEATER
I HXRXIFY CKRTIFY THAT I Ali FS0r1XL.Y MMISTXR D AND/OR PLUMBING FIXTURES
LJOEKSID AS RKQUIRED SY LOS. AKOLlS COUNTY AID] STATIC OF GAS TEST
CALIFOIINIA OR THAT 4 AN THE LIMA OWFPUM OF TIfIC ANKM
DKMCJIDIID RICSID[KTU1L FROrKRTY. UTILITY CO. NOTIFIED
S I GNATU RI (/�!
OF FIRM FINAL
VMMATON ROBERT A. WOOD
MA O, CASH SUFERVISING MKCHANICAL ENO-ft
LXO1 9 7 lrFJ .AAL 2 3 5 A 3.5 0-
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v WORKERS'COMPENSATION DECLARATION DPW 4187 APPLICATION FOR PLUMBING PERMIT
I h8reby, affirm ft I have a certificate of consent to self In- 7&MaA
sure,-or e'certificate'of Workers'Compensation Insurance,ora CE 817(may a/86)
certlflS►d Fbpy?hereof (Sec. 3800, Lab. C.)
Policy No. '� CompanyCOUNTY OF LOS ANGELES DE0T.`OF PUBLIC 1KORK5
Certlfled copy Is hereby furnished.
FOR APPLICANT FILL IN(PRINT OR TYPE) BLDING
❑ J
Certified copy Is filed with the county building Inspection NUMBER FiXTJRE OR rrEM e FEE ADDRESS 7
department. LOCALiTI
Dat• i Applicant t LA WATER CLOSET(TOILET) QOM
1,1
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB 20 pp CROSS ST.
COMPENSATION INSURANCE SHOWEROwrFR
(This section need not be completed N the work Invohred by D
the permft Is for one hundred dollars (=100) or leu.) LAVATORY SS 3
Q� ADDRESS t
I certify that In the performance of the work for which this per- SINK Q
mit is Issued,.]shall not employ any person In any manner so CFY TEL NO
as to become subject to the Workers'Compensation Lows. DISHWASHER 'Q
CONTRACTOR
Ddrte Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificateof Ex- ADDRESS
emptlon,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR
CITY TEL. NO.
sation provisions of the Labor C e, you mutt forthwith.comp'- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provislons of Chapter [ GAS SYSTEM OUTLETS �e
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is In.full force and of- 5 PER SYSTEM FINAL VALIDATION
feat. DATE CL
License Nymbet Lic. Class
F I NAL U
Contrpctor Date BY All O
H
❑ I dm exempt under Sec. W
0.
B.BP.C. for-thls reason Plan check fee , CO)
Date' PLUMBING PERMIT ISSUING FEE;
Signature
y TOTAL FEE
SINGLE FAMILY Plan check applicant
HOME OWNER-BUILDER DECLARATIOaN pP
c
I hereby cr flrm,that I am exempt from the Contractors License. Name
Law far the following reason.(Section 7031.5, Business and
Professions Code): Address
® 3307 17D.yl
I, as owner of the property, will do the work and the City Tel. No. }}
strUcture Is not ihtended or offered for sale(Sectron 7044, 11 :
Business and Professions Code). , TOT _ 50
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. 3D97, Civ. C.).
Lender's Name - 11000-13001 3/ 7191
Lender's Address _ 1963 1 AM -8-26-
1
D76I certify that I have rood 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
outhoelze representatives of this County to enter upon the
above-mentioned property for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Ig Ur.
of Permittee ] —Date