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Home My Public Portal About8814 GARIBALDI AVE_Plumbing__ 76AM7A u•17 bIFV.9/ 7GA"?-CESS17 4-54 1 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANG NDEPARTMENT OF CO EOB GBUILDING AD ELaUY �Na1N[ R WILLIAM A.J[NSKN, SvP�T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN .n:vFJrr Clow ST. NUMBQR FDl T`UR[OR MCM UCH F[[ O.WIm RATER CLOT Sim NAII RATH TUR Im ADPIM CITY TEL NO. SHOWER In LAVATORY In CONTRACTOR sm 1u ADDIM / 0 DEHWASHER Im �� TEL NO.Cormd3 ATE LAUNDRY TUR im REaGIrmTTON NO. 1 COUNTY CLOTHES WASHES Im pIBT1Rl NO. 6 UP ZON[ PROC[!B[D BY WATER HEATER 110 -L GAS SY>fTSI[ OIITLETS 1 AIFTE�PP OVAL O OUTLETS OVER f PER /YXTEK .70 D�PECTION RECORD U oc a h Z I VQ APPROVALS OATC I N SP[CTOR'S I IO N ATU RE PERMIT i 2 00 UNDER SLAB WORK ROUGH PLUM19ING TOTAL RHE 3 GAS PIPING I14139011HE THAT 1 HAVK READ THIS APPLICATION GAS VENT AND STATE THAT THE A1OVE 12 CORRECT AILD ASISO[ TO COMPLY \7TTH AEI. COUNTY ORDIKANCXS AND STATE LAWS REOULATING HOT WATER HEATER FLU M71 N a. 1 HI1mY CEJRIFY THAT I AM PROPERLY REaIST[RED ANDIOR PLUMBING FIXTURES U C[NGXD AS IQGUIRID Iry Lb, AJ40KLLO COUNTY AND STAB'[ OF GAS TEST CALIFORNIA OR THAT I AN THE L rnAOWNER OF,AND INTEND TO RESIDE IN,TH[ASOVE iD AL RTY. UTILITY CO.NOTIFIED _ GIGNATURE OF PERIN TTY[ �� FINAL v r-VALIDATION ROBE A• WOOD cK. M.o. CASH SUPERVISING MECHANICAL ENG'R 0 1 9 9:2 APR 1 5 A 3.5 0- a r y�, • WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT srfflrthat I have a certificate of consent to self 76AWA Insure, or a�ertmiflcate of Workers'Compensation Insurance, CE 817(REV. 10/81) %oro cdttWed ropy thereof (Sec 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy•ls hereby fumished. ❑ FOR APPLICANT TO FILL M(PRINT OR TYPE) VG Certified copy Is filed with the county building Inipec-tion department. NUMBER FTmRE Ok ITEM Oot WATER CLOSET Date Appllrant ST AC CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB �+J COMPENSATION INSURANCE OWNER ST (This secs n nsred not be completed If the yarn Imrohnd by the permit Is for one hundred dollars (;100)or kms.) LAVATORY MALI ADDRESS I certify that In the performance of the work for which this n� permit is Issued, I shall not employ any Person In any manner 51 NUC 1111Ck TEL. NO. to as to became subject to the Workers Com satron Laws. DISHWASHER t 14 J_ CONTRA(.-TOR / \Date r r ~ pllc% CLOThES WASH R ADDRESS /// NOTICE TO APPLICANT: If, After Makin it Certlfltate of SWIMANNG POOL RECTOR Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LMC deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. BY I hereby affirm that I am Ilcensed under provisions of Chapter 9 GAS SYSTEM QUTLEYS �� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 40 IV and Professions Code,and my license Is In full force.and effect. 5 PER SYSTEM FINAL _ VALIDATION- License Number LIc. Class GL FINALZ O Contractor Date BY W� ❑ I am exempt under Sec. y B.$P.C. for this reason x Plan check fee Date. PLUMBING PERMIT ISSUING Fes; Signature ' TOTAL FIS Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name �2 1 0 2 9 A I hereby affirm that I am exempt from the.Controctor s Ucense Law for the following reason (Section 7031.5, Business end ' Address 40 0 0 0 5 Professions Code): City Tel. No. . ❑ 1, as owner of the property, wHl do the"work and the `'° 0 2 2 5 0 sTrUcturb Is not Intended or offered for saleSectlon 704A,Business and Professions Code) ( , o'a o 2 2 �j CONSTRUCTION LENSING AGR4CY C 0 6'—8 I hereby affirm that there Is a corutrudlon lending agency fort the performance of the work for which this permit Is issued (Sec. 3097, Civ. C,) Lendees Name Lender's Address I certlfy that I have read this application dnd state that the , aboye Information I:correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of thls to enter u n the aboerty ve-mentloned prorfor I !r a U"E R EXPLANATORY LANGUAGE grra re Itt Date f.MtORKEItS'COMPENSA'T'ION DECLARATION 74AWw I hemb9 affGrm'teal j have jr certiflc;te of consont to,self Ca all (1-9e) APPLICATION FOR PLUMBING PERMIT insure, or a,certificate pt Workers'Compensation Insurance,or a certified copy iherabf,'(Sec.3600,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. CoYnpany D Certifle¢copy isbdraby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS El Certified copy is fUbd with the county buf)din�inspection R FIXTURE OR rrEm • FIE department. WATER CLOSET LObALfTY Date Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWN E4-�)n JVAAJ (]hJ1 apC4OII need not be ccoommppWed if the Work iatotred LAVATORY A D D R ES8 by the pemtlt is for opo hundred dollars (=10(1) or leas.) } SINK biTV TEL.ND. � I certify that in the performance of the work for which this DISHWASHER permit i. Isstt I shall not em loy-any person in any manner CONTRACTOR so es #�� ejecttoortera matton Laws. CLOTHES WASHER � ADDR U DatApplicantSWIMMING POOL RECEPTOA IAJ NOT ELICANT:If, after making this Certificate of blTEL.NO Q 0.Exe ption, u should become.subject to the Workers' LAWN SPRINKLER SYSTEM N Compensation provisions of the Labor Code, you must forth- STATE LIC. f•�/ Z with comply with such provisions or this permit shall be WATEfl HEATER LICENSE NO CLASS 4� �j — deemed revoked. GAS SYSTEM OUTkET8 DISTRICT NO. ESSE Y LICEN9$D CONTRACTORS DECLARATION OUTLETS OVER C/ I hereby aftlrm that I am lkensed under provisions of Chapter J5 PER SYSTEM 9 (commencing wtth Section 7000) of b bralon 3 of the Busi- FINAL news and Profesdom Code, and my Ucense.is in full fotce and DATE - 2"( VALIDAT6 . effect, �� f FINAL License Number.,bd. //W 'Tic.Class BY Contract Date F1 I am exempt from the licensing u ments as I am a Plan Chw*fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting In my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL Fly Lic.or Reg.No, Dote Plan check appllcant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's oddre« License Law for the fouowing reason (Section.7031.5, Buti- City Tei.No. 5 2 Q.5 A news and Professions Code): ❑ 1, as owner of the property, am exclusively contracting #.o o o oa 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). . IeO2850 CONSTRUCTION LENDING AGENCY '0 - 2a505 I hereby ifflrm that there Is a coratruction lending agency for the performance of the Work for which this permit Is issued(Sec.3097,Ctv.C.). Lender's Name_ Lender's Address I certify that I have read this ■ppliatibn and st4te tbit the above information Is correct.I agree to comply with all County ordinances and State laws re"ting Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE xe representattves of this County to enter upon the ■bo entioned pro for Inspection p Signature of Permittee to