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Home My Public Portal About9241 GARIBALDI AVE_Plumbing__ D.B. 17 25M SETS 12-43 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY �� 1 COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT NO. ROUGH FIXTURESCOMPLETE _ RECEIVED BY READY FOR DATE ISSUED HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION AS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONL JOB E NAME ADDRESS W m ADDRESS LOCALITY D NEAREST '1 CITY TEL.NO. CROSS ST. 6 COUNTY CERT.No. EXPIRES W NAME LOCATION OF SEPTIC TANK, OR CESSPOOL = MAIL NADDRESS NORTH O CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. 1>4 D W ._ OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z BATH TUB FURNACE 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 DATE INSPECTOR'S NAM[ WATER HEATER DENTAL LAVATORY I I ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT I I CESSPOOL I I TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL SEPTIC TANK SEWER I $ UTILITY CO.NOTIFIED I TOTAL FEE "/ FINAL WORKERS'COMPENSATION DECLARATION20-0026 PW 4/87 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) r-'x PolicyNo. ''r Com an / a' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ;, ': P Y Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING F-I,,Certified copy is filed with the county building inspection ADDRESS u department. f/ NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date_ r ''Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- POOL RECEPTOR emption,you should become subject to the Workers'Compen- SWIMMING 00 sation provisions of the Labor Code, you must forthwith comp- CITY TEL. NO. P Y P- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. z CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION C fect. DATE V License Number / ,./Lic. Class J FINAL LL Contractor Date � BY >_ :., Q ❑ 1 am exempt under Sec. B.BP.C. for this reason Plan check fee pop. CL Date: PLUMBING PERMIT ISSUING FEE$ LU Signature TOTAL FEE SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address r I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(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 , L]bove-me information is correct. I agree to comply with all County ances and State laws regulating Plumbing, and hereby rize representatives of this County to enter upon the ntioned property forinspection put oses. SEE REVERSE FOR EXPLANATORY LANGUAGE ture of..P6rmittee Diose woron the COMPENSATION DECLARATIONt 20-0026 DPW,4,87 • APPLICATION FOR PLUMBING PERMIT I fTgrebq, a#Irrn thd> I have a cettlflca4e of content to self In- 7A sure,or a certificate of Workers'C,ymponsation Insurance,or a CE 817(REV. 8/86), certified c4' tthh r600f(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.�Company Certlflad copy Is hereby furnished. tifled. 'py Is 110 with the coun building In"ction FOR AP�ICJ1tfT TO FILL IN (PRINT OR TYPE) ADRESSSS NUMBER FIXTURE OR ITEM FEE 1 LLLLLLJJJJJJ @ LOCAL FTY Date Applicant WATER CLOSET{rOILET) NEAREST CERTIFICATE OF EXEMPT 10 F WORKERS' e'TM TUB � depart nt. ' A COMPENSATION INSURANCE SHOWER OWNER m (This sedlon need not be completed If the work Involved by MAIL the permlt Is for one hundred dollars($100) or less.) LAVATORY ADDRESS I certthat In the perfofmance of the work for which this r- SINK TEL NO. mit It cued, I shall not employ any person in any manner so O CRY G ¢s to become subject to the Workers'C.QMkr?sallon Laws. DISI-IW SHFR /1 C/ CONTRACTOR Date- Applicant CLOT14ES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this.Certlflcate of Ex= C� errtptlon,you shouldbecome subject to.the Workers' CffY T& NO Compen- SWIMMING POOL RECEPTOR sation prpvlsloAs of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly'wlth such provisions or thit permit shall be deembd revok- STATE �� LIC- ed. Ced. WATER HEATER LICENSE NO. O CLASS LICENSED CONTRACTORS DECLARATION DISTRICT I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS(commencing with Section 7000)of Division 3 of the Suslness OUTLETS OVER and Professions Code, and my license Is rn full force and ef- 5 PER SYSTEMFl NAL ALID ION >_ Lice. J DATE 0 License Number Llc. Class _ U FINAI_e�N4 Q Contractor Date BY )0 O I am exempt under Sed. W B.BP.C. fof this reason - Plan check fee , Date: PLUMBING PERMrr ISSUING FEE$ $Ignature TOTAL FEE r SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm thtrt I am exempt from the Contractor's License Name 5 Law for the following reason (Section 7031.5, $uslneas'and {,(,T.A Professions Code): Address Q I, aowner of the propwill do,the work and the City Tel. No. �],:rtr7 s erly 133.00 structure Is not Intended or offered for sale(Sgction 7044, 1 1T�J�s�sC 1J Businessand Professions Code). pill. TOTAL 133 - 00 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for CHECY� M.00 the performance of the work for which this permit Is Issued (Sec. 3097, Clv. C.). . Lender's Name 0000-"l 2/ 7/90 Lender's Address 8826 1 9 1 I certify that Ie have read this application and state that the above,lnforrrlatlo orrice. f agree to comply w4th all County , ordinances an a laws regul ting Plumbin , and hereby authorize r ntatives of- County to yfiter.0 the above-m to pro r Inspection pi e- /?o }-� �� . `?� SEE REVERSE FOR EXPLANATORY LANGUAGE a t4