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Home My Public Portal About9835 GARIBALDI AVE_Plumbing__ S 76A667-CE817 f-60 APPLICATION FOR PLUMB PERMIT DEPARTMENT OF COUNTYGENGINEER 3 BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS - = WILLIAM A. JENSEN. SUPT of BLlIl.MG LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS S NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL ADDRESS BATH TUB CITY TEL NO. SHOWER Z LAVATORY CONTRACTOR r c^ r-_ T J SING ADDRESS DISHWASHER CITY TEL. NO. /-^z CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GRfZONE I PR CESSED BY WATER HEATER ��'7 ` GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a 0 U 27 �� 0 e F En U W a a $1.00 PER ITEM ,A ' OR FIXTURE APPROVALS DATE 'INSPECTOR'S SIGNATURE PERMIT $ Q��O UNDER SLAB WORK IL TOTAL FEE �� ROUGH PLUMBING GAS PIPING 1 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 HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. / UTILITY CO. NOTIFIED SIGNATURE -' OF PERMITTEE ^` FINAL Or e VALIDATION ROBERT A. WOOD, E,O. WR SUPERVISING MECHANICAL ENG'R L 9 z) 1 9 o EEC 6 5 D 12.0 U 7'l-k4;111 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of c"nt to'self 76&bVA ' Insure, or a certificate of Workers' CompensatIon•Insuraflce, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. -Company Certified copy Is hereby furnished. ❑ FOR APPLIC1,Nf TO RLL IN(PRINT OR TYPE) BUILDING Certtfled copy Is filed with the county building Inspec- tion department. NUMBER FD7URE OR ITEM O FEE LOCALITY Date App114aht WATT abSFf rFAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS COMPENSATION}INSURANCE S143WER . OWNER (This sectton nMd not be cornp6t"If fh•wor'k Imrofwd by the pwmlit Its for ono hundred dollars($100)or Ions.) J LAVATORY ADDRESS �� I certl4y thtrt In the performance of the work for which this permit Is Issued, I shall not employ any parson Ira pny manner SINK CITY NO2so as to become subject to the Workers'Compensation Laws. 17 f—M DI51IWA5R CONTRACTOR JC Date-,7743 Applicants CLOTHES WAWER ADDRE NOTICE TO APPLICANT: If, aftef aking this Certfficate of Pm Exemption, you should become subleto the Workers SWIAAMINGPOOLREfEtFPiOR ct CrTY TEL Compensatlon provisions of the Labor Code, you must forth- LAWN with comply with such provisions or this pormlt'shall be SPRINKLER SYSTEM ATE UC deemed revoked. WATER HEATER LCENSE NO. LICENSED CONTRACTORS DECLARATION DISTRICT BY I hereby affirm that I am licensed under provWom of Chapw 9 GAS SYSTEM OUTLETS a (commencing with Section 7000) of Division 3 of the &ulness OUTLETS OVER and Professions Code,and my license Is In full force and effect. S PER SYSTEM FINAL VALIDATION FI Llcetse Number tle. Class OC FINAL J'�'� G Contractor Date BY ❑ I am exempt under Sec. B.BP.C. for this reason Plan check fee Date. Signature PLUMBING PERMIT ISSUING Fes; D TOTAL FEE Plan check applicant 7 C' A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name " o o o o o 5 1 hereby affirm that I am exempt from the Contractor 4 License Law for the following reason {Sectlon 7031.5, Business and Address 'o 0 2 a 5 Q Profealons Code): aty Tel. No. 10 I. as owner of the property, will do the work and the ?p, C.F structure Is not Intended or offered for sole {Section , ( G C 2-8 3 7044, Business and Professlons Code CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending ncy for the performance of the work for which this t Is Issued (Sec. 3097, Civ. L� lender's Name Lender's$ dress I certlfy that I haver Is applrcatlon and state that the ► above Information Is . I agree to comply with all County ordinances and S e laws regulating Plumbing,and hereby authorize repr ntatives of this County to enter upon the above-mentlon grope for Inspecllon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnature of Permittee Dote