HomeMy Public PortalAbout9951 GARIBALDI AVE_Plumbing__ OOUKTY OF LOB AMO[LES APPLMATMN FM
DMSION OF HUIILDING & SAFE'.'Y
WILLIAM L FOX, a■.ty Eminer PLUMBING
FOR APPLICANT
/TO FILL IN j - lo4,-1 -75—z
PLU ■KR Vy I LT' R [ly�p READY FDR /DA 1
I
/� FIRfT INI�[OT70M /
ADDR@a I D ff�Q fJ ( 64D p�'! I �on�, 1a Lp 1
DIT' ADDREOS
COUNTY Exp1 ..g,0..SLOCALITY
N EAR EST
PER RT FELL DROiB HT. Lvy I o
Ifl7M�J! TY►[OF FIXTURI OR MLM FEE OWNER
MAIL
WATER OLOaET(TOILET) a QBO 10 fo ADDREfM
CATH TUB • Q60 CITY Tit. No.
HHOW[R 0.60 I HEREBY A13KNOWLIDUE THAT I HAVE READ THIN
LAVATORY (WASH■ABIN) QBO APPLICH [
ATION AND STATTHAT THE AItOV[ 10 CORRECT
AND ACRE[ TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN FINK 0.60AND RATE LAWS REMULATIM13 PLUMBING.
R TRAY CL 50 I CERTIFYPOS
HEM THAT I POFM THE ABOVE VALID LOS
LAUNDRY TU■
O ANOELrA COUNTY LIOENS[, OR 1 AM TH[ LEGAL OWNKR
�, <YSTE � ! Q60 O OF THE REBID ROP[ �[SORIB[D ABDVE.
■IOMATUR[ OF _
WATER HEATER QBO t✓ 1'4ltMITT[ '� •�
GLOP MINK D.BO INP C ON'RECORD
FLOOR BINK Q QSO
FLOOR DRAIN 0.60
DISHWASHER CL no
DRINKING FOUNTAIN 0.60
d �-
URIMAL • 13.6O e J, 3 a
HOUSE ■EWER QBO
MISC[LLAN[OU■ A */
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YY
i
APPROVALS A/ rk IsoAlj
DATE IN1rmT0117'NAM[
ROUGH PLUMEINO Z F I '
OAS PIPING
113 VI
ENT VNT
CESSPOOL 1,00 ESSPOOL
BEFTIO TANKI [Ft•10 TANK
DRAIN FIT1.00 EWER '
PERMIT 1.DO GAS TEST
UTILITY GQ N=ri.KD
O „ .
TTAL FEE >r * FINAL� A
TUMT DBH#17 ISA2
WORKER'S COMPEN-MTION DECLARATION 20-0020 DPW 9/80 APPLICATION FOR PLUMBING PERMIT
I hereby efflrrF that I haul • cerUflcale of convent to sell Insure,
of a derttflrate of Worker's Compeneatlon Insurance, or a certlfled
copy thergof.(Seo_3600 Lab.C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DEV.
Policy No. Company
I ❑ Gortliw copy Is hereby fumbi»d BUILDING
FOR APPLICANT TO FILL N(PRRfT OR TYPE) ADS
❑ CerltW copy b Tied with the county buWng trrped3on
dopa bl—t- NUMBER FIXTURE OR IT91 FEE LOCALITY
Dade Appicarrt WATER CLOSET NEAFIEST
CEIRTTFICATE OF EXEMPTION FIROM V"*C RB' BATH TUB 288 8T.
COMPENSATION INSURANCE
(This section need not be completed H the work lnvotvsd by the SHOWER MAP BOOK PAGE PARCH.
permit is for one hundred dollars($1 DO)or Ises.) LAVATORY OWNER
I oerdty that In the performance of the work for which this permit fS:TATE
Is Issued, I shall not employ any person In any manner so as to 6 K p
beoome subject to the Workers' Compensadion Laws.
Dt6WA6HER TEL
Date Appkant CLOTH 9 WASHER NOTICE TO APPLICANT: If, after making this Certificate of
Exemptleon,you should beooma sub)ect to the Workers'Compenset3on SWIMMING POOL TOR
provisions of the Labor Code, you must forthwith oomply with such provla+ons or this permit shall be deemed revoked. LAWN 8PRINKLER SYST M
LICENSED CONTFIACTOf.8 DECLARATION TEL_NO.I hereby dfffrm that I am Iloensed under provisions of Chapter 9 WATER��(commenoing with Section 7000) of Division 3 of the Bualnees and i88
Pmfeealons Code, and my Iloense Is In full tome and effect. GAB S OUTlFfBOUTLETS OVER JCT NO. PROCE88ED BY Q
5 PER SYSTEM Q
Lk»r»e Number Llo.Ctses V
DATE �_�_ VALIDATION CL
Gontructor Date
F-1Z
_I am exempt under Sec. ' BY i
B.hP.C.for this reason
Plan check feeoil. �'7.`_i i
Date:
e PLUMBING F>ERMFf ISSUING FEE$ ] I TEM
TOTAL FEE TIiTk 97 - 50
E-1 Plan check RWIc nt C ECC, n f,fid!
SINGLE FAMILY
HOME OWNHI-BUILDER DECLARATION Name ` .COI hereby afflrm that I am exempt from the Contractors Ucenae Law
for the following reason (Seotlon,p031.6, Business and Professions Address
Code):
El 1.
Tel.No. 0301 J j �
I, as owner of the pmperty, will do the work and the structure - !! 1u
is not Intended or offered for sale (Section 7044, Buslneaa q 1 17
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby afTlrm that there Is a construction lending agenoy for the
pertormanoe of the work for which this permit Is Issued (Sec. 3097,
Civ.C.)
LwKWa Nene
Lenders Address
I oerUfy that I have read this applloatlon and stale that the above '
Information M correct I.agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
ropreaentattvee of unty to enter upon the abdvWmentled
Perty n u SEE REVERSE FOR�]�LANATOHY L11f1(iUACiE
ro of Permittee