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HomeMy Public PortalAbout9415 GIDLEY ST_Plumbing__ .pper�- , WORKE(2S'COMPENSATION DECLARATION A P P L I CAT I OPV FOR PLUMBING P E RM I T here4y,affirm that I have a certificate of consent to self 7 A Ensure, or'a'cerlfflcate of Workers' Compensation Insurance, gly fREV.8/ (� or a certified copy thereof (Sec. 3800, Lab. C-) - COUNTY,.OF 1_08 ANCiEt-E8DEPT. OF PUBLIC WORKS Policy No. Company ❑ `. Certified copy Is hereby furnished. FOR APPDCANr TO BLL IN(PRINT OR TYPE) BUAD�S ❑ Certified copy Is filed with the county building Inspec- tion depart"n1. NUMIXR RX[URE OR ITEM RB_ LOCALITY Z WATER CLOSET qant Zlot t Date CERT1FKATE OF�pIiEXEAAPT40N FROM WORKERS' BATH TUB CROSS S�.1` CQ1tAQE 4.SAT1ON INSURANCE OWPSt (This section need not be completed B the work Iesoly by SHOWER NAA the permit Is.for one hun4r}d dollars(=100)or less.,) LAVATORY ADDRESS I certify that In the performance of the work for which this perm Lt Is Issued, F shall not emplay,arry person in any manner SINK QTY TEL NO so as to become subject to the Workers'CoMpensafioO Laws. DIS+WASHER CONTRACTOR Date7�f�- Applicant CLOTHES WASHER ADDRESS NOTICE TO APPUCAN. T: if, after making this Certtficat Exemption, you shout¢ become subject to th6 W en' SWIMhUN�POOL RECTOR CITY � NO Compensaflon provislons of the Labor Code, you must forth- LAWNi SYSTEM with comply with such provhions-or this permit shall beSTATE LIC, deemed rwoked: WATER FEATI�t UCBSNO. CLASS LK MNSED CONTRACTORS DECLARATION KT yp. "SEDBY I hereby affirrh{haf I am licensed under provisions of Chapter 9 GAS SYSTEM' OUTLETS �1 (commencing % l]+ Section 7000) of Division 3 of the Business OUTLETS OVER and ProfesWm Code,and my license Is in full forcaarod effect. 5 PER SYSTEM HNAL V L1D T10N DATE ✓ " License Number tic. Class Fl B Contractor ate BY ❑ I am exempt under Sec. B.RP.C, for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FIE; Signature TOTAL FEE - ;R 7 6 a?A Plan'check applicantt # 0 0 0 0 0,0 5 SINGLE FAMILY. HOMEOWNER-BUILDER DECLARATION Name — t ( ,o o46510 I hereby affirm that 1 am exempt from the Contractors License Law for Jhe following reason (Section 7031.3, Buslnsies and de's 0,0 0 4 b 5 0,5 I'mfesslons Code): city Tel. No. © I, as owner of the property,will do the work and the OR 1 7.�,8 7 structure b not Intended or offered for sple (Section , 7044, Business and P.c,f Ions Code} CONSTRUCTION LENDING AGENCY. I hereby affirm that there Is aronstruction lending agency for. the'performance of the work for,which this permit is Issued (Sec. 3097, Civ. C.). Lenders Name Lender's Address I certify that I have read this application and state that the above Information Is Correct. I agree to comply with all County ordinances and State laws regulating Plurnbing, and hereby authorize reprebntatl.yes of this County to enter upon the above-mentioned property for Inspection purposes. S R1 MUilll "it EXPLANATORY LAWWAW- Sigrwture of P�efmltiee Date V � - [76A667-eE817 12/59 TEMPLE CITI, APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND�S�gTY RIVISION JOHN A. LAMBI OUNTY NGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL INNEAREST y/� ]/ CROSS ST. li NUMBER FIXTURE OR ITEM OWNER WATER CLOSET ZS MAIL J ADDRESS L' BATH TUB CITY '0'00 TEL. NO. sxowER S 747 TR LAVATORY CONACTOR Z5 SINK ADDRESS DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB 5 REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP Z N PMOCESBY WATER HEATER � SZ ' GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD D+ a a 0 U a rn z @ .k%f'pER ITEM I O 0 OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK Z-TOTALFEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL-XROPIi Y. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE FINAL ®F VALIDATION-- ROBERT A. WOOD, cK. M.0. CASH SUPERVISING MECHANICAL ENG'R i t ico 7 2 8 5 NOV 21 5 D 7.00- a COUNTY OF LOS ANGELES APPLICATION FOR PERWaT Department of County Engineer DIVISION OF BIIII.DING & SAFETY PLUMBING 1 WILLIAM I FOX, County Engineer DISTRI:70. GRJOUP I Z13NE PERMII NO FOR APPLICANT TO FILL IN S 115 P PLUMOE IC R[O[IVSQ BY READY FOR DAA IylJICD rQ%V�v� FIRST INSPECTION D ADR[OO /� 22 NU1LDIND ,J OITY TTL No. /— �j ADDREHe y 7� OOUNTY �7 / KKPIREa d— LOOALITY N ICA R[BT PERMIT FEES ORDEW rr. . j-o NUM�iI� TYr[OF Fr1CTU RL OR ITLM FEZ OWNER �. O MAIL WATER OLOSICT(TOILET) 0 [LBO 0 ADDR[DS BATH TUB O 0.60 CITY TEL No. 8H01V[R @ 0.60 I HE ACKNOWLXDD[ THAT I HAVE READ THIS LAVATORY (WASH BASIN) O 0.60 O APPI IOATION AND BTATT THAT TH[ AEV OL Io [ CORROT AND ACNE[ TD OOMPLY WITH ALL OOUNTY ORDINANO[B KITOH[N OINK O MBD AND INTATI[ LAWS REOULATIND PLUMBING. 1D[RTIFY THAT I PEnMKI B TH[ AIIOV[ VALID LOS TUB UB OR TRAY a 0.513 Q AND[LrA OOUNTY LIC[NE[, OR I AMOTHE LEDAL N[R DAH eYeTT TOF TH[ RESIDEP[RT7 u LETa � 0.60 a G OIDNATUI OF WATLR HEATER Q 0.60 Q PERMITTE NTI SLOP 111NK a 0.60 INSPECTION RECORD FLOOR MINK Q 0.60 FLOOR DRAIN 0.60 DISHWA13HER 0.60 ORINKIND FOUNTAIN 0.60 URINAL a eo J t HOUNE SEWER 0.60Z MIBOLLU [ AN[OB Fl O_ IY O APPROVALS D IH n'■ MAN[ ROUGH PLUM OAS PIPING DAB VENT OCMPOOL 1.00 C[BSPOOL REPTIO TANKt eEPTIO TANK DRAIN ( ) PIT ( 1.00 e[WER PERMIT l.m DAB TEAT UTILITY Oa NOTIFIED TOTAL FEB p C Q FINAL p TdMOT DES#1T 8-1211 WOFd<ER S COMPENSATION DECLARATION 2(Y002E DPW 9,86 1)or" amrm that I have a oarttfloate of oonaent to self Insure, 7 &B"A APPLICATION FOR PLUMBING PERMIT or a certMcate of Workers Compenaatton Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. PoA y Na Company ❑ Certtfied copy b hereby tumbF»d FOR APPLICANT TO FILL IN(PFtWT OR TYPE) BUILDING J j/SiiG 'i F1 ed copy b flbd with thou e orrty lxrllding Irrapectlon ADDRESS dspa depar[rnenL NtJ1ISEii FDCiI.IRE OR rrE]I f FEE LOCALITY f Date Appflcant WATER CLOSET NEAREST CERTIFICATE OF E)m1PT1ON FROM WORKERS CROSS ST. SATIi Tue COMPENSATION INSURANCE ASSESSOR (Thks section need not be oomplatod If the work irtvotved by the 81-►OWEA MAP BOOK AGE PARCEL permtt In for one hundred doilsrs(11100)or Fess.) OWNER I certify that In the performance of the work for whloh this permft LWL LAVATORY Is Issued, I shall not employ any person In any manner so as to SIN( become sub)ect to the Workers'Compensation Laws. 3 D18WAS R CITY TEL.NO. D� r O APPS CLOTHES WASHER CONTRACTOR - NOTICE O A P ICANT: i}, after making this Ce loete of Exemption,you should-beoorne sul Jeot to the Workers' Comperuatlon SWIMMING POOL RECEPTOR provisions of the-Labor Code, you must fonhwl-h comply with such 1ADDRES8 provisions or this permit shall be deemed revoked. LAWN SPF000..9T SYSTEM LICENSEp CONTRACTORS DECLARATION CITY TEL NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commenoing with &action 7000) of Division 3 of the Business and /��,, } 1` BTLICEN6-E NO 7 3 TE je X1.88 Professions Code, nae I II fo and efleot. GIB�� �YSV OUTLETS 1 S / Q U TB DXSTRICT NO. PROG:98ED BY 'i'3/ °P1�i SYSTEM .o License Number tic Class ATE D Date 3` 3 /l y3� VAUDATION WW DATE AL F-1I am exempt under Sao. BY _ BAP.C.for this reason Plan check fQe , Date: PLUMBING PERMIT ISSUING FEE_ F-1 TOTAL FEE Pian check"Ic-artt 5 SINGLE FAMILY HOME OYniE7� IO BUILDER DECLARATION Name rn I hereby affirm that I am exempt from the Contractor's Lloense Lar ACCT. for the following reason (Section 7031.6, Business and Profeaalons Address 1.&r� 'rel. 1 IT[�[�F� Code): I,as owner of the prop ,will do the work and the structure r-11, tr- t J Is not Intended or offered for sale (Section 7044, Buslness , TTOTAL A- 1 . 35 and Professions Code). �y CONSTRUCTION LENDING AGENCY `{i 1 I hereby affirm that there Is a construotlon lending agency for the perforrnanoe of the work for which this permtt Is Issued (Seo. 3097, Cv.C.) i e LerxWa Name 'OWO-0001 11��f 7� 2799 1 IM11+07 Lenders Address I oertify that I have read this appiloation and stpts that the above Information Is correct, I agree to comply with all County ordlnances , and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentloned property for Inspection purposes_ SEE REVERSE FOR EXPLANATORY LANGUAGE Stgn&Wre of Permfttee Dete TION WOFOOT8COIJPI7lSAcateDf consent to 20-OM°P'K°/e° APPLICATION FOR PLUMBING PERMIT I hereYjy affirm thgt I have n certificate of consent to self Insure, or a�cedttloa)e-qf Workers Cpmpensa on Inau or`a certed ooh" py tf(�w.9d00 lab.C.) j� Lp - L _ww� zo p� . I" J COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DN. Certttfed copy 1.hereby furtt♦shed. FOR APPucAN-r TO FLL N(Pmw OR TYPE) Bi�Dvlo l LF lTt�L� ♦ . ADDRESS ❑ Certified copy is rli.d with the county bt�ig tnepection P� C C 3 n f t i /dw-trnonlr � M1116EJ� RXTURE OR WATER a oeE7 r� • F� LOCALITYl V/'1�• NEAREBT - CEfl71FlCATE OF EXXBMRTION FROMCFK)BS ST.BATH TUB ABBEeeO�R COMPENSATION NBURANCE YAP BOOK PAGE PARCEL eeorited on need not be compMtf the pork Inyotvad try the SHOWER permtt Is for ons hundred dollars($100)or Fear.} LAVATORY OWNER k) (1"f���(O I oertffy that In the pedormanos of the work for which this permlt A _ Is Issued, I shall not employ any person In any manner so as to 1 gid �,yi I •9 tJ IOW-. beooe subject to the Workers'CompsnsaUon laws. � Df8WA8r-fER CnY TES NO. Data Appfloard CLOTHES WASHER CONTRACTOR t NOTICE TO APPLICANT: If, after making this Certificate of ExempO n,you should beoome"act to the Workers'Compeneadon SWUMiNO POOL RECSTOR provisions of the Labor Cods, you must forthwith oompty with such ADDRE88 g[ provisions or this permit shall be deemed reGoksd. LAWM SMwLER SYSTEM �� } OBS DBaARATIDNWATER HEATER 5 ciTY TEL.NO. d I hereby affirm that I am Ilosns*d under provisions of Chapter 7 (commencing with 8eotton 7000) of DMsion 3 of the Business and aAa SYSTEM OUTLETS STATE �'� � (3 8 Professions Code, and my license is In full force and efTbot. OUTLETS OVER DCBTRICT NO• BY Q /iloerne Nuntxm G�3 1 LkL Clogs 1 6 PER SYSTEM O 1 Dam a w- t /5" f l-Z v iFIINAL ION LLJ ❑ I am exempt under Sec, BY FINALz B.BP.C.for this reason Plan chq&fee Poo- PLUMBING PLUMBING PIE Mrr UMING FEF S Q ❑ TOTAL FEE .a 81WI-E FAMILY Pian otleoJc�M HOME OWNH:i--BUILDER DECLAFV1T10N N� #�L•L T.T I hereby affirm that I am exempt from the Contractors Lloerae Law 83.20 for the following reason (Section 7031.8, Buslness and Professbna- Addreas . God@): 1 ITEM ❑ I,as owner of the property,will do the work and the structure TeL No. Is not Intended or offered for Bale (8eoUon 7044, Buelness lT+t�tT1�� .rt �� and Profeeslcns Code). , .�CLfi 98.+ 0 CONSTAl1ClTON LENDING AGENCY' CHAWE X011 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Seo. 3097, civ.c.) GOOD V1 91 2/91 Lenders Name t57 1 AM 8:27 I lander.Address aI have read thls application and state that the above , correct I agree to oorhpty with all County ordlnaricas Statews regulating Plumbing, and hereby authorize s of this Go u to enter upon the above-mentioned spectbn du /� 1EE FSE FOR FD(PLANATORY LANWAGE e7cf m Permftiae Debs