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HomeMy Public PortalAbout5216 GLICKMAN AVE_Plumbing__ 7 76A667-CE#817 5-61 ! / APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY -77 FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL (�(/ J BATH TUB ADDRESS A SHOWER CITY TEL. NO. LAVATORY CONTRACTOR Valley Plumbing Co. SIN% ADDRESS 442 W. Fleetwood Pi. DISHWASHER CITY Glendora, TEL. NO. Ed 5-1290 CONTRACTOa•s 160847STATE LAUNDRY TUB REGISTRATION NO. COUNTY ❑ f CLOTHES WASHER DISSTR'R'LCT NO. I GROUP ZONE PRO SED BY f WATER HEATER 7/ s 9� f.[7,{(' f GAS SYSTEM (� INDUSTRIAL V WASTE APPROVAL INSPECTION RECORD O F U W d Vf Z @ OR FIXTURE $ Iq J-I- APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 200 UNDER SLAB WORK TOTAL FEE / S' ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES ' LICENSEDAS 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 LOF ATURE PERMITTE FINAL VALIDATION ROBERT A. WOOD (Clf. M.0. CASH SUPERVISING MECHANICAL ENG'R LAGo 7 6 0 8� DEC 4 D 1 6.5 5, ION WORKER'S I have a certificate of consent to 76A666DPW9/69 APPLICATION FOR PLUMBING PERMIT 76A667A ' I hereby affirm that I have a certificate of consent to self insure, �. or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) / �l COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company _ n P,rJ/lly ' ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspection department. -NUMBER FIXTURE OR ITEM @ FEE LOCALITY C� - Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toMAIL Cp become subject to the Workers'Compensation Laws. SINK ADDRESS G G 177!9/7 DISWASHER CITY �) TEL.NO. ly f�3_ /U/ Date Applicant CLOTHES WASHER CONTRACTOR �ONs /�� f t� 77 I NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR 019 provisions of the Labor Code, you must forthwith comply with such ADDRESS (,/� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM filt LICENSED CONTRACTORS DECLARATION CITY TEL.NO. L/y r } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER d n (commencing with Section 7000) of Division 3 of the Business and STATE NO. ( 7!/ CLASS C�V �o U Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS OUTLETS OVER DISTRICT NO. �y PROCESSED B O 5 PER SYSTEM �^ Ei p License Number f�D f`1`/ Lic.Class 4f Q Cv •—J !/(J U o FINAL DATE �'�-��g.� VALIDATION a � ^I ,�✓r ,may Contractor �-�C lJ A �h LZZ!0 Date At./ -✓ j (() F1am exempt under Sec. BY, —'L B.&P.C.for this reason Plan check fee , M! Date: PLUMBING PERMIT ISSUING FEE$ Signature �� _i.a�_i r }•• L r_j ❑ TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name _ I hereby affirm that I am exempt from the Contractor's License Law `-Iw•i for the following reason (Section 7031.5, Business and Professions Address Code): .. ❑ City Tel.No. 1,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business _ and Professions Code). ' ^'=('I'—[ CONSTRUCTION LENDING AGENCY - —• _ (i� __ 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 above , information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for insIAecti purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE 1gn tur o _q4_rm1W Date CL 1 61C., WOME t WORKERS'CQMPENSpTION DECLARATION A PLICATI®N FOR PLUMBING PERMIT {� I hereb'y.affirm that j have a certificate of consent to self 76A667A u insure o,a certificate of Aorkers' Compensation Insurance, CE 817(REV. 10/81) 'or'a Certified.copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company y Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9y Certified copy is filed with the county building inspec- ADDRESS (�[./ (•1 tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. ►C COMPENSATION INSURANCE SHOWER OWNERl. (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this ++�� ,� permit is issued, I shall not employ y person in any manner C;t SINK CITJ TEL. NO. so as to become subject to the r ers' o pensation Laws. DISHWASHER / z a / �5 CONTRACTOR h `/J� Date /-1 �_Applican CLOTHES WASHER O Il ADDRESS NOTICE TO APPLICANT: If, aft making fkis C rtificate of Exemption, you should beco a subject to the Workers' SWIMMING POOL RECEPTOR J Compensation provisions of the Labor Code, you must forth- CITY TEL. NO, 3¢� P P Y LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATELIC. /1 deemed revoked. WATER HEATER / /f/} LICENSE NO.,-)—ACLASS C LICENSED CONTRACTORS DECLARATION f7 Vv DISTRICT NO. R ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 j GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (� and Professions Code,and my license is in full force and eff ct. 5 PER SYSTEM FINAL VALID TION O b , 9 Jc°S DATE License Num r Lic. Class O FIN U. Contract "� Date B ❑ 1 am exempt under S . 0 U B.BP.C. for this reason ► Li.l Plan check fee D.' Date: N PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE �o Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and #z 6 7J G 3 Professions Code): CitTel. No. ® a a o ❑ I, as owner of the property, will do the work and the y structure is not intended or offered for sale (SectionOpp, ( o 0 4 5 0 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY ® ® 0 405'0'0 1 hereby affirm that there is a construction lending agency for 0 1. 14-87 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 above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the a ve ent' ned property for inspection purposes. � 'SEE REVERSE FOR EXPLANATORY LANGUAGE � Y ignat a of permitte Date WORKERS'. hcit I have a c TION DECLARATION APPLICATION' FOR PLUMBING PERMIT I hereby, affirm that f have a certificate of consent to self in- 76A666 DPW 4/87 76A667A - sure,or a certificate of Workers`Compensation Insurance,or a CE 817(REV. 8/86) certified copy the% of (Sec. 3✓ 0, Lab. 1(� s COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy N CJo any , Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING AAry� 0 Certified copy is filed.with the county buildin inspection ADDRESS p� >'V®. department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY ! f Date) LAI / pp. WATER CLOSET(TOILET) NEAREST �J �(1 0�— ary CERTIFICATE O, E MPTION IfROM ORKERS' BATH TUB CROSS ST. S�- COMP SATION INSURANCE SHOWER OWNER e,- (This section need not be completed if the work involved by MAIL ������� c� the permit:is for one hundred dollars ($100) or less.) LAVATORY ADDRESS �/a/'�� ��i" / 6 I certify that in the performanc of the w �k for,which this per- SINK ddd��� mit is issued, I shall not eml y any per on in any manner so CITY EL. NO.(/JJ i as to become subject to the orkers' ompensation Laws. DISHWASHER CONTRACT � / 1>j Date pplicant CLOTHES WASHER [ J�o ADDRESS '' NOTICE TO APPLICANT: f, after m ing this Certificate of Ex- �f emption,you should come sub' ct to the Workers'Compen- SWIMMING POOL RECEPTOR , 4 CITY R. NO. sation provisions of t Labor Co e, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. 3� CLASS C__ LICENSED CONTRACTORS DECLARATION DISTRICT NO. �/ PRESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS f L /�a( 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER (06J and Professions Code, and my license is in full force and ef- 5'PER SYST M FINAL �./�," VALI ATION 9' tett. DATE G' / License Number Lic. Clas< FINAL XpOz Co r rrII—SO 1/ BY 0 I am exempt under S c. U W B.BP.C. for this re on ® y Plan check fee z 8 7 0.9 R ? Date: PLUMBING PERMIT ISSUING FEE$ Signature— TOTAL FEE #,o o'o *,0 5 SINGLE F MILY Plan check applicant ( ®`®A 6,5 0 H OWNER-BUIL ER DECLARATION I hereby affirm that I am exempt from the Contractor's License Name ® � © � 6 510 0 Law for the following reason (Section 7031.5, Business and Professions Code): Address a r. a 5 - ❑ I; as owner of The pr perty, will d the work and the City. Tel. No. structure is not intend d or offered f r sale(Section 7044, Business and Profes ons Code). CONSTRU ION LENDIN AGENCY I hereby affirm that th re is a constr ction lending agency for the performance•of't e work for hich this permit is'issued (Sec..3097, Civ.'C.). Lender's Name Lender's Addre s I certify that have read t s application and state that the above infor ation is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby auth ' e repr,se Tiyes of this County to enter upon the a ve-me ue ro erty or ection purposes. �S— SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of er Date