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Home My Public Portal About10105 GREEN ST_Plumbing__ 76Ak7 Dd 17 7.11 APPLICATION FOR ri-aDiRii DEPARTMENT OF AND SAFETY PLUMBING i COUNTY OFF LOS LOS A11N ANDGELEB WILLIAM J. FOX, DHIKF ENOIMEd FOR APPLICANT Tp FILL,,04 DISIRLOT 1,40. EiIRJ PERMIT Nff.-- PLUMEWP witRIOKNm MY FIBRE DY r1lOTION DATE IIBUm In s BUILDING O rrYTSL N D. 0 ADD REM COUNTY LaDALrrrTe �y�p�� •map NR"Kzrr I PERI aii FIMS OR 6r ET. IdIJM� TYPK OF Fi7 ru"lc"ITOI FEE oWNd MAIL WATER OL.OBET(TCILz-r) ! [Loa ADDRxw MATH TUB ! D.eo OITY TEL. No7-56. oiitza. ■HOW[R ! 0-60 1 HEREBY �IKNOW`LICDMII THAT 1 HAVE READ THIN LAVATORY (WAIH BAJOIN) ! O.sD APINUCIATION AND (TATS THAT THE AIOVK IN DORRKCT AND A3M= TD COMPLY WITH ALL OOUNTY ORDINANOEB KITCHEN ■INK ! 0.60 AND (TATE LAVED REIULATiNO PL.UMSINs. I QERTIFY THAT 1 POfBEIB THE ABOVE VALID LOI LAU61DKY TU■ OR TRAY ! 0.60 ANOELEI COUNTY LIOENBE. OR 1 AM THE - XMAL OWNER kwmvmymTlcM ouTLZT7 ! O.so Or THE RtBIDENTIAL PROPERTY DIMILMNED CIVIL WATER H EATER- ! 4 60 B10 NA WRE OF IXMP MINK ! 0.60 nimm=wN nEmBW FLOOR BINK ! asO rLOOR DRAIN ! 0+60 , ? DIBHWAIHXR O OLEO Al DRINKIN0 rOUN XAIN ! CLOGeo- URINAL ! 0.60 `J HO11BK NEWER ! [LBO _Z M I W[L1AN EOLls 0 A.PPROVALs DATE inMmTom's MAD" ROUGH PLUMBIN■ MAN PIPINv CAI VENT OEBa00L ! 1 m 0ENEIPO3L MPT10 TANKS 111137T1O TANK DRAIN PIT ( ! 1.00 BYWER PERMIT 1.00 MAN TERT 0 TOTAL FEB C uTlLrrr Co.NOTlrlm � _ j�� OF BUILDING AND SAFETY APPLICATION FOR PERMIT loo X7Y OF LOS ANGELES PLUMBING 1 WILLIAM J. FOX, OHIEF ENGINEER FOR APPLICANT TO FILL IN F PLU49M CR�a� READY FIR■TIHMP[OTION !%'iM IioU DQN9■ ��-' ■UILDINO CITY TEL N q#7 ADD RElB +] OOUNTY ^ Cu rrY 1 Nr. RN7T p7m DROP■T. MUMlWR T'Tt OF FIXTURE OR IT3I Fit OWNER 'T O ee MAIL WATER OLOSL'r(Tai ! EL no a ADDREr D OATH TUU ! 0.60 CITY TN:L. No. 8H OWER • CLaO 1 F1EREn/ KH O[ THAT I HAV[ READ THIS LAVATORY (WAUH■AUIN) Q CLOD APPLICATION AND STATE THAT THE A■OVE IS OOIl REOT AND AGREE TO COMPLY WITH ALL OOUNTY DRDINANOIDIII KITCHEN OINK • CLOG AND STATE LAVH RE'OULATINM PLUMBINOL 1 OOiTIFY THAT 1 PO■aAMB E A■OVE VALID 1 0■ LAUNDRY TUB OR TRAY ! CLW ANON7..E0 COUNTY Will r. OR I THE I WA OWNO! t E MAS SYSTM OLrrL[TB • CLED OF THE REST PRD� E RTY ORI■ AMOV . SIGNATURE DF WATER HEATER Q CL an PlOtMITTWIC GLOP ■INK Q O.■O FLOOR ■INK Q CLOO FLOQR DRAIN ! O.■O DISIMASHER @ CL50 DRINKING FOUH.TAIM • CLOO URINAL Q CLOC J RODUE SEWER ! O.■O Z M1SCK "EXm S (9 O APPROVALS DATL I R'R NANE ROUGH INA■ PIPING MAZ VENT OEUSPOOL ! 1mO QEBSPOOL UKPTIO TANK! SNF110 TANK DRAIN ( PIT ( ! 1.00 BLvfm PERMIT 1.00 MAX TAT LMLrrY OCL NOTIFIN:D TOTAL FEE 11151 FrIHAL 76A667A ICE 817B) -4/77 APPLICATION FOR PLUMBING PERMIT BUILDING ND SAFETY DI ION i FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS (J WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. 'r My SHOWER OWNER 001 LAVATORY MAIL 4 ADDRESS SINK CITY �.� TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY O. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYSTEM OUTLETS DISTRICT NO.Q OUP ONE CESS BY OUTLETS OVER U" J1 O 5 PER SYSTEM INDUSTRIAL V WASTE APPROVAL I= INSPECTION RECORD G7 W 0k- pobi216 v Cn Z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURX UNDER SLAB WORK 74- Address ROUGH PLUMBING City Tel.No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUM G. HOT WATER HEATER I HEREBY CE IFY T I M P OPERLY ISTERED AND/OR LICE PLUMBING FIXTURES REQUIRED BY LOS A ELE CO NTY ND STAT F OR IA OR 1 AM THE AS TEST LEGAL OWNER OF N ND, O SIDE IN A OV DESCRIB RESIDENTIAL PROPERTY. U LITYCO.NOTIFIED SIGNAT RE OF PER TFE FINAL J PLAN CHECK VALIDATION M.O. LASH 'PERMIT VALIDATION CK M.O. CASH IL 5 7 5 +;ilk c1 5 1 .J U =:v �- ... �RKERS'COMPENSATION DECLARATION !• l hereby, affirm that t'hove a terttflcat6 of Consent to selk Iri K PPL AT a1 CSR Pltr B Nr P RM.1T )t Y sure,p.r�er9lflcafe of Workers'Compensation Irpurtir c_q ora, g17 J6-/B6)_ 4. _ '.''•' �, 'Z-ertlfaedreop'�'tlibreof (Sec. 3B00, Lab. C.) Poll _ COI]NTY bF LOS A�VG_ELE$.:. DST. OF fUBLiC`WORKS J ry �. Company r Certlfled copy Is hereby furnAshetf.' FOR APPLICANT TO FILL IN•(PR INrl OR TYPE) BUILDING -CIffecf nopy is fllddw(th the ft. Jul ct county buiing inspeion NUMIMR FIXTURE OR MEM 8 FEE . LOCALITY . Dtrte Applicant. WATER CLOSET(To ILET) NEAREST - f TIFICAZE-OF EPTIONLFROM WORKERS' BATH TUB CROSS ST. XE/�1 " COMPENSATION INSUPANCE &40WER OWNER (TSIs section net n-0"toinpletod 0 the Work Irnrohred by .the pwinit In for on*-hundred dollats (;100).or lest✓. LAVATORY ADDRESS E55 t terftfy'tut In o p6rfounarlce of the work for which shit per $INK CRY = mit Ls Issued,`I 1 alll not employ anyperson�ln any manneF.so - as'to becomis sub)bcf ta•the:Workers' Compensation La DISHWASHER CONTRACTOR ¢ate Applicant r CLOTHES WASHL R NOTi�:E T6 APPI;ICANT: If,-after making thls•Ccrtlflcpte:of.Ex-. ADDRESS erhptlon,yo>)iho610 become subject to the Workers.Compen- SNIMMING,POOL RECEPTOR od CITY - TEL NO.. soTlon provlilons,of ihe`LaborC b, you rousFforihwkh comp' LAWN•SPRINKLER SYSTEM ' ly wlth such provlslons or{haat permit sholl.be c"med revok- S`?ATE" LIC WATER 4-ATER � LICENSE NO. CLASS WI ENSED CONTRAQTORS DKLARATJON DI NO SSEfl BY I here affirm that I am Acen>ted Under rovlsto G°5 SYSTEM OUTLETS by. P ris'of Chapter . . 9(commenc}nq with Sectlpn 7000)of Dlvlslon 3 of4he Business OU11-ETS OVER and Professions (;od6, and my Ilc6nse.Is Ir),full force-and of- 5 SYSTEM fegt. F I NIk VALI TION >¢' DATE O . License Number Llc. CIQss' U - FINAL - � Contractor, _ D ' BY H. Il I,am exempt under Sec' a/vy. U W B.BP.0 for this reason plan ch6k fee 'E Datb: PLUMBING PEWIT ISSUING FEE$ Sl.gnature - 1 r TOTAL 4E SINGLE FAMILY • 8 9 7. HOME OWNER-BUILDER DECI;AF�ATION Plan gheck.appLc-onY.` I&aby affirm thal'I arm exempt from the Contractor's License Name :# r o a e)a 5 Law for the 461lowlrlg reason;(Sectlon:7{331.5, Business dnd ( • 61 650 Professlonf Code):' Address o.• •,1 5 Q. r I, as owner of the p+�p�rty, will,do the work and the City Tel. No. stwdure IF not into or offered for sale(Section 7044, 2 t• .�$8 Buslness and O?eofe .Ions Code). ' CONSTRUCTION LENDING`AGENCY. Poo. I hereby affirrn'thot there Is a constructlon jending agency for the perforriiopce of the work for whlch'thls permit.Is.lssued ' (Sec. 3047, SIV:C.). I Lender's NBrrte _4 ' 'Lehdef's Address I certify`th I-hav ead tF is application and state that the Intfo corred.,t agree to comply with all CountyPIP prdln c .Laws r' ting Plumbing,.and hereby zTlv thb ounty 1G.enter aeon the e- o rty'for In ones. Z SEE REVERSE FOR EXPLANATORY LANGUAGE SI n o Permlttbe to - 1�JORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT • I h{�eby, affirm that I�Fiave a certtflcate of consent to self In- q�7ADPW s/� yur� w-a2ertlfIcote of Workers'Compensation Insurance,or a CE B17(may e/86) cg (fled copy thereof (Sec. 38W, Lab. C.) - L `fl Pyllcy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certlfled copy Is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) dCertlfle c'wJs fl lad�vlth the county building Inspection NUMBER FIXTURE OR ITEM FEE ADDRESS re r B LOCALITY S4WATER CLOSET(TOILET) / Date Applicant w NEAR EST RTI TE OF EXEMPTION FROM WORKERS' RATH TUB CROSS Sr. COMPENSATION INSURANCE SHOWER OWNER (This secttfln need not be completed If th6 work Involved by MAIL the permit Is for one hundred dollars j$100)or tots.) LAVATORY ADDRESS 1 certify that In the performance of the work for which this per- SINK (� my TEL NO. mit Is Issued, I shall not employ any person In any manner so as to becomb sublets to the Workers' Compensation L DISPiWASHER CONTRACTOR . Datesk(w Applicant CLOTHES WASHER NOTICE ICANT: tf, offer making this Certificate of Ex- ADDRESS IPJ emptlon,you should become sublect to the Workers'Compen- SWIMMING POOL RECEPTOR Cod CITY TEL NO. satlon provisions of the Labor e, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC ed. WATER HEATER UCENSE NO. CLASS LICENSED CONTRACTORS P�CLARATION DISRI NO. BY I hereby afflrm that I am licensed under provisions of Chapter GAS SYSTEM CUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS.OVER and Ptofesslons Code, and my license Is in full force and of- 5 PER SYSTEM FINALTION y' fect. DATE IL O License Number Lic, Class 0 FINAL Contractor Data' BY 0 0 ~ I am exempt under Sec. W B.BP.C. for this reason Plan check fee ► -289 7 A Data: PLUMBING PERMff ISSUING FEE$ _ # 00 ° °.° 5 Signature TOTAL FEE T e c a 5 0 SINGLE FAMILY plan check a Ilcaht HOME OWNER-BUILDER DECLARATION PP9,2'8.5 I hereby afflrm that I am exempt from the Contractor's License Name. ° 0 T3 Law for the following reason (Section 7031.5, Business and 2 0 3,w-8 8 Professions Code): Address X1, as owner of the property, will do the work and the City Tel, No. structure Is not Intended or offered for sale(Sectlon 7044, Business and Prdfeulons Code). CONSTRUCTION 1 LADING 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 ve r his application and state that the a Infor n Is c . I agree to comply with all County , ces State regul g umbIng, and hereby a nto v oft Coun to enter upon the f Inspectl n pu . 2 .3 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 91bte WORKERS' COMPENSATION DECLARATION2026 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A-06067ADPW 4/87 sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date I ? 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 ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issue I shall not employ any person in any manner so •,i +7 _ as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER >_ and Professions Code, and my license is in full force and ef- 5 PER SYSTEM a FINAL VALIa'p►TION fect. DATE License Number Lic. Class LU FINAL LL. Contractor Date BY >_ cc ❑ 4 I am exempt under Sec. Q 8.8P.C. for this reason Plan check fee oil. d Date: PLUMBING PERMIT ISSUING FEE$ W Signature ~ TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor's License Name ' c .9 Law for the following reason (Section 7031.5, Business and Professions Code): Address « 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 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 prop6rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee f /Date