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Home My Public Portal About9228 LONGDEN AVE_Plumbing__ ORKF�RS=dgIVENWIONDECLARATION APPLICATION FOR PLUMBING PERMIT 11zt1fie,d • affirm that I hake a%certificate of consent oto self 76A667A , C a certificate of Workers'Compensation Insurance, E 817(REV. 10/81) lfUc t of(Sec. 3800, La . C.) . COUNTY OF LOS ANGELES BUILDING AND SAFETY C � ompany copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGG/ Certified copy is filed with the county building irispec- ADDRESS O%Q � . ti depa fm nf. � r, NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appligant WATER CLOSET NEAREST ERTI ICATE OF EXEMPTION FROM RKERS' ' BATH TUB CROSS ST.. COMPENSATION INSURANCE (This section need not be completed If the work Involved by SHOWER OWNER the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ' I certify that in the performance of the work for which this ADDRESS permit is issued,I shall not employ any person in any manner SINK CITY TEL.NO &5-`g so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant I CLOTHES WASHER ADDRESS ! l NOTICE TO APPLICANT: If, after making this Certificate of J Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO.. 39 with comply with such rovisions or this. permit shall be LAWN SPRINKLER SYSTEM P Y P P STATE LIC. deemed.revoked. i WATER HEATER /� LICENSE NO. 3 CLASS LICENSED CONTRACTORS DECLARATION IJ DIST R NO. PR ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS ,��C,`f (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM IL FINAL rf DATE — LIDATION Oat License Nu er Lic. Class ki n FI O Contractor Date dL7 ❑ I am exemp nder Sec. Oma, B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant 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 6 9 a.2 A Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the' # o o o 0 0 5 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® .- 2250 CONSTRUCTION LENDING AGENCY o 0 0 2 2 5 0 v I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 &30-87 . (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 ordlnan sand State laws regulating Plumbing, and hereby ' author! representatives of this County to ente upon the above entioned pr erty for' specflon purpo's I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee J 1,0ate 11 A-'"W.ORXERS'COMPENSATION DECLARATION 76AG67w I bhgrebfirm that,,t have a' certificate of consent to self CE a„(z-ao) APPLICATION FOR PLUMBING PERMIT ,t ;5 ins)n�,e;ora•der4ificate of Workers'.Compensation Insurance,or a certified:copf thergof(rSec.3800,Lab.C.) - COUNTY OF.LOS ANGEL BUILDING AND SAFETY Policy No. . Company 0 Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 9` z �, �" p. � Certifiedcopy is filed with the county building inspection NUMBER FIXTURE OR ITEM. FEE department. LOCAL'I� Y. WATER CLOSET Date Applicant NEAREST ' BATHTUB CROSS ST. /✓, Nor t CERTIFICATE OF EXEMPTION FROM WORKERS' y COMPENSATION INSURANCE ' SHOWER 3 r OWNER � r V'. + RY TMAIL VAO ' (This section need not be completed if the work involved LA 1 ADD R ESS 2 z.� 1 v N�l�ter✓ by the permit -is •for• one hundred dollars ($100) or less.) SINK 7� O CITY T�h.0 Le C, TEL.NOa��1�J U I•certify that in the performance of the work for which this DISHWASHER permit is issued, I•shall not employ any person in:any manner CONTRACTOR kjAJP_►- O so as to become subject.to the:Workers'Compensation Laws. �/ CLOTHES WASHER ' ADDRESS Date Applicant LU a SWIMMING POOL RECEPTOR NOTICE TO APPLICANT:•If, after making this Certificate of CITY.. TEL.NO. N Exemption, you' should become subject to the Workers' LAWN SPRINKLER SYSTEM STAT LIC. Z Compensation provisions of the Labor Code,you must forth- LICENSE NO. CLASS with .comply with such provisions or this permit shall be / WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PRO ESSEErBY /� ,• LICENSED CONTRACTORS DECLARATION OUTLETS OVER v rO .I hereby affirm that I am licensed under provisions df Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 bf the Busi- FINAL nese and Professions Code, and my license is in full force and DATE Z 7�� VALIDATION effect. FINAL ` L•icense.Number Lie.Class BY A. Contractor Date , sr exempt from the-licensing requirements as I am a Plan check fee + licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, :Bus.- iness and Profess(ons Code). ', TOTAL FEE Lie.or Reg.No.: Date Plan check applicant HOME OWNER-BUILDER.DECLARATION Name ata } I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason .(Section.7031.5, Busi- ness and Professions Code): :2 2.4 7 2 A I, as owner of the property;am exclusively contracting # o o 0 0 o rj with licensed contractors to construct the project (Section 7044,Business and Pro€essions Code). - 2o o. 2 a 0 0 CONSTRUCTI..ON LENDING AGENCY _ I hereby affirm that there is a construction lending agency o 0 o28.0 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). ' IaG6-80 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab o )me�t(oned property for inspection purposes. /0 aD Signature of Per t� ,Date, d6.yL�/J I 1