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Home My Public Portal About9433 LONGDEN AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION A TION COR PLUMBING L MBIN PERMIT ER IT I hQ,pby, af"That I have a certificate of consent to self in- 20-0026 6�67A PW�`� Mr M �" V V G ,Y, 1 sure;or a certificate of Workers'Compensation Insurance,or a 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 $s department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Ddte Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS', BATH TUB CROSS ST. fk k 44rf- COMPENSATION INSURANCE SHOWER OWNER eTS ,_ E�„ (This section need not be completed If the work involved by MAIL I w the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS �n Ave.. I certify that in the performance of the-work for which this per- SINK / mit is issued, I shall not employ any person in any manner so �rp CITY C TEL'NO.�� i as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- em tion,you should become subject to the Workers'•Com en- SWIMMING POOL RECEPTOR P Y I P - CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS.OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE ;�^ �' a License Number Lic. Class FINAL ACCT n g V ContractorDate BY 3303 43040 O 1 am exempt under Sec. 1 ITEMS V B.BP.C. for this reason Plan check fee TOTAL �'3 p'�--� U05► 4 Date: 'PLUMBING PERMIT ISSUING FEE$ �:7 3 o CHECK 43e40 Signature TOTAL FEE � -0 CHOINGE .00 SINGLE FAMILY Plan applicant HOME an ceca OWNER-BUILDER DECLARATION pp I hereby affirm that I am exempt from the Contractor's License Nbme• 0000-0001 8/22/95 Law for the following reason (Section 7031.5, Business and Professions Code): Address 1936 1 ASI $119 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 property for inspection purposes. r A&P-2t, j SEE REVERSE FOR EXPLANATORY LANGUAGE /"Signatur ermittee Date • ' r 76Y► �! IQ i 1 7 10-62 •r APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST DING W�7 iy JOHN A. LAMBIE, COUNTY ENGINEER RESS .J L/k-<— WILLIAM A.JENSEN, SUPT OF BUILDING ALIT FOR APPLICANT TO FML IN SS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 BATH TUB 1.25 ADDRESSCrl2" Ae/ SHOWER 1.25 CITY • TEL. NO. / LAVATORY 1.25 2 CONTRALTO SINS 1.25 ADDRESS' DISHWASHER 1.25 CITY TEL. NO. LAUNDRY TUB 1.25 CONTRACTOR'S STATE REGISTRATION NO. G�/� COUNTY ❑ CLOTHES WASHER 1.25 DISTR�NO. 1.7 P ZONE P OCE ED BY WATER HEATER 1.50 ' GAS SYSTEM OUTLETS 1,50 INDUSTRIAL �„ L OUTLETS OVERWASTE APPROVA 'S PER SYSTEM 90 f� INSPECTION,4AECORD7 u •• I. del ( .�'��,•� J` ,.+ l,�r`,�/� � — e - APPROVALS //DA-TE I NSPECT,OR'S'SI 9sfATU RE PERMIT S 21 00 UNDER SLAB WORK ROUGH PLUMBING V J �!/fes✓� TOTAL FEE GAS PIPING f I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER �r 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS�TEST T CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DE CRIBED RESIDENTIA ROPER . UTILITY CO.NOTIFIED A SIGNATURE OF PERMITTE FINAL ds LIDATION ROBERT A/.WOOD r CK. M.0. i CASH SUPERVISING MECHANICAL ENG'R �l7�oz o c-;220 5 A 5.75- 14 MM67-CE817-8-68 (. APPLICATION FOR P''L,UMBING PERMIT 1 COUNTY OF LOS ANGELES i` + DEPARTMENT OF COUNTY ENGEM= BUILDING AND SAFETY DrMON TrOHN A. LAMBIE, County �es CASSATT D.GRUTM.Supt of Rnildiag IiOCAL rrY FOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM OWNER . WATER CLOSET lEAII. RATE TUB ADDRESS SHOWER CITY TEL. NO. LAVATORY CONTRALTOS $ I DRESS 2 O g� 87 DISHWASHER > ��- f TEL.TUB C�ONTBACTOR'S E ❑LAUNDRr REGISTRATION NO.CLOTHES WA R DISTRICTT GROUP ZONE BY WATER HEATER GAS SYSTEM II,DUSTRIAL WASTE APPROVAL lKSPECTION RECORD f 0APPROVALS Q B 0 PI'DC0 8Em I: DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT 31 2 00 ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AN OR GAS TEST LICENSED AS REQUIRED BY LOS GELES COUNTY AND ST OF CALIFORNIA OR THAT T LEGAL 0TH OVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTI P SIGNATURE OF PERMITTE " FINAL ROBERTA.WOOD. ®a VALIDATION SUPERVISING MECHANICAL ENG'R cK. B.0. CUB 2 9 8 ''kY 5 H 3.00 {�