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Home My Public Portal About5226 MCCLINTOCK AVE_Plumbing__ 76A667-CE817-8-57 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER' BUILDING AN'D SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS G:.. ;No.CASSATT D. GRIFFIN, SUPT OF BUILDINGLOCALITY'FOR APPLICANT TO FILL IN. NEAREST •CROSS ST: rNUMBER FIXTURE OR ITEM WATER CLOSETOWNERMAIL BATH TUB- ADDRESS''SHOWER CITY I. TLAVATORY CONTRACTOR SINS' ADDRESSDISHWASHERCITY 4,7T .I LAUNDRY TUB CONTRACTORS STATE REGISTRATION NO. / /L COUNTY i CLOTHES WASHER DIST, O. GROUP ONE I READY FOR INSPECTION , WATER HEATER — 1 J GAS SYSTEM INDUSTRIAL WASTE APPROVAL. INSPECTION RECORD' APPROVALS @ $1.00 PER ITEM I, DATE INSPECTOR'S SIGNATURE, ORFIXTIIAE $ �f UNDER-SLAB WORK r7 r I./ ROUGH PLUMBING PERMIT S 1100 w GAS PIPING TOTALFEE e. a v GPs VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER. AND STATE THAT THE ABOVE IS CORRECT'_AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND: STATE" LAWS REGULATING OLUMBING FIXTURES -PLUMBING. I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED'BY LOS ANGELES .COUNTY AND STATE OF CALIFORNIA .OR THAT I AM THE LEGAL 'OWNER OF THE ABOVE UTILITY CO. NOTIFIED t? DESCRIB:.D RESIDENTI PR RTY. SIGNATURE L. OF PERMITTFINAL EE ea .Si s - Cis v ATION ROBERT A. WOOD, SUPERVISING MECHANICAL ENG'R • K. N.'O. CASH - y , WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A sure, r a cerMicate of Workers'Compensation Insurance,or a certifi d copy thereof(Sec. 3800, Lab. C.) Policy o. Company r �l�$� CU TY OF LOS ANGELES �g l.� DEPT. OF PUBLIC WORKS E] C rtified copy is hereby furnished. 11 G (i -(7� FOR APPLICANT TO ILL IN(PRINT OR TYPE) BUILDI Ce tifled copy is filed with the county building Inspe. ion ADDRESS �p �j p �i• de artment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Ddte Applicant WATER CLOSET(TOILET) NEAREST C\! the TE OF EXEMPTION FROM WORKERS' - BATH TUB• CROSS ST. C•� OMPENSATION INSURANCE SHOWER OWNER (This sectd not be completed if the work Inv Ived by MAIL the permione hundred dollars(;100)or les ) LAVATORY ADDRESS I certify thperformance of the work for whi thisper- mit is issuall not employ any person in any anner so SINK' CITY" �� L. NO.P" rQ as to becject to the Workers'Compensat' n Laws, DISHWASHER CONTRACTOR � Date Applicant CLOTHES WASHER ADDRESS a NOTICE TO APPLVRAR : If,.after making this C rtificate of Ex- SWIMMING POOL RECEPTOR 3 emption,you shcome subject to the W rkers'Compen- sation provisions he Labor Code,you mus forthwith comp- LAWN SPRINKLER SYSTEMS CITY TEL.NO. ly with such proor this permit shall e•deemed revok- STATE LIC. [v7 ed. WATER HEATER LICENSE'NO. CLASS 62 LICENNTRACTORS DEC RATION 1 DISTRICT NO. Qf,ES b BY I hereby affirm tlicensed under rovislons of Chapter GAS-SYSTEM OUTLETS 9(commencing tion 7000)of Di sion 3 of the Business OUTLETS OVER and Professions d my license 1s in.full force and ef- 5 PER SYSTEM FINAL VALIDATION fecf. HOSE BIB DATE' License Numberic. Class 'i d FIN. C V ContractorDate BY i O I am exemer SeB.BP.C. for121 ason Plan check fee I / 1 ITEMSA. �„ y Date: PLUMBING PERMIT ISSUING FEE$ �,� ► l A � 1d TQTAL 4J.o �0 Z Signature V g TOTAL FEE Q ID {:HECK 43.10 SI LE FA ILY. Plan check applicant CHANGE .00 HOME OWN -BUILDE DECLARATION PP• (, / I hereby affirm.that.I a exempt fr m the Contractor's License Name "J b Law for the following reason (Sec ion 7031.5, Business and �dQ'�QQ1 /��/93<t Professions Code): Address I, as owner o the property, w I do the work and the City Tel. No. 5043 j 1' structure is no intended or offere for sale(Section 7044, Business an Professions Code). r C STRUCTION LENDING GENCY, _ ► I hereby affir that there is a construct! lending agency for the performa ce of the work for•which his permit is issued (Sec. 3097, v. C.). Lender's N me Lender's ddress I certif that I have read this application a d state that the , abov information is correct.I agree to comp) with.all.County ordiq nces and State laws regulating Plumb! g, and hereby apt brize representatives of this County to ter upon the y ab e-mentioned property for inspection purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Da e WORKERS'COMPENSATION DECLARATION APPLICATION FOR. PLUNKING PERMIT I hereby affiLrm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A'667A City of Temple City or a certified copy thereof(Sec. 3800, Lab. C.) i COUNTY'OF LOS ANUELES DEPT.OF PUBLIC WORKS Policy No6969-0004..pany MMIC 16651 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ® Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple Cit Date 4/1/91 Appli4�s'Ipnar'a7 Install- WATER CLOSET NEAREST CERTIFICATE OF EXEMPTIQN FROM WORKERS' BATH TUB CROSS ST. Freer St COMPENSATION INSURANCENER Robert AcoSt3 (This section need not be completed if the work Involved by MAIL SHOWER OW the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 5226 No. McClintock Ave. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner SINK CITYTEL. '444-4610 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS 6558 West Blvd. NOTICE TO APPLICANT: If, after making this Certificate of i SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Los Angeles TEL. NO753-2541 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. 3 WATER HEATER ' S0 LICENSE NO. 3.51A-19 CLASS C36 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 9�� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license Is in full force and effect. 5 PER SYSTEM FINAL VALIDATION II: License Number Xf= 15113 P Class C36 DATE Q FINA X Contractoi7-0. Provin Date 4/91 BY I am exempt under Sec. VI-45 BAP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 131.00 Signature TOTAL FEE 1 20.50 SINGLE FAMILY Plan check applicant ' HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License A?,--'C Tv v Law for the following reason (Section 7031.5, Business and Address _ r` 3l_' 20.50 Professions Code): City Tel. No. i ❑ I, as owner of the property, will do the work and the 1 ITEMS structure is not intended or offered for sale (Section ® TOTAL}T AL 20 a 50 7044, Business and Professions Code). � t~io j{} CONSTRUCTION LENDING AGENCY I hereby affirm that there is atconstruction lending agency for CH It .00 the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.). Lender's Name C►CIDtJ-0 �1 1 / ter' '+.I Lender's Address 3440 f AM11:46 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 guI ting Plumbing, and hereby authorize re rese i of this County to enter upon the above-.me lone ro rty r inspect' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0/16/90 Signature of Phimittdq7 Date WORKERS'COMPENSATION DECLARATIOq .APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of coAserg to self 76A insure, or a certificate of Workers'Compensation Insurance;"! E 1 1 . l0/81) or a certified copy thereof(Sec. 3800, Lab. 4;.) COUNTY OF LOS ANGELES ee BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS e Certified copy is filed with the county building inspec- �,t ,��' � /t� tion department. NUMBER r FIXTURE OR ITEM @ FEE LOCALITY Date Appligant WATER CLOSET NEAREST x, CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER e�'y� (This section need not be completed if the work involved by / MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any per n inQ manner SINK CITY ?� �, TEL. NOS so as to become subject to the W kers' ompensaaws. DISHWASHER ll1 CONTRACTOR z2 01,1 Date Applicant ---- CLOTHES WASHER ADDRESS 7 NOTICE TO APPLICANT: if, a.ferlmaking this Certificate of SWIMMING POOL RECEPTOR Exemption, you should bA me subject to the Workers' Compensation provisions of t e Labor Code, you must forth- CITY , TEL. NO. with comply with such provisions or this permit. shall be LAWN SPRINKLER SYSTEM ' P Y P P STATE LIC. deemed revoked. WATER HEATER LICENSE NO. 7 1Nf CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR ESSEq!Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION O License Numb e Lic. Class � DATE 'Z_ 2(—�3 � w FINAL O Contractor r �� ' Date BY ❑ I/a ee empt under Sec. for this reason ! Plan check fee Signature Date: PLUMBING PERMIT ISSUING FEE$ �a TOTAL FEE SINGLE FAMILY Plan check applicant o a 0 0 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 Professions Code): City Tel. No. " , o 0 ❑ I, as owner of the property, will do the work and the ,� p r t structure is not intended or'offered for sale (Section - , . _ 7044, Business and Professions Code). I 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 represen es of this County to enter upon the abye-m tioned operty for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE Siof Permittee Da WORKERS'COMPENSATION DECLARATION s APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent;d , insure, or a certificate of Workers'Compensation Insuran CP%/B1.) ' or a certified'copy thereof(Sec. 3800, Lab. C1) f .� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No: Company Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE r Date Appii4ant WATER CLOSET LOCALITY A LIT CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. -r-0- L %o C Q- COMPENSATION INSURANCE SHOWER OWNER Op. Co J (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS AAA_C I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO.4JVg4V so as to become subject to the Workers'Compensation Laws. DISHWASHER �`T T ss►�� CONTRACTOR o Xj IJ446.4je/L— Date `y Applicant' DA wJ W A-Cr-a✓CA_ CLOTHES WASHER ADDRESS.Z 2-0NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR V Z_&1eQ Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forth- CITY TEL.NO. [a LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS C-Z o LICENSED CONTRACTORS DECLARATION DISTRICT NO: PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM d 'OUTLETS �� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL DATE Zl �3 VALIDATION d License Number Z � LLc. Class �-w 1 Z- AG a / � I FINAL O Contractor 2144AIL-511-6Ad�Date ! �d BY Y b- ❑ V I am exempt under Sec. � 1� N B.BP.C. for this reason ► ` J %Z`7 I Plan,check fee Date: PLUMBING PERMIT ISSUING FEE$ f0 Signature' ov TOTAL FEE 3(� • SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION iL Name a r o O O I hereby affirm that I am exempt from the Contractor's License Address 0 o c L G Law for the following reason (Section 7031.5, Business and Professions Code): ' City Tel. No. a o ❑ I, 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). jl 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.)L 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 ve-mentioned,property for inspection purposes. ,,nSEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pefttee ate I I