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Home My Public Portal About5833 OAK AVE_Plumbing__ PCRKFRS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I FproWy affirm that I have a certificate of consent to self 76A667A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) _ or a certiV46557-acimpanyEz coy therreof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N I^n?l9 17 ❑ Certified copy is herebyfurnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING -^ 011 Certified copy is filed with the county building inspec ADDRESS S tion depart en/t NUMBER FIXTURE OR ITEM Q FEE LOCALITY // �(* WATER CLOSET Date Applicant � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS STS COMPENSATION INSURANCE SHOWER OWNER Se G (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less) LAVATORY ADDRESS V I certify that in the performance of the work for which this --- permit is issued I shall not employ any person in any manner SINK CITY �,m TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS 7 _ NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers ��, , .g��- Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY 017 - TEL NO-:499 �S with comply with such provisions or this permit shall be STATE l LIC P deemed revoked WATER HEATER LICENSE NO �S, � CLASS LICENSED CONTRACTORS DECLARATION r DISTRICT NO ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM —L---OUTLETS —�' ' 6 d (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O and Professions Code andel my license is in full force and effect 5 PER SYSTEM FINAL VALIDATI License Number ` S S DATE lac Class �^ Q�j (�C//UQ ��T IY �� 3s ` FIN Contracto Date BY ❑ I am exempt under Sec V B 8P C for this reason W Plan check fee ► o. Date PLUMBING PERMIT ISSUING FEE$ /U Z Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address 4 Law for the following reason (Section 7031 5 Business and Professions Code) City Tel No ❑ I as owner of the property will do the work and the structure is not intended or offered for sale (SectionpopR 5 8 7 OA 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY # • • • • • 5 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued - 2250 (Sec W97 Civ C ) _ • • • 2250 Lender s Name 1 105-86 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 jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the ,pbo),re mentio roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dole t WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT yAffirm that I have a certificate of consent to self 76A667A ,r i if certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certifi opy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 1 Company Ea/C/771,24r7t - - Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING . Certified copy is filed with the county building inspec 41ADDRESS tion depart m nt NUMBER FIXTURE OR ITEM (� FEE G n LOCALITY to/f7, b6 WATER CLOSET r✓� Date Applicant ir NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST L COMPENSATION INSURANCE OWNER r (This section need not be completed If the work Involved by SHOWER 600MAIL the permit is for one hundred dollars($100)or less) LAVATORY OCIADDRESS �s+Z I certify that in the performance of the work for which this CITY y permit is issued I shall not employ any person in any manner SINK �/n le TEL NO� Gr, S so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR ' Date Applicant CLOTHES WASHER ADDRESS g NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers /.� Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY t 6—)-L Jl/G/ TEL N with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO JILASS LICENSED CONTRACTORS DECLARATION DISTRICT N PROCESSED I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATI DATE License Number 31S3� Lic Class FINAL ContractorDate BY ❑ I am exempt under Sec B&P C for this reason W Plan check fee ►, t1 Date Cn PLUMBING PERMIT ISSUING FEE$ fi 56 a9 A Z Signature TOTAL FEE Q # 0 0 0 0 0 5 SINGLE FAMILY Plan check applicant 1 - 4050 HOME OWNER BUILDER DECLARATION Name 4 0 5 0 50 I hereby affirm that I am exempt from the Contractor s License Address Low for the following reason (Section 7031 5 Business and - 1 Q 7 i 8 6 Professions Code) City Tel No ❑ 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) lop CONSTRUCTION LENDING AGENCY I hereby nffirm 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 entionetop rty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 6 io i 3 4 t Signature of Permittee Date WORKERS COMPENSATION DECLARATIONA,P�P L I C A T I O N FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consentnsent r to elf Iz so insure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 39415-9- Company AP-tna T_nis 0 Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Oak Ave Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE WATER CLOSET LOCALITY Temple Clt Date e r Applicant Qi1m $rn4_p1hg_ NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SHOWER OWNER Chris Construction LAVATORY MAIL (This section need not be completed if the work involved ADDRESS } by the permit is for one hundred dollars ($100) or less) SINKa CITY Ar dla TEL NO287-7118 � I certify that in the performance of the work for which this DISHWASHERU permit is issued I shall not employ any person in any manner CONTRACTOOwen CONTRALTOBros Plumbin Inc so as to become subject to the Workers Compensation Laws CLOTHES WASHER0 i ADDRESS 4265 N Baldwin Ave 0 Date ApplicantSWIMMING POOL RECEPTOR 0 NOTICE TO APPLICANT If after making this Certificate of CITY EI Monte TEL Nc443-0078 wa Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEMSTATE LICU) ��++ ' Compensation provisions of the Labor Code you must forth WATER HEATER LICENSE NO 231 741 CLAS9✓36-20 Z with comply with such provisions or this permit shall be deemed revoked GAS SYSTEM OUTLETS DISTRICT NO PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER (� I hereby affirm that I am licensed under provisions of Chapter 15 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Bust FINAL r, VALIDATION ness and Professions Code and my license is in full force and DATE t Z effect 231 741_ Lt. C1asSC36-2(L_ BY AL �°�--- License Number Contract RrQa.PJ gpate$/9-1/92 IF 0 1 am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ O acting to my professional capacity (Section 7051 Bus iness and Professions Code) TOTAL FEE r Lic or Reg No Date Plan check applicant ;2 595 4 A HOME OWNER BUILDER DECLARATION Name # • • • a a 5 1 hereby affirm that I am exempt from the Contractors Address 2 r• • 1 &50 License Law for the following reason (Section 7031 5 Bust City Tel No ness and Professions Code) • • • 1 65050 I as owner of the property am exclusively contracting with licensed contractors to construct the project O a 3 1 —82 (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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby aut orize representatives of this County to enter upon the ab men oned property for inspection purposes 8/23/82 Slg4jure of Permittee Date