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Home My Public Portal About6013 OAK AVE_Plumbing__ 76A667A ICE 6178) 11/76 • APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /I/ O/I NUMBER FIXTURE OR ITEM ® FEE ADDRESS 0 xk WATER CLOSET S LOCALITY BATHTUB C NEAREST ST c7acL SHOWER OWNER F2/AAS d09' LAVATORY MAIL ADDRESS SINK CITY TEL NO DISHWASHER CONTRACTOR �!M �Ri CLOTHES WASHER ADDRESS { SWIMMING POOL RECEPTOR CITY v / f TEL NO 0Fj-—2 LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO ,!� C GAS SYSTEM OUTLETS DISTRICT 1 G NE PROCESSED BY OUTLETSOVER 5-t (9 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL O INSPECTION RECORD V GO HI d N z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE ?j 50 Plan check applicant Name APPROVALS DATE INSPE S SIGNATURE UNDER SLAB WORK 17 Address ROUGH PLUMBING fLj�rf City �/ Tel No X77 GAS PIPING I HEREBY ACKNOWLEDGE AT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT A AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER AND STATE LAWS REGULATING PLUMBING 4 I HEREBY CERTIFY HAT I AM PROPERLY REGISTERED R LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS AN COUNTY AND STNOFALIF NU1 AT1AMTHEGAS TEST LEGAL OWNER OFA IN ND TO RESIDEINOV ESC RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERM ITTEE FINAL PLAN CHECK VALI ATION _ CK M o CASH PERMIT VALIDATION CK Mo CASH 5 1 0 r AUG 30 5 ® 1 3.5 a •ss WORKERS COMPENSATION DECLARATION zewesrA + I hereby affirm that I have a certificate of consent to self cs a„(a ae) APPLICATION FOR PLUMBING PERMIT insure or a cerfii42ate of Workers Compensation Insurance or a certified copy,thereof c 3800 Lab QC ` , COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No &' mpany Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Cert �e copy is filedM�co�unty �Idm tion NUMBER FIXTURE OR ITEM • FEE ADDRESS WATER CLOSET LOCALITY e1 Date 8Z—.pplica NEAREST BATH TUB CROSS ST CERTIFICATE OF E O F M WORKERS '� W� COMPENSATION INS ANCE SHOWER OWNER Uv LAVATORY MAIL (This section need not be completed if the work involved ADDRESS 65 1:0 by the permit is for one hundred dollars ($100) or less) SINKCIT ` a + �� TEL NO I certify that in the performance of the work for which this DISHWASHER U permit is issued 1 shall not employ any person in any manner CONTRACTOR wbim so as to become subject to the Workers Compensation Laws CLOTHES WASHER c ADDRESS 1 n O Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT If after making this Certificate of CITYTEL NO W Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM G. STATE Compensation provisions of the Labor Code you must forth LIC WATER HEATER LICENSE NO CLASS with comply with such provisions or this permit shall be deemed revoked GAS SYSTEM OUTLETS 6TRICTNg ED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER t o I hereby affirm that I am licensed under provisions of Chaptfr 5 R SYSTEM 9 (commencing with Section 7000)of Division 3 of the BusFINAL p� IDATION ness and Professions Code and my license is in full force anz) DATE a effect License Num >�'� Sic Class FINAL i r Contractor Date &-Z_0 I am exempt from the licensing requirements as I am eck fee licensed architect or a registered professional engineeUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051 Bumess and Professions Code) VLic or Reg No Date ck applicant HOME OWNER BUILDER DECLARATION 1 I hereby affirm that I am exempt from the Contractors IlAddress License Law for the following reason (Section 7031 5 Buse City Tel No ness and Professions Code) I as owner of the property am exclusively contracting with licensed contractors to construct the project (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) 23865 A " Lender s Name #'r • • • • 5 Lender s Address 2 • - 1 2 5 0 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 �a 0 - 12505 ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the 0504-82 a ntioned propertyfor r ction pu e 81 S177i of P m tee Date ,.WORKERS.;0tt1ENSATIO1J DECLARATION APPLICATION FOR PLUMBING PERMIT {� hereby pffam thot'1 have a certificate of consent to self 76A667A LJ ensure or a eertificateof Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished BUILDING / i / ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS God /✓ r✓//�G- Certified copy is filed with the county building inspee tion department NUMBER FIXTURE OR ITEM � FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER 4DZ (This section need not be completed If the work invohred by the permit Is for one hundred dollars(:100)or less) LAVATORY CESS V1 t4 13 A/, 0410 I certify that In the performance of the work for which this �..� permit is issued 1 shall not employ any person in any manner SINK d� CITY �'�� TEL NO so as to become subject to the Workers Compe ti n laws DISHWASHER CONTRACTOR ��s f�' `e U��f�� —'LZ".Applicant /� Date pplicanf CLOTHES WASHER ADDRESS �'/�/ NOTICE TO APPLICANT If after making this Certificate of SWIMMING FOOL RECEPTOR Exemption you should become subject to the Workers A TEL NO Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY ` O with comply with such provisions or this permit shall be STATE LIC C, G deemed revoked WATER HEATER LICENSED CONTRACTORS DECLARATIONGAS SYSTEM / OUTLETS DISTRICT NOD BY I hereby affirm that I am licensed under provisions of Chapter 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 VALID TION License Number Lic Class e'r3 li � S IS PLV�l3 ,f,G FINAL S Contactor Date 5 '�_ BY a, Q1 am exempt under Sec C�.. B&P C for this reason W re ��-2 Z �� Plan check fee ) PLUMBING PERMIT ISSUING FEE$ Z Signatu TOTAL FEE p2$ SINGLE FAMILY Plan check applicant HOME OWNER BUILDER DECLARATION Name .-446919 1 hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5 Business and • e2&50 Professions Code) City Tel No ❑ I as owner of the property will do the work and the ;522-86• *28505 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 100above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing and hereby authorize reprelentatives of this County to enter upon the above meM?oneZZ -Z for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE r��C'� Sr-2 - -16 Signature of Permittee Date