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Home My Public Portal About6220 OAK AVE_Plumbing__ WOR9RS'COMPENSATION DECLARATION— I b � , APPLICATION FOR PLUMBING PERMIT phreby affirm that I have a certificate of consent to self (76A667A V-7, or a certificate of Workers'Compensation Insurance; ICE 817(REV. 10%81) or led f(Sec. 3800 Lab. C.) /�'�1. (d° ° COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑o i`I`cy No. 'Company Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL:IN(PRINT OR TYPE) ADDRESS Certifled.copy is filed with the county buildin inspec- tion d[el4artmpnt. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appliga t WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORK BATH TUB CROSS ST. COMPENSATION INSURANCE `' SHOWER OWNER (This section-need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or lessJ LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued,I'shallnot employ any person in any manner SINK CI \ , TEL.NO. _ so as to become subject'to t. Workers'Compensation Laws. CONTRACTOR S Date Applicant CLOTHES WASHER r NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Ekempfion, you should become subject to the Workers.' SWIMMING POOL RECEPTOR Compensation provisions of the Labor•Code, you must forth- CITY TEL.NO LAWN.SPRINKLER SYSTEM ' with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS ` LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (.commencing'with Section 7000)of Division 3 of the Business OUTLETS OVER r 0 and Professions Code,and my license is 1 r full force and effect. 5 PER SYSTEM FINAL ` � VALIDATION O License Number. Lit. Class DATE -[ 09 ` FINAL O Contractor' Date "1 BY d ❑ I am exempt under Sec. ` Z BAP.C. for.this reason ` Plari check fee , 107 8 Date:, PLUMBING PERMIT ISSUING FEE$ b ' Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 9754 A I 0 hereby affirm that I am exempt:from the Contractor's License Address �' Law for the following.reason (Section 7031..5, Business and ,0 0 0 0 Professions Code): ❑ City Tel. No. 2 o so. 2'U50 I., as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® o o'o 2 ` E C 7044, Business and Professions Code). ; CONSTRUCTION LENDING AGENCY 0 ,� '8 4 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 5 (Sec. 3097, Civ. C.). ' I Lender's.Name Lender's Address I 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 I abov -mentioned property for inspection purposes.. I SEE REVERSE FOR EXPLANATORY LANGUAGE i )gnature 0 Permittee Date :.. •. 7SAG87,,6k#8172-132 / TEMPLE CITY _ APPLICATION FOR PLUMBING PERMIT' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUlLDIN JOHN A. LAMBIE, COUNTY ENGINEER ADDRES WILLIAM A.JENSEN, SUPT OF BUILDING / LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE ' OWNER r WATER CLOSET $1.25 MAIL BATH TUB 1,25 ADDRESS. SHOWER 1.25 CITY TEL. NO LAVATORY 1.25 CONTRACTOR r SINS 1,25 'ADDRESS DISHWASHER 1.25 CITY TEL.'NO.' LAUNDRY TUB 1,25 CONTRACTOR'S STATE ❑ REGISTRATION NO. - COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT.NO. GROUP ZONE P SEED BY WATER HEATER 1.50 C9 GAS SYSTEM OUTLETS- 1.50 INDUSTRLAL. L ` WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM, .30 INSPECTION RECORD u .� lu ' APPROVALS • DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBINGr^�ff TOTAL FEE. I _ ,�PIPING ✓1' I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE' IS CORRECT AND'AGREE TO COMPLY ' WITH ALL COUNTY ORDINANCES'AND 'STATE L.AwS REGULATING HOT WATER HEATER PLUMBING. ; 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST ' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND,TO RESIDE IN,THE ABOVE DESCRIBED DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIEDLzi SIGNATUREOF PERMITTEEFINAL t � VALIDATION ROBERT A WOIOD' f' A CK. M,O. CASH SUPERVISING MECHANICAL•ENG'R Li l,O '2 1 1;o i AP _ 5 D .,n 9 ^ �• 76667-Gari• '817 2-62 - APPLICAYION FOR.' PLUM INC PERMI COUNTY OF LOS.ANGELES DEPARTMENT OF COUNTY.ENGINEER BUILDING AND SAFETY DMSION BUILa1NG //'� �I� JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CJ 2 V. WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY r _ FOR APPLICANT TO FILL IN' ' EAREST CROSS ST. NUMBERI FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 �. MAIL G BATHTUB' 1.25 - r S ADDRESS. SHOWER 1.25 'CITY TEL. NO. 2 LAVATORY 1.25 Z S O ,'CONTRACTOR'__ J' jaitk i SINS 1.25 f LZs— ADDRESSWeIZ !J� DISHWASHER 1.25 CITY TEL. NO.Ep71 CONTRACTOR's STATE LAUNDRY TUB '1:25 REGISTRATION NO. /.7, COUNTY ❑ CLOTHES-WASHER 1.25. z DIS CT GROUP ONE P OC EyD BY., WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 56 INDUSTRIAL WASTE.APPROVAL OUTLETS OVER 5 PER SYSTEM .30 ,• INSPECTION'ECORD 1g_3Ai3 171 W - U. APPROVALS I DATE INSPECT•OR'S.SIGNATURE•• PERMIT $ 2 00 UNDERSLAB'WORK �� 6' ,'•'lJ /3 ROUGH PLUMBING N 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS, REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT 1 -AM PROPERLY:REGISTERED AND/OR• PLUMBING FIXTURES I =�� I• LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST i �} RESIDE IN,-THE ABOVE DESCRIBED.REBID TIAL OPERTY. UTILITY CO.NOTIF ED \t` ` 7- v r j SIGNATURE �• j/� OF PERMITTEE ALIDATION ROBERT,A. OO�D t CK. M.O. CASH SUPERVISING MECHANICAL ENG'R L;ALo 9 0 7 4 JAe 3 5 d i 3.7 5N. 12, 7A:,llV'Cff'4l7 2.1.2 APPLICATION FOR PLUMMBIN PERMIT COUNTY OF LOS ANGELES- DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIxG JOHN A. LAMBIE. COUNTY'ENGINEER ADDRESS D .62 �'WILLIAM A.JENSEN,SUPT OF,BUILDING LOCALITY FOR'APPLICANT TO FILL IN CROSS ST .• NUM'4I R--' _- FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL .. BATHTUB 1.25 ADDRESS P1 SHOWER 1.25 CITY TEL. NO. .' LAVATORY 1.25 CONTRACTOR • ^ l• :t r SINS 1.25 ADDRESS YlYZ Al ItlPto'C-494101 A& DISHWASHER 1.25 CITY- ale. �bv� SEL.NO. LAUNDRY TUB 1.25 I CONTRACTOR'S / p STATE REGISTRATION NO. D ✓, COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO GROUP- ZONE PROLES D BY WATER HEATER. 1.50 - 1.50 INDUSTRIAL GAS SYSTEM OUTLETS WASTE APPROVAL OUTLETS OVER$ PEA SYSTEM 30 INSPECTION RECORD o ® . i APPROVALS DATE INSPECTOR'S SIGNATURE PFrRMIT $ 2 00 UNDER SLAB WORK h,. ROUGH-PLUMBING TOTAL FEE � /S 'GAS PIPING I HEREBY ACKNOWLEDGE. THAT 1 HAVE READ THIS APPLICATION GAS VENT ' AND STATE THAT:THE•ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. , HOT WATER HEATER ' 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES-COUNTY AND STATE-OF. 'GAS TEST LO RNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO I n IN,THE ABOVE DESCRIBED RESIDENTIAL P oPERTY. 'UTILITY CO.NOTIFIED ` Al", TURE r ) 11Z.1111. ERMITTEE FINAL. AI IDATION ROBERT A.V�/OOD UI ' CK. M.0. CASH SUPERVISING�MECHANICAL ENG'R LJCo 8 0 5 0 DEC 7 5 D 13.75- 9