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Home My Public Portal About6390 OAK AVE_Plumbing__ 76AG67A(Cty,61781-11/76 - APPLICATION FOR PLUMBING PERM-IT fi BUILDING AND.S.AFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTUREOR.ITEM ® FEE ADDRESS •rAve. m 1 1t �-� WATERCLOSET LOCALITY Temple Cit Ca. BATH TUB NEAREST cRosssT.Lemon Street SHOWER OWNER Church of the Nazarene LAVATORY ADDRESS 1-546 E. Wash !� SINK -goo CIT'Pas a.dena C • OT .N079L-710 DISHWASHER CONTRACTO CLOTHES WASHER ADDRESY2661 Glen Ave. Altadena.Ca .SWIMMING POOL RECEPTOR CITY Altadenay Ca TEL.NO: 0 2 LAWN SPRINKLER,SYSTEM STATE �" LIC: WATER HEATER LICENSE.N0.31240O CLASS C®36 )j GAS SYSTEM , OUTLETS DIST ICT NO. GROUPNE C ED BY O TLETS OVER M PER INDUSTRIAL ®. WASTE APPROVAL INSPECTION RECORD e � rPlan eck fee ji'¢''`"® 'ale— z PLUMBING PERMIT ISSUING FEE$ TOTAL FEE ck applicant Name APPROVALS DATE INSPE 'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel.NO. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT 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 I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES --7 REQUIRED BY LOS'ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY-CO.NOTIFIED STGNATU TURE RE OFPERMITTEE FINAL PLA,IdVG � LIDATION r � PERMIT VALIDATIONCK. M.o. cases POLICY HOLDER:� . � 1 a 4 r--AUG 18 5 a• 3 4.5 0 AWS POLICY NUMBER: 3 77 3 0 Os ION WORKER'S I have a certificate of consent to 7�67A PW 9/89 APPLICATION FOR PLUMBING PERMIT I h�,,�I. y affirm that I have a certificate of consent to self insure, or''$�certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab:C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF.PUBLIC WORKS DIV. Policy No. Company / C�� ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building Inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEELOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ' CROSS ST. �/ COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued-, I shall not employ any person In any manner so as toSINK ADDRESS become subject to the Worker's'Compensation Laws. DISWASHER CITY TEL.NO. r Date Applicant , CLOTHES WASHERCONT bTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. > I hereby affirm that I am licensed under provisions of Chapter 9 ; WATER HEATER C (commencing with Section 7000).of Division 3 of the Business and STATE LIC. GAS SYSTEM OUTLETS Professions Code,and my license is in full force and effect. �%" LICENSE DIS CLASS Ix • OUTLETS OVER DISTRICT NO. � PROCESSED BY 5 PER SYSTEM0� �n License Number 1:10.Class H FINAL DATE &0_— V� DAt�ON a Contractor Date 3303 Val o 10 C1 ❑ � i?.�E•s' FINAL 2 I am exempt under Sec. BY a ITEMS E ML BAP.C.for this reason Plan check.fee Tf1TAL 65 . 10 Date: PLUMBING PERMIT ISSUING FEE$ /�" ® CHECK 6.5.10 Signature L FEE D ��NA�Gt �CEyI ❑ Plan check applicant TOTA SINGLE FAMILY , HOME OWNER-BUILDER DECLARATION Name' 1313313-131A3 1/24. I hereby affirm that I am exempt from the Contractor's License Law ,, for the following reason(Section 7031.5, Business and Professions Address sOr i I AM :32) 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). 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.) ti 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 repress talies this County to. r Pon the.abov -mentioned , pro o a tion. urposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sle atura of Parmitfwr� data . I WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1 hereby,affirm that I have a certificate of consent to self in- 76AA667ADPW 4/90 supe,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab. C,) , COUNTY OF LOS ANGELES. DEPT. OF PUBLIC WORKS Polity No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �f /1 �/ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS ea-v �/. department. C FEE LOCALITY WATER CLOSET(TOILET) Dtlte Applicant NEAREST e CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by I MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS le— I certify that in the performance of the work for which this per- SINK CITY TEL.NO.�kk��Cf mit is issued, I shall.not employ any person in any manner so as to b. a sub' ct to the Workers'Compen tion L ws. DISHWASHER a � 47 CONTRACTOR Dats- �v Applicant i CLOTHES WASHER ADDRESS �✓ �/ NOTICE TO APPLICANT: If, after ma ng this-Certificate of Ex- ✓ `� ��/G� em tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR P Y I P CITY TEL. NQ� �� . sation provisions of the Lob-r(.ode,you,must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE /G LIC. gs� ed. WATER HEATER LICENSE NO.GO O CLASS �d LICENSED CONTRACTORS DECLARATION DISTRICT No. (/� PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter I GAS SYSTEM OUTLETS �rJ� 9(commencing with Section 7000)of Division 3 of the Business { OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE J . ..� License Numbe 0 11e7 L.ic. Class IL O BY AL V Contractor Dat I am exempt under Sec. tJ B.BP.C. for this reasonW Plan check fee oil. a Date: I PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY' HOME OWNER-BUILDER DECLARATION I Plan check applicant C I hereby affirm that I am exempt from the Contractor's License I Name Law for the following reason (Section 7031.5, Business and ACCT.` Professions Code): _ i .Address ?Z�i i° 6?, gr33 b t n ❑ I, as owner of the property, will do the work and the City Tel. No. 1 ITEMS structure is not intended or offered for sale(Section 7044, Business and Professions Code). {!7'f{ a� ` CONSTRUCTION LENDING AGENCY ► CHECK 60.10,I3 I hereby affirm that there•is a construction lending agency for CHANGE .010 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 00I -010101 10/21/94 Lender's Name 73491 �t�''1;,ie�,i.y Lender's Address , I certify that I have read this application and state that the I Poo.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- tioned prop rty for inspection purposes v SEE REVERSE FOR EXPLANATORY LANGUAGE . Sig ure of Permittee Date