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HomeMy Public PortalAbout10569 OLIVE ST_Plumbing__ �:�•. ,WORKERS'COMPENSATIONDECLARATION 20- 26 DPW 4/87 APPLICATION FOR PLUMBING PERMIT i., n � i,hereby' a#km that r have a certificate.of consent to self in-, 76A667A sure,ora cprtificate of Workers'Compensation Insurance,ora CE 817(REV.8186) certified copy thereof(Sec.3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM @ FEE ADDRESS OJ(p 9 Q Z,-.rS department. LOCALITY Date - Applicant WATER CLOSET(TOILET) Q� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER QO OWNER o J (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.)• LAVATORYADDR ESS (J Q/,oG I certify that in the performance of the workfor which this per- SINK mit is issued, I shall not employ any person in any manner so CITY G'. TEL. NO. Q as to become subject to'the Workers'Compensation Laws. DISHWASHER CONTRACTOR. Date 37,18Y Applicant Ism . .Xc�^ CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation•provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS. LICENSED CONTRACTORS DECLARATION DISTRICT No. C SSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions'Code, and my license is in full force and ef- 5 PER SYSTEM FINALVALIDATION >' tett. :, i ! QQ DATE O License Number . .Lic. Class () t FINAL. Contractor Date BY O 1 am exempt under Sec. W' ' a B.BP.C..for this reason ► - Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION pp q I hereby affirm that I am exempt from the Contractor's.License Name Law for the following reason (Section 7031.5, Business and ACC °a / Professions Code): Address ; ® Cit Tel. No. _ `4.5 0 1, as owner of the property, will'do the work:and the Y n structure is not intended or offered for sale(Section 7044, !) Business and Professions Code). oil. TOTAL 3-4.50 CONSTRUCTION LENDING AGENCY CHECK c 1 hereby offirm that there is a construction lending agency for O'� the performance of the work for which this permit is issued CHANGE °00 (Sec. 3097, Civ. C.). ' Lender's Name �1;( �(-Cll:(�71 /17/$�' Lender's Address 1945 1 AM SQ2 I certify that I have read this application,and state that the above information is correct.I agree to comply with all County I , ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above m tioned property for inspection purposes. ���. p _ SEE REVERSE FOR EXPLANATORY.LANGUAGE Signature of,Permittee Date z '`t -}� WORKERS'CtOMPEN$ATIOI�DECLARATION APPLICATION FOR PLUMBING PERMIT 1 hereby`affirm that I have a certificate of consent to self 20-0026 DPW 6/87 �,.in"sure; or a Eertificate of Workers'Compensation Insurance, 76A667A or o certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS n policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING I �11 P ❑ Certified copy is filed with the county building inspec- ADDRESS NUMBER FIXTURE OR ITEM FEE LOCALITY tion department. ,s /J •_/ , Date Appligant WATER CLOSET NEAREST CERTIFICATE.OF EXEMPTION FROM WORKERS' BATH TUB ' CROSS ST. COMPENSATION INSURANCE SHOWER OWNER SD ff (This section need not be completed It the work Involved by MAIL y� the permit Is For one hundred dollars($100)or less.) LAVATORY ADDRESS 6 04U I certify that in the performance of the work for which this i / permit is Issued,I shall not employ any person in any manner SINK CITY TEL.NO. / so as to become subject to the Workers'Compensation Laws. DISHWASHER r CONTRACTOR Date Applicant y CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after malffhg this Certif' to of SWIMMING POOL RECEPTOR Exemption, yoU should become subject to the orkers' CITY ) TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. , deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION STRICT NO C BY 1 hereby affirm-that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)ofDivision 3 of the Business i OUTLETS OVER and Professions Code,and my license is in full force and effect, 5 PER SYSTEM. FINAL DATE /W VALIDATION License Number Lic. Class j FINALno Contractor Date BY O ❑ ,I am exempt under Sec. w W B.BP:C. for thls reason a- Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ >6 Signatur 1.15 w TOTAL FEE ll Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License \ yr ` Law for the following reason (Section 7031.5, Business and Address J`, 1, 04 Processions Code): City Tel. No. .$ 76. LJ' I, as owner of the property, will do the work and the I structure is not intended or offered for sale (Section a' ® TOTAL ©+�� 7044, Business and Professions Code,). CONSTRUCTION LENDING AGENCY ! CECK Cbfa 16.301A®o 1 hereby offirm that there is a construction lending agency for the performance of the work for which this permit is issuedc (Sec:3097, Civ. C.). cum 1, Lender's Name I 1 6/23/89 Lender's Address I certify. that I have read.this application and state that the I ► 4143 1 M 9-0i above information is correct..1 agree to comply with all'County ordinances and State laws regulating Plumbing, and hereby authorise representatives of this County to enter upon the above-mention Id property for Inspection purposes. -SEE REVERSE FOR EXPLANATORY LANGUAGE _. �— Aigo ZfPermitte ' Date I �: w, V1(ORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT '1 lhefe6j. affirm tidt I have q cert?kcate of consent to self in- 2Q•0026 DPW+.4/87 76A667A sure,or a.certff!gate of Workers'Compensation Insurance,or a CE 817(REV.8/86) certified cppy thecedf(Sec. 3800, Lab. C.) , i - Polici No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copyis hereby furnished. Ej Certified co is filed with the count building p FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /O� / 'v� �� copy y gins inspection ADDRESS C� C/ , department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) 0 NEAREST _10— CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB in CROSS ST. t Jj9/9 G. COMPENSATION INSURANCE SHOWER OWNER D SC7 Go��d �S (This section need not be completed if the work Involved by r� (/�y the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS /OS tj 9 ////C s T, 1 certify that in the performance of the work for.which this per- mit is issued, I shall not employ any person in any manner so SINK CITYr TEL. NO. yle1_1101- as to become subject to the.Workers'Co pensation Laws. DISHWASHER ' l _ n CONTRACTOR Date Or V q Applicant CLOTHES WASHER NOTICE O A PLICANT: If, after making this Certificate of Ek- ADDRESS SWIMMING POOL RECEPTOR � emption,you should become subject to the Workers'Compen- CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTR`,TA P OCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS CC// 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER l and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL411-1 1 VALIDATION >_ fect. �v DATE Al— License Number Lic. Class_ pz;pl fi 0V FINAL Contractor ' Date BY O I am exempt under Sec. W B.BP.C. for this reason Plan check fee , Date: PLUMBING PERMIT ISSUING FEE$ Q Signature TOTAL FEE O SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 5 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business-and ACCT.F Professions Code): Address val 34.50 I_� as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, l e.3 k0 Business and Professions Code). ► TOTAL 34 o 50 CONSTRUCTION LENDING AGENCY CHECK 34.50 1 hereby affirm that there is a construction lending agency for n the performance of the work for which this permit is issued ��"ifi(4'-Z .00 (Sec. 3097, Civ. C.). Lender's Name .FzU1 2/11/8' Lender's Address j AM 3:10 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 ab ov a tinned property for inspection purposes. IX /v " SEE REVERSE FOR EXPLANATORY LANGUAGE SignaturZ of Permittee Date 76A567-CE*817 2-62 ` ✓ r / � 1 APPLICATION OR PLUMBI G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ,� � 'e ` WILLIAM A.JENSEN, SUP'T'OF BUILDING 4 LOCALITY FOR APPLICANT TO FILL IN NEAREST / CROSS ST. Q/✓ NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 y ' MAu BATH TUB 1,25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1,25 CONTRACTOR SINS 1.25 A-� ADDRESS DISHWASHER 1.25 CITY TEL. NO. LAUNDRY TUB 1.25 CONTRACTOR'S STATE REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 2-Jr DISTRICT NO. GROUP Z NE P SSED BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL . WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD d O _ ®C F� lit 9. APPROVALS DATE INSPE R' G URE PERMIT $ 2 00 UNDER SLAB WORK ,11 ROUGH PLUMBING ALM lff y TOTAL FEE 4" GAS PIPING T N 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 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 1� CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO-NOTIFIED s� SIGNATURE OF PERMITTEE FINAL LIDATION ROBERT A WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R L460 2 8 6 0 NOV 2 2 5 D 7.0 O N 1I