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Home My Public Portal About9217 OLIVE ST_Plumbing__ -x6,eG7 , ' APPLICATION FOR :PLUM-BING PERMIT � 1 OBS•17 9•SS ,r DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Ang@les BUILDING WM.J.FOX, COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING ,...�:�•�.+ LOCALITY FOR APPLICANT TO FILL IN NEAREST OWNER ^�Af DISTRICT NO. GROUPI O�EI READY FOR INSPECTION MAIL 501119" Illy NOW ADDRESS_ --Ifl�� INDUSTRIAL CITY TEL.NO. WASTE APPROVAL PLUMBER GENERAL INSTALLATION CO. INSPECTION RECORD / ADDRESS 6558 west Blvd. CITY L.A. 43 TEL.NO.PLeasant 3-2541 LICENSE NO: , 787 C. 36 151.839 NUMBER TYPE OF FIXTURE OR ITEM FEE - WATER CLOSET(TOILET) $ BATH TUB SHOWER LAVATORY (WASH.BASIN) — '.- KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER 1 WATER SOFTS ER i _ 00 ------------- TOTAL NO. 0.80 APPROVALS DATE INSPECTOR'S SIGNATURE GAS SYSTEM OUTLETS @ 1.00 .WATER HEATER Co. 1.00 UNDER SLAB WORK ROUGH PLUMBING PERMIT S ' 1 00 GAS PIPING TOTAL-FEE ' , 2 00 GAS VENT 1.HER15BY•ACKNOWLEDGE THAT-.1 HAVE'READ-THIS' APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES .AND STATE.LAWS REGULATING PLUMBING FIXTURES PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS.ANGELES COUNTY AND STA7E,OF ' .UTILITY CO.NOTIFIED CALIFORNIA OR THAT I AM T,HE•LEG OW ER 0 THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SIGNATUREFPERkITTEE OF PERMITTEE FINAL WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLBG.INSPECTOR' L,1 ,5 :B 16�R MAY 3. 2.0 0. In _ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 76A667A I hereby,affirm that I have a certificate of consent to self in- DPW 4/90 sure,ora Certificate of Workers'Compensation Insurance,ora 6A667 certified copy thereof(Sec. 3800, Lab. C.) .01 Policy No., �5"/'S"5b Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN,(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspection department. / NUMBER FIXTURE OR ITEM FEE LOCALITY a0011Date `� a Applicant 5 WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. AI6- Til'G O- COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the woik involved by MAIL the permit Is for one hundred dollars($100)or less.) f. LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL.NO.' mit is issued,_1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date. Applicant CLOTHES WASHER 6y NOTICE TO APPLICANT: If, after,making this Certificate of Ex- ADDRESS 1�1 em tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR P Y I P CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ekks ly with such provisions or this permit shall be deemed reyok- STATE LIC. ed. WATER.HEATER LICENSE.NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N PR 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 d,Professions Code, and my license is in full force and ef- 5.PER SYSTEM FINAL'FIA5 VALI TION fe � HOSE BIB - �, License Number (d Lic. Class gig. 107.80 no' moi[ FINAL Contractor // �� Date BY 1 I am.exempt under Sec. o TOTAL 7 .80 B.&P.C. for this reason ► CHECK C Plan check fee 107°$0 in Date: PLUMBING PERMIT ISSUING FEE$ CHANGE °00 z Signature TOTAL FEE ' SINGLE FAMILY ' HOME OWNER-BUILDER DECLARATION Plan check applicant 0000_0001 2/1j/96 1 hereby affirm that I am exempt from the Contractor's License Name °!1 Law for the following reason (Section 7031.5, Business and 4901 1 Pfd 6: 2 Professions Code): Address ❑ 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, Business and Professions Code). v. ► 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 ordinances and State laws regulating Plumbing, and hdreby authorize representatives of this County to enter upon,the above-mentigned� proper y for,inspection purpo es. 7S— SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I°laher ffirm.that I have'a certificate of consent to self in 76A667 26ADPW a/87 667A - sure,or-ti certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) certified copy thereof.(Sec. 3800, Lab. C.) � � • COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS, Policy.No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING F1 Certified copy is filed with the county building inspection ADDRESS 017 L4 G�t dli �1 department. NUMBER FIXTURE OR ITEM (d FEE ,t LOCALITY Date ApplicantI ', WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST: COMPENSATION INSURANCE SHOWER OWNER 6 (This section need not be completed if the work involved by MAIL - the permit is for one hundred dollars(;100)or-less.)' LAVATORY ADDRESS I certify that in the performance of the work for-which this per- mit is issued,'I shall not employ any person.in'dn.y manner so. SINK, CITY TEL..NO..X97 ¢ as to become subject to the Workers'Compensation Lgws. DISHWASHER C r�•: CONTRACTOR Date Applicanf CLOTHES WASHER NOTICE j6 A PLICANT: if, after making this Certificate of Ex- ADDRESS SWIMMING POOL RECEPTOR emption,you should become subject to the-Workers'Compen- CITY TEL. NO. sation provisions of the Labor•Code,you must for"thwith•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. PROC ED 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 FINAL >� fect. DATE &V IDATIO4 a License Number Lic. Class Fl 2952'2V v Contractor Date Q B . a2i# I p #'0 0 0 0,0.5 V I am exempt under Sec: OW. B.BP.C.for this o o reason Plan check-fee -( 2 a 5 O Date: PLUMBING.PERMIT ISSUING FEE$ ► 2.8 5�;Q Signature TOTAL FEE — O Q1 O 0_8 8 SINGLE'FAMILY Flhk aPP i licant HOME OWNER-BUILDER an cec DECLARATION I hereby affirm that I am,exempt from the Controctor's.License Name Law for tiie followirig reason (Section 7031.5,"Business and Professions Code): Address '7 I,'as owner of.the property, will do;'the,work and the � 'M�jZ' �' jP. Tel. No. ?" 6 f17structure is not intended or offered for sale(SeCtlan 7044, ; Business and Professions Code). CONSTRUCTION LENDING AGENCY- I hereby affirm:that there i3 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 pool informat)on 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-mentioned propert spe tion purpo ps. �Q� ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of• a �' D04