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HomeMy Public PortalAbout9822 OLIVE ST_Plumbing__ : a 7 76MU-CE617 6.60 APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANr S DEPARTMENT OF COUNTYII�TEERBUILDING AND SAFETY ION BUILDING jJOHN A. LAMBIE. COUNTYEER ADDRESS ©// �� WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TOB ADDRESS ` + SHOWER CITY TEL.NO. LAVATORY CONTRACTO r--,e E SINK ADDRESS 16 DR3IiWASHER CITY TEL. NO 3), CO TOR'S STATE LAUNDRY TUR REGISTRATION NO. COUNTY CLOTHES WASHER DISTRICT No GROUP I ZONE I P CESSED BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD O ' 0 03 , O F` w • fin_ 08 FD'TITBE $ I —5-.. APP§tOVALS PATE INS EC�T•OR:S SIGNATURE PERMIT S 2 00 UNr)ER-oE-*"BVbRK rF►/ rY,*+/� • TOTAL FEE 0 ROUGH PLUMBING GAS PIPING (ef 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP CATION 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 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ) LICENSED AS REQUIRED BY LOS ANG LES CO 7Y AND STATE OF GAS TEST -1-/)b re/., f/ q 1 CALIFORNIA OR THAT 1 AM THE GAL N OF THE ABOVE _ DESCRIBED RESIDENT I PROPERTY. UTILITY CO.NOTIFIED SIGNATURE + y 'o n OF PERMITTE FINAL • �av VALIDATION ROBERT A. WOOD, a, M,0. CAM SUPERVISING MECHANICAL ENWR 1'•s�O 6 2 6,- X1 3 5 D 7.00 �. ION W.ORKER'SCOMPENSATate of consent to 7BA668DPw9/89 APPLICATION FOR PLUMBING PERMIT I Fiereby'aifirm (hat Ihave acertificate of consent to self Insure, 78A887A f, or a Certificate ot,Worker'a+Compensation Insurance,or a certified I copy thereof(Sec.3890 Lab.C.)' r. j 6 1 �/ 9i 40072!P I POUNT� OS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished., ' E] + FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is'filed with the county building inspection ADDRESS department.• NUMBER FIXTURE OR REM FEE LOCALITY" Date Applicant WATER CLOSET CERTIFICATE OF EXEMI''TION FROM WORKERS"- CROSS$T:; COMPENSATION INSURANCE. BATH TUB ASSESSOR' (This-section need not be completed If the work Involved by the SHOWER MAP BOOK; I PAGE PARCEL permit Is for one hundred dollars($100)or.less.) NER I certify that in the performance of the work for which this permit i LAVATORY W5;6 is issued, I shall not employ any person in any manner so as to , MAIL LTi r5 become subject to the Workers'Compensa Laws. SINK S S ry� .. ADDRESS J DISWASHER CITY TEL.NO. �_ Date /de9.r:c�pplicant CLOTHES WASHER o 4 NOTICE TO APPLICANT: If, after making t is ertificate of ,. � � CONTRACTOR � � Exemption,you should.become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply.with such = provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. 1 hereby affirm that I am licensed under provisions of'Chapter 9' WATER HEATER, a (commencing with Section 7000)of Division 3 of the Business and STATE LIC' 'Professions Code,and my license is in full force and effect. OUTLET OVER \ OUTLETS N SSE a A GAS SYSTEMLICENSE NO. CLASS STRICT NO. PROCESSED BY 5 PER SYSTEM ! C License Number Lic.Class F FINAL l VALIDATION LL DATE Contractor. Date Cl. ❑ I am exempt under Sec. FINAL 25BY B.AP.C.for this reason Date: Plan check fee Signature PLUMBING PERMIT ISSUING-FEE$ TOTAL FEE .{{// , . .El .0Doth .•i�1_ Plan check applicant L,� �� ^ SINGLE FAMILY "^"' w_Z 4 HOMEOWNER=BUILDER DECLARATION Name - =rv'` ` ,= a^1•E I hereby affirm that I am exempt from the Contractor's License Caw !mak•:"" _- tpe for the following reason.(Section 7031.5, Business.and Professions Address. ,✓� 6°` J3 — Code): - r..•,:r.. -F_f• a City �e-� Tel.No. 7- i 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). j , '.„ _i 'T CONSTRUCTION LENDING AGENCY iI. •' 1 r'e e I•hereby affirm that there is a construction lending agency for the I performance of the work for which this permitAs issued(Sed'.3097, Civ:C.) Lender's Name Lender's.Address 1,certify that I have read this application and state that the above _ Information is correct. I agree to cdmply with all-County ordinances , and State laws regulating Plumbing, and hereby authorize representatives.of this County t enter upon the above-mentioned props sec o ur SEE REVERSE FOR EXPLANATORY LANGUAGE 9� ; 'turd (if fPer flee Date ORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT ereby, affirm that I have%certificate of consent to self in- 76A667A sure,or a cerfificatelef W Akers'Compensation Insurance,ora 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 Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE �c LOCALITY Date Applicant WATER CLOSET(TOILET) (Jo NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB G J CROSS ST. ityt COMPENSATION INSURANCE SHOWER O OWNER (This section need not be completed if the work involved by , MAIL KACM the permit is for one hundred dollars($100)or less.) LAVATORY C)o ADDRESS I certify that in the performance of the work for which this per- 7 (� mit is issued, I shall not employ any person in any manner so SINK CITY TEL. NO. as o bec me su ject to the Worker ' mpens t' L s. DISHWASHER CONTRACTOR �--�� Date Applicant CLOTHES WASHER NOTICE O AP LICANT: If, after making this Certificate of Ex- ADDRESS emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER &160 LICENSE NO. _ CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. VPSfJSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ` `,f) 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �J and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA LI TI N } fect. DATE ti License Number Lic. Class O FINAL V1CContractor Date BY O Fj I am exempt under Sec. W B.&P.C. for this reason I Plaa n check fee � Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE L�- C� SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Nam Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. '77-- structure is not intended or offered for sale(Section 7044, Business and Professions Code). -- CONSTRUCTION LENDING AGENCY I I rte+ f 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.). c_i: Lender's Name i 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 autho 'e representati es of this County to enter upon the ab ntioned rty f r inspection pur ses. 3 • SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat