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Home My Public Portal About9024 PENTLAND ST_Plumbing__ • 76AM7A r CE 817(REV 11/78) r APPLI AT N F R PLUNING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FORAPPLICANTTO FILL IN(PRINTOR TYPE) BUILDING /� � NUMBER FIXTURE OR ITEM ® FEE ADDRESS L,' � ( WATER CLOSET LOCALITY ,E NEAREST BATHTUB CROSS ST 17 1 v SHOWER OWNER LAVATORY MAIL r ADDRESS SINK CITU TEL N � Ce DISH W ASH ER CONTRACTOR f CLOTHES WASHER DRESS C SWIMMING POOL RECEPTOR / .� TEL LAWN SPRINKLER SYSTEM STATE 1\ �' LIC WATER HEATER o LICENSE NO A / ,CLASS u U GAS SYSTEM OUTLETS APPROVALS DATE' INSPECTOR s SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING d GAS PIPING U GAJ VENT HOT WATER HEATER G. PLUMBING FIXTURES 14 GAS TEST V61 Plan SAKUTILITYCO NOTIFIED a MBING PERMIT ISSUING FEE E TOTAL FEE FINAL y-b Plan check applicantPLAN CHECK VALIDATION Name Address City Tel NO r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES a C V ( p 8 p A AND STATE LAWS REGULATING PLUMBING N PERMIT VALIDATION 2 O 1Q I HEREBY CERTIFY THAT LV REGISTERED AND/OR LICENSED AS IA • • • • • C REQUIRED BY LOS ANGEL AND STA CALIFORNIA OR THAT I AM THE 'fl J LEGAL OWNER OF AN TEMD t0 RESIDE IN THF A VE DE�FDRESIOENTIAL 21• • 1, (100 OF PTURE • O • 1-000'. DISTRIC NQ P SSED By o602,80 INDUSTRIAL ./ f�J/ WASTE APPROVAL irmORKERS that COMPENSATION cafeDECLARATIONcorse APPLICATION FOR PLUMBING PERMIT Y affvm that I have a certificate of consent to self 20 0046 DPW 6/67 a certificate of Workers Compensation Insurance 76A667A ed copy $hereof (Sec 3800, Lob C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS FyC.r'N. Company ified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Im Certified copy is filed with the county budding Inn ADDRESS 0 Z zl non deportment NUMBER F XTURE OR ITEM ® FEE LOCALITY / L' Data ApphSant �� WATER CLOSET ( NEAREST CERTIFICATE OF EXE M WORKERS BATH TUB ( CROSS ST COMPEN INSURANCE SHOWER OWNER (This section need net be completed If the work Into ed by MAIL the permit Is for one hundred dollars (5100) or less ) VsVATORv ADDRESS I certify that in the performance of the work for which this ,/� permit Is Issued I shall not employ any person in any manner SINK VOA CITY TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER 4f� CONTRACTOR 6/A,67 Date Applicant CLOTHES WASHER I 4-, r NOTICE TO APPLICANT If after making this Certificate of ADDRESS / - Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR s Compensation provisions of the Labor Code you must forth - CITYPAITEL NO��'7Q.f 77 with comply with such provisions or this permit sholl be LAWN SPRINKLER SYSTEM STATE ` t LIC deemed revoked WATER HEATER LICENSE NO d 3 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT No PROCESSED BY I hereby affirm that 1 am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER }} and Professions Code and my license is in full force and effect 15 PER SYSTEM EFINAL VALIDATION p; DATE -20 -k'9 O License Number _ 3 Ltc Class I J q U / FINAL Contractor 116/E71/S G9M1. Date BY L ' ❑ I am exempt under Sec — B 8P C for this reason Plan check fee Date Z PLUMBING PERMIT ISSUING FEE$ Signature ' r TOTAL FEE Plan check applicant —" SINGLE FAMILY . 5 HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address ACCT'0 Law for the following reason (Section 703) 5 Business and Professions Code) City Tel No _ 3307 40.50 ❑ I, as owner of the property 'will do the work and the - 1 ITM structure is not intended or offered for sale (Section r TOTAL 40- O 7044 Business and Professions Code) _ , + CONSTRUCTION LENDING AGENCY MCK 40,50 1 hereby affirm that there Is a construction lending agency for - bnt9n7G s� the performance of the work for which this permit'is issued (Sec 3097 Cee C ) Lender s Name C-i Y swJUV�JVVl b/ 5/89 Lender s Address ,y 3764 1 A9 8147 1 certify that I have read this application and state shot the , above informationIs cortect I agree to co ply with all County ' ordinances and Slate laws regulating P umbing and hereby authorize reprelentatives of this Co I to enter upon the above mentioned property for mspe purposes ' SEE REVERSE FOR EXPLANATORY LANGUAGE Stgnat a of a Dale . '• ` WORKERS COMPENSATION DECLARATION �I hereby, affirm that I have o"certificate of consent to self In 7200026 DPW A187 - • APPLICATION FOR,, PLUMBING- PERMIT surd or a certificate of Workers Compensation'Insurance,or a CE el s(REV B/86) 7 :• _ • ' ` ' certified copy thereof'(Sec 3800 Lab C ),%i . ., r �Pohcy No `,.t < Company' COUNTY OF LOS'ANGELES DEPT OF PUBLIC WORKS ❑ Certified copy is hereby furnished + , -FOR APPLICANT TO FILL IN (PRINT OR TYPE)t - ,BUILDING Candied copy is filed wnh the county building inspection ADDRESS (�/y ) 'IF] ,r� department t r ^, L. - v e NUMBER + `FIXTURE OR ITEM @ FEE " I ,- = � Ilcanl 'JG JSG J 'loin(( , LOCALITY r , Date ..,�ro� I WATER CLOSET(TOILEi)c "' •' J ' P NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST- t COMPENSATION,INSURANCE " < .. r"// . ;` o SHOWER . ' + t OWNER ,G? >� -1, �� ,f• lr 1�1 + (Thistsectlon need not be completed if the work Involved by -I L - ` Thi permit a for one hundred'dollars (510 0)or less )` - LAVATORY'y i ADDRESS 1 '1 H r n u Lcerhfy that In the perforrna nce_of the work for which this per SINK r - "TEL" NO is issued I shall not employ any person m any manner so CITY I ,1"[I N 69A STEL'NO ��, l� F ' *t`as to become sublectlto the Workers' Compensation Laws .. - 'DISHWASHER _ i-rl'+1, I - M ` - "f 'CONTRACTOR J fy' Date '" - ' r' Apphcant ' , t i ' e CLOTHES WASHER • ADDRESS NOTICE TO APPLICANT If after'making'this,Certificate of Ex SWIMMING POOL RECEPTOR `emphon you should become subject to the Workeri Compen CITY t TEL NO u s t scion provisions of the Labor Coda you must forthwith comp - ° LAWN SPRINKLER SYSTEM edwith such provisions or this permit shall be deemed revok STATE r . LIC ( WATER HEATER LICENSE NO CLASS ' �.. LICENSED CONTRACTORS DECLARATION " GAS SYSTEM a OUT STRI T I hereby affirm that I am Lcensed under provisions of Chapter 7�-7-p�L �- ` 9(c`ommenc,q with`Section'7000)of Division 3 of tie Business t ' - OUTLETS OVER a '' •�.ry4cr'}:.' •� , and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL ALIDATION *7 r fact t n' _^". i , - • L _ - DATE Ucense Number LIa`Class ^ IFINA r .Q Contractor' i Dote t _ BY V p 41 ❑ .I amlexempt under Sec' > 1' `°W s 'S' B�BP C for this reason n - c Plan check tee ► i ca t s •$tji i+ ca Date ' d ` PLUMBING PERMIT ISSUING FEE Signature t. '- - P - TOTAL`FEE • T `sSINGLE FAMILY r _y _ , �� +• i ` HOME OWNER BUILDER DECLARATION Plan check aPP,hcant hereby affum that I'am exempt from the Contractor s L¢en`se r Name - • r ' Law for the following reason (Section 7031 5, Busiriess'and Professions Code) �f ' ° 'Address 1+ ^ - - It • t ' _ air:T.T .. ' h s. A7, 1b,`{I ❑r I as ownei of the property will do the work and the City �-t .'. Tel' No f r �.. � s , a structure Is�oot intended or offered for sale(Section 7044 - - _ ` 1 ITEMS " a Business and ProfessionsiCode) T _ '4. - r + ,� " ' Y G GE C 'Y , ' r TOTAL� 16 . 50 .CONSTRUCTION LENDIN A N Y T ^ +`' ! " `f.- c -i t , •' - ,I hereby affirm that there Is a construction lending agency for b.`I� - ' CHECK - i , the performance of the work for which this permit Is�ssued - ,T - i 'Yo +- .,• C.HANGE ✓ - .�b l' e (Sec 3097 Gv Lenders Name' • ' ` • s ` OGOO�I� Lenders Address L ' ' •f,< s _ _ _ _ i ar• , y' T w g 1 certify that I hove,read this application and state,thot the { - ,` f _ 7646_ i' SAM,9 b above Infcimat,on Is correct I agree to comply witk all County ' .S` ►t r - _ , , ordinances and State laws regulating Plumbing and hereby authorize represent t ei of this County to'enter upon,the, v ve menti ed pr arty for Inspection purposes SEE REVERSE'FOR EXPLANATORY LANGUAGE ` c s SI azure o4 P mule - Dote^ rte. .i" ' .. 2 •+ . } . .. t" " , - ' - , , .. .• ,