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Home My Public Portal About9538 PENTLAND ST_Plumbing__ WORKERS'COMRENSATION DECLARATION UCAIrION OR PLUMBING PERME I hereby, affirm that 1-have a certificate of consent to self in- y6�7A �� /A - FOR LI C7 su,e%nor a ceIrtiftcate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF L®S•ANGELES DEPT. OF PLDBL9C WORKS Policy No. I . Company ❑ Certified copy is hereby furnished. ` FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS �. Certified copy is filed with the county building inspection department. [NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 0 COMPENSATION INSURANCESHOWER OWNER !J r _ 2 (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 7 UL AV tie I certify that in the performance of the work for which this per- SINK CITY TEL.NO .`tel-mss' mit is issued, I shall not employ any person in any manner so _ as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION g DISTRI Y O� PR I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS4. 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d,Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VAL9 ATION fe HOSE BIB � 4 License Number Lic. Class C FINAL NUT.4 C Contractor Date BY F1 I am exempt under Sec. C`} 3303 172°20 C B.&P.C. for this reason Plan check fee � TOTR� IT�•i�,�o��a Date: PLUMBING PERMIT ISSUING FEE$ �1 Signature TOTAL FEE C � y � 172020 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant .00 I hereby affirm that I am exempt from the Contractor's License Name Low for the following reason (Section 7031.5, Business and Professions Code): Address M29-M01 9/14/95 I, as owner of the property, will do the work and the City Tel. No. 2292 1 AN 8-0 48 structure is not intended or offered for sale(Section 7044, Business and Professions Code). IN- 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 hereby authorize representatives of this County to enter upon the above-m tioned petty f i pection pu oses. (\ 13 SEE REVERSE FOR EXPLANATORY LANGUAGE n re of rmittee ? to BAS67AP LICT1 ON FOR PLUMBING PERMIT MIT 03..171710.56 Y-' DIVISION OF BUILDING AND SAFETY ,rj-lP-`e„ � Department of County Engfneor County of Los Ang0103 `BUILDING...,.. ..,,.. . /�.,r........ JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �•-7 r.��f �.i /�U�IIP�.�� :e. CASSATT D.GRIFFIN,SUP'T OF BUILDING c' LOCALITYg��,Ac Cy /!r FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER DISTRICT NO. 9ROUP ZONE I READY FOR INSPECTION MAIL 5/ ADDRESS INDUSTRIAL CITY TEL.NO. WASTEAPPROVAL PLUMBERq�� INSPECTION RECORD ADDRESS ' +/C�wn�� Lam.•' �_ a �_ + . NO/�/ v yv�L4-s•LC s.,a1� a_;;J%r -_,.��-�'�G_„� 'r'i LICENSE NO. lev 1``3 NUMBER TYPE OF FIXTURE OR ITEM I FEE ��✓L iL��iL WATER CLOSET (TOILET) @ $1.00 $ ro �'ooe "J':" i� _.�L„�L.�j BATH TUB @ $1.00 7 SHOWER @ 51.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ S1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ St.00 a a. WATER HEATER @ S1.00 GAS SYSTEM @ 51.00 APPROVALS +DATE INSPECTOR'S SIGNATURE w. UNDER SLAB WORK ”,I PERMIT 1 00 RHOUGPLUMBING '� ��_� •_ _ 5 ,. GAS PIPING w 76 +i�i - TOTAL FEE "' GAS VENT G' I _ HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER ATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -_-_ _ _HE-_ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBINGFIXTURES PLUMBING. _ ___ _- I HEREBY CERTIFY THAT I PERLY G) ED A /OR G_AS TEST LICENSED AS REQUIRED BY A S E OF -- CALIFORNIA OR THAT LE ER ABOVE TILITY CO.NOTIFIED DESCRIBED RESIDE L ERTY. - - - -- -- -- SIGNATURE - - - ---OF PERMI FINAL DHN A. LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR CK. tl.0. CASH 7SA667 APPLICATION FOR PLUMBING PERMIT oB5.I7IDIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los COUNTY Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS � CASSATT D.GRIFFIN,SUPT of BUItnINo LOCALITY �iC� �i s� FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER !�/C�qa DIST�r NO. GROUP ZONE I READY FOR INSPECTION MAIL ADDRESS INDUSTRIAL CITY TEL.NO. WASTE APPROVAL PLUMBER ,��}x 77I��+ mil! ` INSPECTION RECORD RECORD ADDREESS 3 S�i�/ //�Tl// .G y .'� �w"CFa C�r6A �'�¢� w C�4f Wt 1 r?. CITY.JO��i /�i *EL.NOA; dPoaa'1 LICENSE NO. /to/ NUMBER TYPE OF FIXTURE OR ITEM FEES B=1 WATER CLOSET (TOILET) @ $1.00 'S'/dv LJ' BATH TUB @. $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $.1.00 — -- CLOTHES WASHER @ $1.00 O e WATER HEATER @ $1.00 GAS SYSTEM @ $1..00 APPROVALS D TE I ORS Pi GNAT URE UNDER SLAB WORK _- PERMIT $ 1 00 ROUGH PLUMBING 2 c ? / GAS PIPING / TOTAL FEE (O GAS VENT I HEREBY .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. PLUMBING FIXTURES I HEREBY CERTIFY THAT I PERLY G D A -OR GAS TEST LICENSED AS REQUIRED B A E OF CALIFORNIA OR THAT LE ER ABOVE TILITY CO.NOTIFIED DESCRIBED RESIDE L RTY. SIGNATURE !� OF PERMIT FINAL �` �Jb :/�r�•• �. IOHN A.LAMBIE,COUNTY ENGINEER. VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR M.9. CASH 1 &8 7 6 3,", JUL31 3 6,. n