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Home My Public Portal About4905 ROBINHOOD AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT \ I herebf affirm that I have a certificate of consent to sell 76A667A unsure, or a certificate of Workers'Compensation Insurance; CE 817(REV. 10/81) n or c rtified copy thereof(Sec. 3800, L I ` COUNTY OF LOS ANGELES BUILDING AND SAFETY \ Company ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Q /� Certified copy is filed with the county building inspec tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY 6 Date Applicant WATER CLOSET NEAREST CE TIFIC E OF EXE 1O FR ORt BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR I Date Applicant ' CLOTHES WASHER ADDRESS07— NOTICE TO APPLICANT: If, after making this Certificate of 3 3C) SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' r• T-�U CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- t 7 with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. deemed revoked. 11 WATER HEATER LICENSE NO. O CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS >_(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL LDATEs VALIDATION 0 License Number 0 Lic. Class � � FINAL ;O Contract o `Date BYt' k' ❑ 116i am exempt under Sec. `� �f FA B.BP.C. for this reason Plan check fee ► Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY r HOME OWNER-BUILDER DECLARATION Name l 3 4 2 6 A I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and Address o�G o o 0 0 0 5 Professions Code): City Tel. No. 0 - 1650 ❑ I, as owner of the property, will do the work and the 2 structure is not intended or,offered for sale (Section 000 0 0 16505 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 11706-83 1 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ,S atur of it a fe FGA667 )BS-17:10•SS APPLICATION FOR -PLUMBING-PERMIT 1 3-I 1, DMSION OF BMLDING .AND SAFETY Deportment of County Engineer County Of LOS Angeles BUILDING A JOHN A:L.AMBIE, COUNTY ENGINEER ADDRESS 4 CASSATT D,GRIFFINS SUP+T OF BUILDING LOCALITY FOR APPLICANTTO FILL IN NEAREST CROSS ST. OWNER DISTRICU9. GROUP I Z IE , I READY FOR INSPECTION MAIL - tj_ 11 ADDRESS INDUSTRIAL CITY TEL.NO. WASTE.APPROVAL PLUMBER INSPECTION RECORD ADD RIC CITY TEL.NO. LICENSE-NO. ICENSENO. �, i' /� ,*-x'3,5' c,(y6 .�.. -cr? J NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET)-' @ $1:00 � BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 O KITCHEN SINK Q $1.00 eP DISHWASHER @ $1.00 ��iL/7t c? LAUNDRY TUB OR TRAY @ $.i.00 1A,4 /� dv✓ �h,�,� CLOTHES WASHER @ $1.00• 60 '� A WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 . . /3 /�.,r`•ei iI/.. � � APPROVALS i1 f j/ DATE INSPECTOR'S SIGNATUR`; UNDER B WORK ` �1 '( y�.I PERMIT- IS 1 00 ROUGH PLUMBING ///. GAS.PIPING Av ,4/I _ � TOTAL FEE- GAS VENT 1 HEREBY ACKNOWLEDGE THAT I .HAYE READ THIS APPLICATION HOT WATER HEATER 7' AND STATE THAT THE ABOVE IS CORRECT' AND AGREE TO COMPLY �/ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBINGFIXTURESIIJt�S/ PLUMBING. 1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1: THE LEGAL OWN F' THE ABOVE UTILITY CO.NOTIFIED. DESCRIBED RESIDENTIAL OPERTY. SIGNATURE OF PERMITTEE. FINAL �`-` � s.In.�i-00 OHN A.LAME.COUNTY ENGINEER VALIDATION, ROBERT A.WOOD.CHIEF PLBG. INSPECTOR C6. B.0. CASH { 8 0 41�; JUN 4 3 1 1 .0 0• WORKERS'COMPENSATION DECLARATION— 'h' • r '<� APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of conseslt to sel =:�,76A667q Insure; or a certificate of Workers'Compensation Insurance; CE 817(REV. 10/81) �7 OF I' r o certified co y fh r f(Sec,3800, Lab. C.) �} n COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGgDDRESSns � Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM (off FEE tion d partment. LOCALITY si Date Appligan I n J WATER CLOSET ' NEAREST > � CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. G/ vC COMPENSATION INSURANCE SHOWER OWNER SA 11L4 (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR OMS_ Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR , Exemption, you should become subject to the Workers' CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be LSTATE ICENSE NO. VIS-��7 LIC. deemed revoked. WATER HEATER CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSi;D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Div.ision.3 of the Business OUTLETS OVER y. and Professions Code,and my license is in full force and effect. 5 PEIMYSTEM FINALA. VALIDATION (� f DATE 0 License Number44� •&7 Lic•Class _y O FINAL• t9 Contractor ddD� 7 / ate 7" 1, BY � ❑ V I am exempt under Sec. � H B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Slgnat� a A.��1�1,,..a i TOTAL FEE SINGLE FAMILY Plan check applicant ? !L r - HOME OWNER-BUILDER DECLARATION Name + 0 0 0 0 0 rz I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 0 `; �.r--.O Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the r' S C 7- structure structure is not intended or offered for sale (Section .1 7044, Business and Professions Code). 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.). r 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 i authorize representatives of this County to enter upon the above-roenAoned property for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE I 'S-Ig-nature of Permittee Date j COUNTY OF LOS ANGELES TEMPLE CITY # 0508 C- PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS L-.EL-05-08-0008310006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GA D: FEES PAID B D XG-A. SS• TR: 19043 LT: 4 4905-ROB INHOOP &V FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CIF9-f7804031 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: RYLAND 8585-009-008 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: 85 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLA BY: E PIR S ON: 08/31/00 UT 02/28/01 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: SILVA JENNIE TR (626) 443-0949- �) 4905 ROBIN HOOD AV TEMP 917804031 DESCRIPTIONO OR CHANGE OUT OF WA ER HEATER APPLICANT: TE N ALAP ASSO. (818) 407-1247- 7229 VARNA ST. SPECIAL CONDITIONS: N. HOLLYWOOD, CA ES co CONTRACTOR: TEL. NO: �O� APPROVALS DATE INSPECTOR SIGNATURE ALAP ASSOCIATES (818) 407-1247- 7229 VARNA ST LIC. NO UNDER SLAB WORK NORTH HOLLYWOOD CA B/L RHE WATER SERVICE PLASTIC Y/N METAL Y/N ARCH T OR ENGINEER: TEL. O: ROUGH PLUMBING LIC. N0. / 1111111 L GAS PIPING Irl n n �> K GAS • ENT LI /U p L 11 WG OT ATER HEATER u ��J JJJ S PLUMBING FIXTURES f O 0 f-. O g k�AAA LAWN SPRINKLERS Q ❑ i �� t GAS TEST �p El �i �y UTILITY COMPANY NOTIFIED 46�• El of 0 'C `9erviC " hs GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508