HomeMy Public PortalAbout4906 RYLAND AVE_Plumbing__ '�QWERSf,C,OMPENSATIPN DECLARATION APPLICATIONFOR PLUMBING PERMIT
I hereby aff ,`rrf'that I have a certificate of consent to self 76A667A
' insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
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 inspec- ADDRESS r%
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET
Date Appli4ant ' CROSS ST.T. � c� 2 �
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE SHOWER OWNER 11N le SA 0
(This section need not be completed if the work involved by MAIL r
the permit'is for one hundred dollars($100)or less.) � LAVATORY a ADDRESS 1J
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CI PIC C 14 TEL. NO.qJ0 96
so as to become subject to the Worke 'Cnmpensatio ws. DISHWASHER
CONTRACTOR
Date,#l�L�!" Applican CLOTHES WASHER
NOTICE TO APPLICANT: If, after making is Certificate of ADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
P Y I CITY' TEL. NO. ,
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit•shall be STATE LIC.
deemed revoked. WATER HEATER' LICENSE NO.. CLASS
LICENSED CONTRACTORS DECLARATION. DISTRICT NO. P ESSED BY
�
>_I hereby affirm that-I GAS SYSTEM OUTLETS am licensed under provisions of Chapter 9 �
(commencing �4 �
with Section.7000)of Division 3 of the Business OUTLETS OVER A.
and Professions Code,and my license.is in full force and effect. 5 PER SYSTEM DATEL VALI ATION 0
License Number Lic. Class 99
FINAL O
Co tractor' Date BY y
nea
I am.exempt under Sec. X 3 3 6 5 A. y
9
B.BP.C. for this reason # o o 0 0 0 5
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE:$ 1 o o4&50
Signature - � o - 465005
TOTAL FEE I t 0 1 -85 85
SINGLE FAMILY
Plan check applicant
'
HOME OWNER-BUILDER DECLARATION , Name TD S a r(�
I hereby affirm that I am exempt from the Contractor's License Address r
Law'for the following reason (Section 7031.5, Business and C
Rrofessions Code): Cite C ' Tel. No.
❑ 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).
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 D
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize,representativ of this County to enter upon the
ab0 e- ntioned pro er y for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
fr3 P
31--As�
ignatureermittee Date
td ,
-
76A667 17 11-49 APPLICATION FOR PERMIT •
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES P—L 1 '
WILLIAM J. FOX, CHIEF ENGINEER
D ST IC GROUP ZONE FOR APPLICANT TO FILL IN
PLUMBER// I-/./j f�rf/y'���c�i ;?�?f'+.r'•L3, :- s RECEED BY READY FOR DATE ISSUED
/ �• / FIRST INSPECTION r3
ADDRESS/ .�J L/ ,fir d EEL BY
CITYIO / riGC� fQ r / f BUILDING /�/i/ u� /1 � V
TEL.N (f•//' ADDRESS �!(J(�T�.
COUNTY EN E NO. v//• II EXPIRES �/J` �B ' LOCALITY /i�/ Ll+ l',�./�f
NEAREST r
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERMAIL
/,��1_(-��•/l�7(iC• .�/J'�[L' /J���]Y.�/P �(�?��
WATER CLOSET(TOILET) @ 0.50 S ADDRESS
BATH TUB @ 0.50 CITY / TEL. No.
SHOWER 0 0.501 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 13.513 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPMR R EBF IBED ABOVE.^ J
GAS SYSTEM OUTLETS @ 0.50 �! /.f(1L
SIGNATURE OF it r
WATER HEATER @ 0.50 PERMITTEE-
SLOP
ERMITTEE SLOP SINK @ 13.5o INSPECTION RECORD
FLOOR SINK @ 0.50(
(FLOOR DRAIN @ 13.51
DISHWASHER @ 0:50 I
DRINKING FOUNTAIN 0.50
URINAL @ 00.5 J
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS I O
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSP60L
fiEPTIC TANK:
SEPTIC TANK
DRAIN ( ) PIT ( ) a 1.00 SEWER
PERMIT I 1.131, GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE FINALc