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HomeMy Public PortalAbout5008 RYLAND AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION 20-W26'DPW 4/90 A P P L O CA ll Mil l F®R P L UMf N N G P E RN T I hereby,affirm that I have a certificate of consent to self in- 76A667A 14 sure,ora certificate otWorkers'Compensation Insurance,ora cersified-cccopy ther&of(Sec. 3800, Lab. C.) P y N6. ���'O•�S Compan COUNTY OF LOS ANGELES DEPS'. OF PUBLIC WORKS 1 ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL.IN(PRINT OR TYPE) p Certified copy is filed with the county-building inspection NUMBER FIMURE OR ITEM ® FEE ADDRESS 6.;i department. LOCALITY_ /% L—Date plicantAAA" WATER CLOSET(TOILET) NEAREST`•./ vtr CERTIFICATE OF EXEMPTION FROM W RKERS' 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($100)or less.) 'LAVATORY ADDRESS x:570b I certify that in the performance of the work for which this per- SINK. CI , ,� TEL. IVO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS &eb0 &J .0(J NOTICE TO APPLICANT: If, after making this Certificate--of Ex- SWIMMING POOL RECEPTOR " emption,you should become subject to the Workers'.Compen.- CITY 1 TEL.NO. sation provisions of the Labor Code,you must forthwith comp- •LAWN SPRINKLER SYSTEMS lywith such provisions or this permit shall•be deemed revok- STATE �- LIC. ed. i WATER HEATER 3 LICENSE NO. (, b 6 CLASS LICENSED CONTRACTORS DECLARATION / DISTRICT NO. PROCESSED BY I hereby affirm that j am licensed under provisions of Chapter GAS SYSTEM OUTLETS �r ft�eJ 9(commencing with Section 7000)of Division 3o the Business OUTLETS OVER and.Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB .DATE i.- License Number 61 Lic. Class p-� FINAL O 4/3, Cf1 NSt. �•-t d BY Contractor f•— Date I am exempt under Sec. K. - U B.&P.C. for this reason �T's U Plan check fee � � a Date: PLUMBING PERMIT ISSUING FEE$ 1 ITEMS _ 11 Signature TOTAL FEE SINGLE FAMILY Plan check a licant TOTAL 44- 10 HOME OWNER-BUILDER DECLARATION PP i li� 44.10 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and CHANGE ,00 Professions Code): Address I, as owner of"the property, will do the work and the City Tel. No. � li—f structure is not intended or offered for sale(Section 7044, - 71IG196 Business and Professions Code). © 7338 AM10:29 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"mentioned pro ty for ins action purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature'of Perm tee Date ; 76A667 17 11-49 ; APPLICATION FOR PERMIT DEPARTMENT ©F'BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRIrGRD P fO . PLUMBER �K� RECEIVED BY READY FOR DATE 188UED f� FIRST INSPECTION �P A ADORERS CITY n/ �jj p.j0 ADDREING SS o D O 6 .• LCi!/T/ 'CUNyam,. TE4 N g _ L CENSE NO.% �� EXPIRES e�7 Q LOCALITY p NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER / •� ` MAIL WATER CLOSET(TOILET) @ 0.50 111 AD RESS L 2,"4w� I BATHTUB @ 0.50 CITY Xgh TEL. No. SHOWER OR 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS ® LAVATORY (WASH BASIN) @ 0.50 APPLIC;%TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 1 KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS J LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER 0 BAB SYSTEM OUTLET5 0.50 OF THE RESIDENTIAL RO �D�ESCRIBEL) +ABOy _ SIGNATURE OF® ,u -A off« I WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 0.5131 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER O.5OI DRINKING FOUNTAIN 0.50 URINAL @ 0.50 J Q HOUSE SEWER 0.50 Z (MISCELLANEOUS L7 I D I APPROVALS DATE IPBPECTORIB NAME ROUGH PLUMBING I s .1• GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT I 1.00 GAS TEST -7" UTILITY CO.NOTIFIED TOTAL FEE /` �v FINAL 78AG87C (CE-8171B) -9/75 #Cr. APPLICATION FOR PLUMBING PERMIT BUILDING D SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ��T�� NUMBER FIXTURE OR ITEM @ FEE ADDRESS 5508 N. R W- M AVE. WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. SHOWER OWNER ]?ISANO PMS LAVATORY MAIL. ADDRESS SAW SINK CITYj,E ,�f TEL.NO. 42-2217 DISHWASHER CONTRACTOR TRANE HCC CLOTHES WASHER ADDRESS Hn SWIMMING POOL RECEPTOR 9-034 N- PECK LAWN SPRINKLER SYSTEM CITY S, a MDM TEL. No- 579-7982 STATE LIC WATER HEATER TATE LICENSE NO. 265094 CLASS C-20 0} CD 1 GAS SYSTEM 1 OUTLETS '� OQ DISTRIC .N O. GROUP NEI `ESSE BY � OUTLETS OVER ( CD 5PER SYSTEM INDUSTRIAL LUI.1 WASTE APPROVAL y INSPECTION RECORD Z 1"o".4 .��'aFf /et-1 9-2,3.7 Y 0 L4.vGZ- Plan check fee PLUMBING PERMIT ISSUING FEES 50 TOTAL FEE Plan check applicant Nagle APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. NO. GAS PIPING i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THEABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST /.� CALIFORNIA OR THAT I AM THE LEGAL OW OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDE A PR ERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEEIA&4� AL ,a3•�� )Qd&w/tfifO6s PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 6.5 4 APR 13 5 0 7.5 4 AS8 /,p v'2D .173-9 S DIVISION OF BUILDING-1�ND SAFETY - _ -- 'Deportment of County Engineer ' County of Los Angeles WM.J. FOX, COUNTY ENGINEER� ' BUILDING / ADDRESS (—' Z CASSATT D.GRIFFIN,SUP"[OF �BUILDING �/_ 1 LOCALITYj��L- FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER `i - DIST O. I GNJJP ZOOREADY FOR INSPECTION MAIL Some ],/ _ I /1—/ I Now AIL +1� CITY TEL.NO. INDUSTRIALWASTE APPROVAL PLUMBER GENERAL' INSTALLATION .CO. INSPECTION RECORD ADDRESS 6558 West Blvd. CITY L.A. 43 TEL NO Legsont 3-2541 LICENSE NO. 787- C-36 151839 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER-CLOSET (TOILET) $ BATH-TUB SHOWER LAVATORY.(WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER 1 WATER SOFTENER 1 00 ' TOTAL-NO. @ 0.80.. APPROVALS • DATE INSPECTOR'S SIGNATURE GAS SYSTEM' OUTLETS @ 1.00 • WATER HEATER (p1 1.00 UNDER SLAB WORK PERMIT S 1 ROUGH PLUMBING 00 • GAS PIPING , TOTAL FEE 2 00 GAS VENT I HEREBY ACKNbWLEDGE THAT I 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 FIXTURES PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LE IER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE !,` �r OF PERMITTEE FINAL WILLIAM J. FOX, COUNTY ENGINEER;. VALIDATION R.A.WOOD',CHIEF PLBG. INSPECTOR 4 4 7 CR mAR 2 6 . . .3 2.00 In WLs t/ �.