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Home My Public Portal About5025 RYLAND AVE_Plumbing__ Vor S'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hat I have a certificate of consent to self 20-0026 DPW 6/87 cate of Workers'Compensation Insurance, 78A667A thereof(Sec. 3800, lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Company a.� Ck Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS _170-312 ( Q CeBUILDING rtified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Two M /� G � •� WATER CLOSET Date �� Appli4anf v CROSS ST. CERTIFICATE OF EXEMPTION ROM WORKERS' BATH TUB COMPENSATION IN RANCE SHOWER OWNER r (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESSQL VX I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner SINK CITY ` TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR J o T- , Date Appl!cant CLOTHES WASHER ADDRESS did NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY c TEL. NO.9/�-f/dj Compensation provisions of the Labor Code, you must forth- 9&4`✓• CO..-cn 7 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be I STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS. LICENSED,CONTRACTORS DECLARATION DISTRICT NO. PROCL� ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (/ � L /LG (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER e1 and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION a DATE (. / �C�zr.- License NumberL`5 7 7 Q7 Q� Lic. Classes C I-- Y FINAL Contractor c n F- Date - —� C k ❑ I am exempt under Sec. C B.&P.C..for this reason _ - CLu !!—2 7—q ( Plan check fee -?=1e - Dpte: PLUMBING PERMIT ISSUING FEE$ Signature � = yi .. / TOTAL FEE !T T1 A;_ 3 ..r w Plan check applicant i r -- :-:; SINGLE FAMILY =T�Ct-+= HOME OWNER-BUILDER DECLARATION Name .- I hereby affirm that I am exempt from the Contractor's License CHANGE °`_" Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. 1, as owner of the property, will do the work and the 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.). 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 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR FLUMBING REKNIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance; CE 817(REV. 10/81) u ,cep cer Pied cop thereof(Sec. 3800 Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY IPS '� 7 � r /f f ` Pol No. /d CompanyJ` /� / ��0/11e/ ❑ Certified copy is hereby fur nis ed. I BUILDING Certified copy is filed with the county building inspec-I FOR APPLICANT TO FILL IN(PRINT OR TYPE) j�j ADDRESS O •. XII tion department. r 'i NUMBER FIXTURE OR ITEM @ FEE 'LOCALITY' '�� Date —/ —97 Appligant I WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCEOWNER �� (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( ) LAVATORY ADDRESS Pt� I certify that in the performance of the work for which this: permit is issued,I shall not employ any person in any manner SINK CITY TEL. NO. Ll —/7 ' so as to become subject to the Workers'Compensation Laws.; DISHWASHER CONTRACTOR /Z4 1,2 ,DAI�dl= Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING Exemption, you should become subject to the Workers' POOL RECEPTOR. ; �^ Compensation provisions of the Labor Code, you must,forth LAWN SPRINKLER SYSTEM CITY `,e ur`� TEL. NO. �Y? with comply with such provisions or this permit shall be STATE ( LIC. L .J deemed revoked. I WATER HEATER LICENSE NO. O�3 r CLASS a3 LICENSED CONTRACTORS DECLARATION DISTRICT ME D B I hereby affirm that I am licensed under provisions of Chapter 9 , GAS SYSTEM % OUTLETS C (commencing with Section 7000)of Division 3 of the Business! OUTLETS OVER and Professions Code,and my license Win full force and effect. i 5 PER SYSTEM FINA VALID TION �f73/ c 3� DATE a License NumberV63 Lic. Class Q -FIN `�7 (d e_ f/ D/ Date -1 8 '1 BY _ Contractor` dIft Z I CI ❑ I am exempt under Sec. B.BP.C. for this reason ® a Plan check fee Date: CC PLUMBING PERMIT ISSUING FEE$ ` Signature TOTAL FEE 6 5 2 8 A I Pian check applicant o o SINGLE FAMILY ugo HOME OWNER-BUILDER DECLARATION Name o 0 o 1 6.5 0 5 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 0 2- 1 $z 8 7 Professions Code): City 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). loop i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for i. 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 ab -men'oned properfy�erynsjiection purpose lS/n�//J SEE REVERSE FOR EXPLANATORY LANGUAGE _ ,//�Da r Signature of Permittee Date I "Now yr 11 as to APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM J. FOX. CHIEF ENGINEER "~FO. PLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO PLUM Roto-Roote Service & Plumbing Co. RE EIVED BY READY FOR DATE ISSUED S SOUTH FRESNO ;)J� FIRST INSPECTION /�/D `� ADDRESiS A1VGC �, SSS . BUILDING r CITY TEL. NO. ADDRESS �O. •- Al COUNTY LOCALITY LICENSE NO. EXPIRES gg A m CROSS ST. J G l/c.! NEAREST PERMIT FEES - NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER _ MAIL WATER CLOSET (TOILET) @ 0.50 $ ADDRESS q� BATHTUB @ 0.50 CITY / TEL. NO. SHOWER @ 0.50. 1 HEREBY ACKNO LEDGE THAT 1 HAVE READ THIS LAVATORY WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. — — - I CERTIFY THAT I POSSESSTHE ABOVE. VALID- LOS LAUNDRY TUB OR TRAY @ 0.50 - -ANGELES—COUNTY-LICENSE; OR- 1 AN1-THE—LEGAL-OWNER - OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE OF WATER HEATER @ O.SO PERMITTE 1 �' SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 1 — )1—.r - FL.q FLOOR DRAIN @ 0.50 - DISHWASHER @ 0.50 W ►o S 4 Ir I�iqQ „y�-1 pq L; 'c DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 HOUSE SEWER. @ 0.50 , � � -�Q yj�(m p �'�JPZ MI CELL NEOUS 1r to APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING — -- GAS PIPING. GAS VENT CESSPOOL @ 1.00 CESSPOOL- SEPTIC TANK: I SEPTIC TANK DRAIN ( ) PIT ( ). @ 1.00 SEWER PERMIT . 1.00 GAS TEST' UTILITY CO. NOTIFIED TOTAL FEE S I' (/ FINAL /—/e� Y e. ►�.y.y „WSA667 17 25M.BETS 7-49 t APPLICATION FOR PERMIT I3EPARTMENT OF BUILDING AND SAFETtr COUNTY OF LOS ANGELES PLUMBING 1 n WILLIAM J. FOX, CHIEF ENGINEER � FOR APPLICANT TO FILL IN CI �-� . ROU PERMIT � u. PLUMBER RECEIVED BY READY'FCR DATE ISSUED FIRST INSPECTION ADDRESS /2./'"Or CITY TEL.:No. J I COUTY ADDRESS N - ' LICENSE NO. EXPIRES LOCALITY �r;��yj.bi�A .. �✓ �� Air I CERTIFY THAT I POBBEBS THE ABOVE VALID LOS NEAREST ANGELES COUNTY LICENSE. CROSS ST. �.r t OWNER 'rtr-� C.%i., f+ ri•r .�r1.3yi :?-�/'•i� MAIL. PLUMBER ADDRESSf PERMIT FEE IS .$1:OD FOR THE FIRST FIXTURE OR CITY ;.; (_, Iil� Y- TEL Na. ITEM LISTED BELOW, PLUS 50a FOR EACH ADDITIONAL I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT,OR DRAINFIELD ERTY DESCRIBED ABOVE. $1.00. MINIMUM FEE FOR ANY PERMIT $1.00. EACH GASSYSTEM 15 A .SEPARATE ITEM. �l �•� 6 NUMBER TYPE OF FIXTURE OR ITEM WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER LAVATORY (WASH BA91r1) KITCHEN SINK LAUNDRY TUB OR TRAY GAS SYSTEMOUTLETS WATER HEATER SLOP SINK Q FLOOR SINK _Z FLOOR DRAIN DISHWASHER O DRINKING FOUNTAIN URINAL. MISCELLANEOUS APPROVALS DATE INSPECTURIS NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL SEPTIC TANK - DRAIN (. ) PIT ( ) $ SEPTIC TANK CESSPOOL $ SEWER MOUSE SEWER $ ,GAS TEST TOTAL FEE $r> 1no UTILITY CO.NOTIFIED -t2 r C'' FINAL 1 1 76A667-CE#617 2-66 APPLICATION FOR PLUMNG PERM COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 1 BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS So 15 COLEMAN W. JENKINS. SUPT. OF BUILD'I'NG LOCALITY FOR APPLICANT TO FILL IN CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE f OWNER WATER CLOSET 51.25 MAIL BATH TUR 1.25 ADDRESS / SHOWER 1.25 as CITY TEL. NO. LAVATORY 1.25 �SCONTRACTOR ` SINS 1.25 ADDRESS DISHWASHER 1.25 CITYvn TEL.. NO.Y iL3 `0() STATELAUNDRY TUB 1.25 LICEN LIC / LICENSE NO. � 1 ` � CLASS P O BY CLOTHES WASHER 1.25 DISTRICT N GRg13P' E WATER HEATER 1.50 o / GAS SYSTEM OUTLETS 1'50 WASTE APPROVAL C OUTLETS OVER 5 PER SYSTEM .80 INSPEC ON RECORD. v v W a Z APPROVALS DATE INSPE SIGNATURE PERMIT JEE 2 00 UNDER SLAB WORK -` ROUGH PLUMBING TOTAL FEEGAS PIPING I HEREBY ACKNOWLEDGE' THAT I HAVE READLICA ON GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND COMPLY WITHPLUMNGL COUNTY ORDINANCES AND STATE ULATING HOT WATER HEATER1HEREBY CERTIFY THAT 1AM PROPERLY RANWOR PLUMBING FIXTURESICENSED. AS REQUIRED •BY LOS ANGELES COUSTATE OF GAS TESTCALIFORNIA OR THAT 1 AM THE LEGAL OWNER TEND TORESIDE IN,THEABOVE CRIB RESIDENTIAL PUTILITY CO.NOTIFIED SIGNATURE 'OF PERMITTEE FINAL ATION JACK R. ALLEN CK. M.0. CASH p SUPERVISING MECHANICAL ENG R. (� �G7 6..5 4% Hhy22 5 D 5,75 V