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Home My Public Portal About5435 RYLAND AVE_Plumbing__ WORKERS'COMPENSATION.DECLARATION .ICE 817A APPLICATION P®R PLUMBING PERMIT I hereby affirm that I have a' certificate of consent to self ,ice e�7 (z-ao) insure,or a certificate of Workers'Compensation Insurance,or :011CYNo.—Compan certified copythereof Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDINGANDSAFETY y El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE 4art ei ,[ (r WATER CLOSET LOCALITY M ` Dat Applicant Pkv 1 khE J W LCF NEAREST BATH TUB CROSS ST. C s CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER' MAIL (This section need not be completed if the work involved LAVATORYADDRESS a by the permit is for one hundred dollars ($100) or less.), SINKO CITY TEL.NO. V I certify that in the performance of the work for which.this DISHWASHERC permit is issued, I shall not employ any person in any manner CONTRACTOR Ai! U�� +� so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS Date Applicant C n.l, �� A ,gI U SWIMMING POOL RECEPTOR W NOTICE TO APPLICANT:-If, after making this Certificate of CITY TEL.NO.3 _�qL5 tl Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. H Z213 CLASS C— 3L with comply with such provisions. or this permit shall be deemed rbvoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER a iI hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINALr VALIDATION ness and Professions Code,and my license is in full force and DATE i effect. IJP i �,[ FINAL iLicense Number haS 3? Lic.ClassC--- 1'� ��/ BY ContractorNu I E 11W lh Date d I I am exempt from the licensing requirements as I am a Plan Check fee I p licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ i acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic,or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name '.I hereby affirm that I am exempt from the Contractor's Address License Law for'the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): PI, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044,Business and Professions Code). i j 222926A CONSTRUCTION LENDING AGENCY i Z hereby affirm that there is a construction lending agency # 0 0 0 0 0 5 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). 2 0 0 1250 Lender's Name L 000 Lender's Address —� , 12505 i I certify that I have read this application and state that the ! 0 2 1 1. '—8 2 above information.is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize repr entatives of this County to enter,upon the abo enti property for inspection purposes. I Signature of Permittee Date j ION CLAR ATI e . WORKER-have PENSATate of consent to B�aADPW9/89 APPLICATION FOR PLUMOING PERMIT I he;eby affirm that I-have a certificate of consent to self insure, ora ceFtifi ate of that Compensation Insurance, or a certified copy thera`o ec.3800°Lab.C.) •dol cy. d Company ,COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ C%miffed copy is hereby furnished. BUILDING ! !� r� ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �� G,�/��r i7 • department. , NUMBER FIXTURE OR ITEM FEE LOCALITY Date Applicant 3 IWATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB 00 ASSESSOR (This section need not be completed If the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred.dollars.($100)or less.) LAVATORY OWNER Go_U�• I certify that in the performance of the work for which this permit MAIL is'issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER, 7 CITY a% TEL.NO. Date OP. Applicant f CLOTHES WASHER CONTRACTOR �}v�7 NOTICE TO APPL CANT: If, after making this Certificate of ( � L Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR /�� — e provisions of the Labor Code,you must forthwith comply with such ADDRESS / �`/�C� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYe�0l&Pj¢ /r TEL.NO a I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and STATE ,/_,/j0.313 COASS /� V GAS SYSTEM OUTLETS LICENSE NO. f 7" `.'^ Professions Code,and my license is in full force and effect. ` OUTLETS OVER DISTRICT NO. PROCESSED BY cc /J 5 PER SYSTEM �� Q License Number / 'Lic.Class Yom. ,� ` FINAL ��Z d_ VALIDATION LU Contractor`—Kn,"✓e.05&'er"iDate�! �� DATE 0 U) ❑ I am exempt under Sec. +_ BY IFINAL /f/Jyj„�y�,� B.&P.C.for this reason _ J �``"• '`7 Date: Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ A ❑ TOTAL FEE SINGLE FAMILY Plan check applicant, e HOME OWNER-BUILDER DECLARATION Name l o I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address 3Q7 tri 1SJ.+o 0( Code): City Tel.No. I ITEHIS 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). �- AL 103 1 fl CONSTRUCTION LENDING AGENCY CHECK 1035.00 1 hereby affirm that there is a construction lending agency for the CHANGE .1313 performance of the work for which this permit is issued(Sec.3097, Civ.C.) Lender's Name 1000`0001 i 1A4/90 Lender's Address 38031 AM 11 e 3c 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 7FjA657 DBB 17 7-51 APPLICATION FOR PERMIT ..DEV�VrNENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FO PPLICANT TO FILL , DISTRICT . GROUP ZONE PERMIT PLUMBER / / „•j RECEIVED SY READY FOR DATE ISSUED of/vV FIRST INSPECTION I�G1 °may/ j o" ADDRESS ,G • � BUILDING L S CITY 1Grll�.to TENo. ADDRESS v /.COOLICENSE NO. 7 ,� S EXPIRES rJ ] ry LOCALITY NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER • f r� MAIL WATER CLOSET(TOILET) @ 0.50 0 ADDRESS BATH TUB 0.50 CITY TEL No.i SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 PO 8 THE ABOVE VALIp LOS LAUNDRY TUB OR TRAY Q 0.50 ANGELES COUNTY LICE R I AM THE LEGAVWNER - -- OF THE RESIDIENTIAL O RTY DESCR DSA OVE. GAS SYSTEM UTLET9 0.60 SIGNATURE OF WATER HEATER Q 0.50 PERMITTE SLOP BINK 13.513 INSPECTI0brRECORD FLOOR BINK 0.50 ' G� P � L17'S- 1v ' -.s FLOOR DRAIN fat 0.50 9 '96. DISHWASHER O.SO n/.d�!J yCa r/_1 � _�rjo /v DRINKING FOUN'1•AIN O.BO G � � G✓ URINAL 0.-50 +y/� Q HOUSE SEWER 0.60 Z_ MISCELLANEOUS O APPROVALS DA'T/Er IN ECTUR'B NAME ROUGH PLUMBING OAS PIPING GAB VENT CESSPOOL �y 1,00 CEBBPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) 1.00 SEWER PERMIT 1.DD GAR TEST UTILITY CO.NOTIFIED 2 TOTAL FEE FINAL `T.3