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HomeMy Public PortalAbout6304 SALTER AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION 76A667A 11 hereby affirm that I have a' certificate of consent to self ce 617(z-eo) A P PU C A T I ON FOR PLUMBING PERMIT nsure,or a certificate of Workers'"Compensation Insurance,or certified copy thereof(Sec.3800,Lab.C.) n� INA COUNTY OF LOS ANGELES ✓ �� BU1LDfNG AND SAFETY Policy 1V6 8 4��bm.pany I C] Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 6304 N. SALTER AVENUE Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM G FEE departuren,t. WATER CLOSET LOCALITY TEMPLE." CITY ate l-6-t52 ApplicgntKINNEYAIR CONDITIONING NEAREST BATH TUB CROSS S.T. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE SHOWER OWNER VINCEN PETRALIA LAVATORY MAIL This section need not be completed if the work involved ADDRESS 6304 N. SALTER AVENUE } y the permit is for one hundred dollars ($100) or less.) SINK CITYTEMPLE CITY 91.780 TEL.NO. 2'86-1347 p certify that in the performance of the work for which this' DISHWASHERV ermit.is issued, I shall not employ any person in any manner C.O.NTRACTOR. KINNEY-AI R CONDITIONING Vas to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESSI�FIF1 SO. ANAHEIM BLVD. 0O ate Applicant SWIMMING POOL RECEPTOR U OTICE TO APPLICANT: If, after making this Certificate of CITY ANAHEIM, 92805 TEL.NO. 772-1441 a xemption, you should' become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LI-C. CL ompensation provisions of the Labor Code,you must forth- LICENSE N.O. 158685 CLASS C—.20 ' SC4 ith comply with :such provisions or this,permit shall be 1 WATER HEATER SOALR 1 4..00 eemed revoked: DISTRICT NO. PRO SSED BY GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER �� ereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM (commencing with Section 7000)of Division 3 of'the Busi- FINALZ s and Professions Code,and my license is in full force and DATE 3 -2 VALIDATION ect. ense Number" 15868.8 Lic.Class C-20 S. SC-44 FINAL " BY ntractorKINNEY AR COND&te 1=6-82" I am exempt from the licensing requirements as I am a Plan Check fee l licensed architect or a registered professional engineer 2r.3 V PLUMBING PERMIT ISSUING FEE$ 8.50 acting in my professional capacity .(Section 7051.., Bus- iness"and us-iness"and Professions Code).. TOTAL FEE 12 50 or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name. ereby affirm ,that I am exempt from the Contractor's Address ense Law for the following reason (Section„70.31.5, Busi- City Tel.No. s and Professions Code): 8 9 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project #! o o o o a 5 (Section 7044,Business and Professions Code). 2 0 01 250 CONSTRUCTION LENDING AGENCY - ereby"affirm that there is"a construction lending agency ° ° o 1 2 5.V 5 the performance of the work for which this permit is ed(Sec.3097,Civ.C.). 02,08-32 der's Name er's Address rtify that I have read this application and state that the e information is correct.I agree to.comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ,nances and State laws regulating Plumbing; and hereby orize representatives"of this County to enter upon the e-ment'oned property f r' spection purposes. � 1 gnature of Permittee Date 79N6§7-,CE917,-8-71 7—pqto�!9 U�I Tir -;,�APLICAT'ION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 6304 Salter LOCALITY m t FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. WATER CLOSET 1.75 � OWNER Bowen Construction Cor J MAIL BATH TUB 1.75 ADDRESS 1620 Melanie Lane SHOWER 1.75 CITY Arcadia TEL. NO. 445-1197 LAVATORY 1.75 JF" CONTRACTOR OWen BrOS� plumb Inco I SINK 1.75 j ADDRESS 4265 North Baldwin n DISHWASHER 1.75 7 CITY E1 Monte TEL. NO. 1+43—oo7g CLOTHES WASHER 1.75 STATE LIC LICENSE NO. 231 741 CLASS C36 SWIMMING POOL RECEPTOR 1.75 „.._a;.. QTRIdCO. UP I ZONEI D LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75 ��'.. INDUSTRIAL WASTE APPROVAL A. GAS SYSTEM OUTLETS 1.75 INSPECTION REC D OUTLETS OVER 5 PER SYSTEM .30 ( ' g m Man check fee See reverse. 'd PLUMBING PERMIT ISSUING FEE $ 3-100 TOTAL FEE —V APPROVALS PATEp IN P CTOR'3 Sit N TURF Plan check applicant UNDER SLAB WORK 3 Name ROUGH PLUMBING / 3 Address GAS PIPING City Tel. No. GAS VENT IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY RLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST s!r 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I M THE LEGAL OWNER OF, AND INTEND TO 012 42 RESIDE IN THE ABOVE E CR RESIDENTIAL PROPERTY. FINAL , SIGNATURE I OF PERMITTEE Y " +' ,r PERMIT VALIDATI CK. M.O. CASH PLAN CHECK VALIDATION CK.. M.O. CASH .a1 5-73 APR 17 5 o 2 7, ©Ara