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HomeMy Public PortalAbout6342 TRELAWNEY AVE_Plumbing__ 7BA667 CU17 12/59 j`� Q, APPLICATI FOR UMBING PERMIT _ClOIINTY OF LOS / /j D +fil_ 1NlENTGL EPIRMIll I ivrx O1NGER I DDBBSB6 .J 7/ ,��]F,(�N]-[j�{ �, �! FOR APFUCANT TO FUL IN �TNUMBER FIXTURE OR ITEMWI WA71'�CLONES TAM SAM SADDRESS OD CRY TRI. NO SHOWER LAVATORT CONTRACTOR ✓ Ref[ ADDEERR DIBHWABEM CRT TEL NO ONZAA R'R A LAUNDRY TDD REGISTRATION NO COUNTY CLOTHED WASHER DI/S-T�RICTpNO ORO P ZONE P CESSED BY WATER HEATER L7 Q O GAG SYSTEM 12MURYffiAL WASTE APPROVAL HiEPECTION RECORD O U m . O , i w m iy OmR0 ffi RFs yA� APPROVALS- DATE INSPECTOR HlIGXATURE PERMIT S 2100 UNDER a WORK TOTAL FEE 00 ROUGH PLUMBING OAS PIPING �' 1 HEREBY ACIIN0IFLEDGB THAT 1 NAYS READ THIS APPUCA710D GAS VENT AND STATE THAT THE ABOVE IS CANDECT AND ABB[[ TO CODING WITH ALL COUNTY OEDINANC86 AND !TATE LAMB REGULATING PLUYBIp6 HOT WATER HEA 1 HEREBY CERTIFY THAT 1 AN IROPERLY REGISTERED AND/OR PLUMBING FIX ES '3 LICRUSED AS REQUIRED BY LOS ANGELES COUNTY AND RAT[ OF GAS.BST 1 CALIFORNIA OR THAT GAL OW�*FE ADMDESCRIBED RESIDENTIAL P UTILITY CO N TEPEES SIGNATURE OF PERMirmw 1j FINAL O m� VALIDATION ROBERT A WOOD, CE B 0 =UI SUPERVISING MECHANICAL ENG R J)Eab 6 3 7 ' J1?J 3 5 D 600 WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A mSUre or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy th eof (Sec 380D Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company CeRCOMPENSA s her by furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BDADDRI� /L 7 L�WEy 5 r spn filed t building inspec- �O honI NUMBER FIXTURE OR ITEM ® FEE /� �,,/ LOCAun DateA WATER CLOSETNEARES - L,�A OF t0 RKERS' BATH TUB CROSS ST OLEO—/A I URANCE OWNER (This section reed not be completed If the work Involved by MAIL SHOWER the permit is for one hundred dollop($100)or less ) LAVATORY ADDRESS L _ T, _ I certify that in the performance of the work for which this - permit is issued, I shall not employ any person to any manner SINK CITY TEL NO so as to become subject to the Workers Compensation Lave DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR TEL�/�Q^ Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY ��� 7Y19 with comply with such provisions or this permit shall be STATE —yT q/t LIC deemed revoked WATER HEATER LICF6E NO ;v 0 .7 LICENSED CONTRACTORS DECLARATION DISTRICT By I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER V UV y and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL V (DATION DATE — r O License Number be Class W FINAL 1:19BY Q Date ate sss0LLL ❑ I am exempt under Sec M B 8P C for this reason Plan check fee = Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE V6 .5y Plan check applicant SINGLE FAMILY �' �s ;231 9.2 A HOME OWNER-BUILDER DECLARATION Nome- PAS7�JL� L.vr7� M I hereby affirm that I am exempt from the Contractor s License ��q� # • • • • • 5 Law for the following reason (Section 7031 5 Business and Addreu3 Z �_ eo //• l" Professtons Code) City Tel No—;95& ( e • 1 6 5 Q ❑ I m owner of the property, will do the work and the , structure is not intended or offered far sole (Section 7041, Business and Professions Code) • e v 1 6505 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work fa which this permit is issued 1 Q 16-85 (Sec 3D97 Civ C ) Lender s Name Lender s Address 1 certify that I have read this application and state that the , above information is correct I agree to comply with all County 4o,rdmis and Statelawsregulreprenbhves of thisironed propertyforinspection purSEE REVERSE FOR EXPLANATORY LANGUAGE rm. to