HomeMy Public PortalAbout6342 TRELAWNEY AVE_Plumbing__ 7BA667 CU17 12/59 j`�
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APPLICATI FOR UMBING PERMIT
_ClOIINTY OF LOS / /j
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FOR APFUCANT TO FUL IN �TNUMBER FIXTURE OR ITEMWI
WA71'�CLONES TAM
SAM SADDRESS
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CRY TRI. NO
SHOWER
LAVATORT CONTRACTOR ✓
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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
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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