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Home My Public Portal About6418 TRELAWNEY AVE_Plumbing__ ,� .T GUM 8� T-, 1 APPLICATION FOR PRISM 1 DEPARTMENT OF BUILDING AND 8AFET ' COUNTY OF LOS ANGELES I PLUMING WM J. FOX.CMIRF mHGINEER " NATURE OF INSTALLATION 018TRICT NO GROUPI r ROUGH FIXTURES COMPLKTK I HKATKR CKSS1000/. SKP'fIC TANK READY FOR R FIRST DY FOTION APPLICANT FELL IN HEAVILY OUTLINED PORTION ONLY Q NAME tt ADDRKp76 4 / C ADDRESS ..1 LOCALITY m1KARXST L CITY TEL No Z�� CKOSS STET of kw fsw COUNTY LI [NEE NO KKPIREDZ6 NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Y MAIL a ADDRESS NORTH O CITY TEL JADO)V�X 1 AM THE LEGAL POSSESSOR OF TANG4KS COYNT7 CmIT1 U1 AM THU LEGAL OWNER OF THE PR ABOVE. CORRECTIONS SOUTH J DESCRIPTION OF WORK i TH TUB FURNACE rc HOW= ^URHWASNO! O VATORY REFRIGERATOR HEN GIMK WATER SOFTmHUR FLOOR SINK TRAP OINK ^^gt DRAIN WASH TRAY 'URINAL APPROVALS WATmt CLOSET DRINKING POUIITAUI DATE INP►EClOK•S lura WATmt NEATER DWffAL LAVATORY ROUGH PLUMBING ETKR-----.GAG FOUNTAIN SN PIPING OUTL IT "3 GAS VENT CEM►001. ��TOT—AL NUMUM OF FIXTURES .7 V SEPTIC TANK comp0ou OKPTIC TANK OD SEWER UTILITY CO NOTIFIED TOTAL P66 V 7M6 17 90N 9R9 >-, APPLICATION FOR PRELIM K DEPABTNT OF BUILDING AND SAFETY CO �� '�� ' COUNTY OF LOS NG WM J. PDX.CNIKI NGINZIOI EKI i ROUGH IDITURO COMPLETE ' x•AT•R CESSPOOL BKRK:TANK CKIV DY ►RIBT IREADY MRION MTC ISSUED r LIC FILL IN HEAVILY OUTLINED' RTION ONLY JOB y. NAM L ADORE= tvx S ADDRESS LOCALITY Ole NKARK•T CITY p CROSS ST COUNTY -2LICENSE NO D -Af IR �• NAME LOCATION OF-SEPTI- TANH, CE8.9POOL MAIL ADDRESS NORTH O CITY Tla NO I AM TNR LEGAL • eSS or LOS ANGELn COUNTY 1 ICT P R I AM THE LEGAL OWNER OP THE PROP DBSCRWED ABOVL OWMO CORRECTIONS SOUTH �J DESCRIPTION OF j ��E / ATN TUB v q�RNACE G C xowKl ^I•xwA•xsR O vATORY R17RIOKIIATOR ITCHEN SINK WATKR SOPTENCR R SINK SAND TRAP SINK w XM DRAIN WASH TIIAY URINAL APPROVALS WATKi CLOSET ^RINKING FOUNTAIN DATE I 't Nw•t WATER H/�CATM - ^RITALLAVA"" ROUGH PLUMBING 2R KTKR_L_GAS A^M FOUNTAIN a"PIPING OIJrm GAB VEIfT YCESSPOOL TOTAL NUMBER OF PUTTUR•S SEPTIC TANK COSPOOL�KP71C TANK SKW KR Q • UTILITY Co NOTIFIEDTOTAL FEC FINAL 78E 817 B/SS �C APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER J BUn DING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPT OF BUILDING 7=1%' t FOR APPLICANT TO FILL IN PR NT OR TYPE NUMBER FIXTURE OR ITEM EACH FEEWATER CLOSET 1 50BATH TUB 1 50 EN SHOWER 1 50 CRT !L. p0 LAVATORY l 50 C CTO SINK 1 50 ADDRESS DISHWASHER 1 50 CITY TEL NO CLOTHES WASHER 1 50 STATE LIC LICENSE NO CUSS SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GRO a BRED SIT LAWN SPRfNKLER SYSTEM 2 00 m�p WATER HEATER 1 50 WDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1 50 pSPECTION RECORD V OUTLETS OVER 30 5 PER SYSTEM Z lid Plan check fee 25 of aboNe See revLrse PLUMBING PERMIT ISSUING F U 3 00 TO IAL FF F APPROVALS DATE INv[cTall nelONwTUFE Plan check apphrant UNDER SLAB WORK Name . ROUGH PLUMBING Address GAS PIPING GAS VENT Gll) lel NO HOT WATER HEATER I HERGGT ACNMOWL[DO[ THAT 1 HAY[ IQAD THIS APPLICATION R AHO AT[ THAT TH[ AAOU CORIIECT AND AOIQ[ TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY OHDINANC[E AND RAT[ LAWS H[OULATINO GAS TEST PLU M\INO I H[RUDY CE"IFY THAT I AM PROPERLY 11[O] [R[O ANo/on UTILITY CO NOTIFIED LICENHD AS R[OUIR[D DY LOG ANO[lLR COUNTY AMO ST OF CALIFORNIA OR THAT 1 AM TH[1C.OAL. OW R O AND 1 D TO RGGIO[ IN TH[AINWR DEGCR 11 L PP[ FINAL I S SIGNATURE ` JACK R. ALLEN, SUPERID K VISING CM o CASH ENG'R OF PERMITTEE PLAN CHECK VALIDATION CK M o cwGH PERNUT VALUDZ 18 8 29 AW11 5 0 825~ ' TEAACT bee lT to ee APPLICATION FOR PLUMBING PERMIT 1 DIVISION OF BUMI)ING AND SAFETY Depozhnent of CoantT Engineer Como of Loa An leo ADOi�,t`- c JOHN A LAMBIE COUNTY ENGINEER RE d CASSATT D GRIFFIN.SUF T OF BUILDING LOCALITY Ar mp LI FOR APPLICANT TO FILL IN NEAREST /t?� ROSS 8T OWNER DISTRICT_Lf. _ GROUP ZONE EKADY POA INAPEDYIDN MAIL �^ V p- DREGS �N INDUSTRIAL r CITY 1 TEL N O WABTH APPROVAL PLUMBER ♦ INSPECTION RECORD ADDRESS 1 CITY 1 TEL NO4X2 7 LICENSE NO 3S NUMBER TYPR OF PIRTURC OR ITEM FEE WATER CLOSET (TOILET) 4100 S BATH TUB $I DO SHOWER @ $100 LAVATORY (WASH BASIN) Q $100 KITCHEN BINK @ $100 DISHWASHER a 3100 LAUNDRY TUB OR TRAY 0 $100 CLOTHESWASHER ® e100 WATER HEATER @ fl 00 OAS SYSTEM ft00 APPROVALS DATE INSPECTOR S SIGNATURE r NDER SLAB WORK PERMIT g ROUGH PLUMBING GA8 PIPINGTOTAL FEEGAB VENTiHEREBY ACKNOWLEDGE THAT I HAVE READ THIS HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREEWITH ALL COUNTY ORDINANCES AND STATE LAWS PLUMBING PLUMBING FI%TURES I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTER LASTESTLICENSED AS REOUIRED BY LOS ANGELES COUNTY ANFCALIFORNIA OR THAT i AM THE LEGAL OWNER OF E UTILITYCO NOTIFIED DESCRIBED RESIDENT PROPERTY SIGNATURE OF PERMITTEE FINAL JOHN A LAMBIE, NTY ENGINEER VALIDATIO ROBERT A WOOD, CHIEF PLBG INSPECTOR cE ■ e uAx L&2 7N MV13 3 2.00 D >OAOe> APPLICATION FOR PLUMBING PERMIT 1 CEO a BIIII.DING AND SAFETY DrvmoN Department of County Engme" County of Los Angel" BUILDING JOHN A LAMBIE,COUNTY ENGINEER ADDRESS la!/I Lej&941Y CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEARBHT C52 ST OWNER DISTRICT NO GROUP I ZONE I READY FOR INSPECTION MAIL ADDRESS INDUSTRIAL CITY TEL NO WASTEAPPROVAL PLUMBER DON'S P UMBING SERV E UISPEMON RECORD ADDRESS 840 So. Baldwin Avenue CITY Arcadia, CalifNrE17 Nyi 7-0882 LICENSE NO 30- NUNetN TYPE OP PIXTUNe ON TTNM PNN WATER CLOSET (TOILET) @ v 00 S BATH TUB @ $it DO SHOWER ® 0100 LAVATORY (WASH BASIN) @ $100 KITCHEN SINK 0 vt00 DISHWASHER $100 LAUNDRY TUB OR TRAY @ {100 CLOTHES WASHER @ •1 00 WATER HEATER 1 00 GA: SY EM ® $100 APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT 00 ROUGH PLUMBING /0 OAS PIPING TOTAL FEE GAB VENT LSTATE BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOTW TER HEATER L COUNTY ORDINANCES AND STATE LAWS REGULATINGG PLUMBING FIXTURES EBY CERTIFY THAT I AM PROPmILY REGISTERED AND/OR GAS TEST D AS REOUIRBD BY LOS ANGELES COUNTY AND STATE OFNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITYCO NOTIFIED ED RESIDENTIAL PROPERTY URERM ITTEE FINAL44 ROBERTA WOOO. JOHN A LAMBIE Co TY ENGINEER VALIDATIOINSUPERVISING MECHANICAL ENO R a 1110 /0 LALO 6 2 3 ON OCT 30 5 A 3.0 0 l I/ .-76A a Ej-"C E-8171-4/72 \ APPLICATIOPsJ'FOI�UMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION AIA AE CHECKS PAYABLE TO BUILDING ADDRESS HARVEY T BRANDT, COUNTY ENGINEER LOCgLI FOR APPLICANT TO FILL IN (PRINT OR TYPEI NEAREST CROSS ST NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET 1 75 OWNER MAIL BATHTUB 1 75 ADDRESS SHOWER 1 75 CITYTEL NO.� �� LAVATORY 1 75 CONTRACTOR - \ SINK 1 75 ADDRESS �t DISHWASHER 1 75 CITY TEL NO CLOTHES WASHER 1 75 STATE LIC SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS LAWN SPRINKLER SYSTEM 1 75 DISTRICT NO GROUP V.Qp FRO ESSE By r WATER HEATER 1 75 INDUSTR AL WASTE APPROVAL GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD U OUTLETS OVER 5 PER SYSTEM 30 CD W Y Plan Check fee Se. Reverse PLUMBING PERMIT ISSUING FEE S 3 00 TOTAL FEE APPROVALS DATE INSPECTOR a elrNArD Rc Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THATHATTHE ABOVE IS CORRECT AORCOMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATETE LAW!S REGULATING PLUM BIND GA$TEST Q-74 I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO NOTIFIED LICENDEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO REB:DE IN THE ABOVE DES ED SIDENTIAL PR ER TY FINAL _ SIGNATURE OF PERMITTE PERMIT VALIDATION cK D CASH PLAN CHECK VALIDATION CK M D CASH 2 1 3�NOV 8 5 U 43 5 Ab� r 7EI14471; ICK-EnAI ••/)E APPLICATION FOR PLUMBING PERMIT 13UIL13IN AND SAFETY DIVI O`N, y FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDING yl N t NUMBER FIXTURE OR ITEM ® FEE ADDRESS s LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST SHOWER OWNERAIL 2�I_ LAVATORY ADDRESS 69 l SINK CITY j.6T 1-/t-119L NO YY-7 S"ff DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY EL N STATE LIC WATER HEATER LICENSE NO LJ� CLASS GAS SYSTEM OUTLETS DISTRICT NO UP N PR ESSE BV OUTLETS OVER E CD DC 5 PER SYSTEM IN TRIAL WASTE APPROVAL y,1 d INSPECTION RECORD = Plan check Fee PLUMBING PERMIT ISSUING FEE 9 TOTAL FEE iz Plan chec applicant Name APPROVALS DATE IH1P¢TDR B B1.N ATGRI UNDER SLAB WORK Address ROUGH PLUMBING City Tel NO GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ "IS APPLICATION GAS VENT AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY WITH ALL CWNTY ORDI NANCIES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING / I HEREBY CERTIIY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENBEO AS REQUIRED BY LOS ANGELES COUNTY AND STAT! 01 GAS TEST CALIIORNIA OR THAT I AM THE LED L OWNER 01 AND INTINO TO RESIDE IN THE ABOVE 1ESCRISCD RCS 1NTSIGNATU )1A1AALL PPTRROPE�RTY UTI ITY CO NOTIFIED OF PERMITTEE VN•� FINAL PLAN CHECK VALIDATION CK M G CASH PERMIT VALIDATION cK M G CASH Y L R Cc X—d-- -2,9, 7 908 t is o O �� 7"7A : , CE a 17 IMV e/7111 mix .A APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY Al FOR APPLICANT TO FI LL I N I PRI NT OR TYPE BUILDING //I �� ADDRESS L T NUMBER FIXTURE OR ITEM B FEE WATER CLOSET LOCALITY NEAREST BATHTUB - CROSSST IV SHOWER OWNER ''' Aov LAVATORY MAIL ADDRESS W SINK CITr� e TEL NO DISHWASHER CONTRACTOR G IE44.0 CLOTHES WASHER ADDRESS/ / R SWIMMING POOL RECEPTOR CITY A6 h TEL N jVya LAWN SPRINKLER SYSTEM STATE ��/{ f S ' L�Css WATER HEATER LICENSE NO I 7 Q GAS SYSTEM OUTLETS 0'Q APPROVALS DATE INSPECTOR 5 SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING O GAS VENT V IN HOT WATER HEATER FO PLUMBING FIXTURES [J GAS TEST Plan check fee UTILITYCO NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Name d- l�G�cWtl4 VE READ NUS APPI�AMN AND STATE Add"' s' e �,L City L j4- Tel N.7/i -� ,P THATTHEEABOVREBYE IS CORREBY RECT AND AGRSTATE EE TO WRIT ALLCOUNTY ORDINANCES 23024A AND STATE LAWS REGULATING PLVYeINO PERMIT VALIDATION y -US I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS M ' • • 5 MAN. AN' REQUIRED BY LOS ANGELES COUNTY AND coSTAT4 OF LALIPORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE"SCRIBED RESIDENTIAL 2 , 019.00 PROPER Y SIGNATURE • y• • 19.000 OF PERMITTEE 0 u O 2_7 DISTRICT NO ED BY y To Q g IN OU 'TR WASTE APPROVAL WORKERS Ihave COMPENSATION catsDECLARATION once APPLICATION FOR PLUMBING PERMIT �) I hereby affirm that I have a certificate of consent to self 7y'1667A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑ohcy No Company Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDING 66�18 ^ Certified copy is filed with t county building i ADDRESS Q u/rteIl no t NUMBER FIXTURE OR fTHA E ® FELOCALITY t Date--� Applta WATER CLOSET Te G'! NEAREST �e CERTIFICATE OF EXEM F M WORKERS' BATH TUB Q2055 ST COMPENSATION INSURANCE OWNER moe- (This section need not be completed R the work Involved by SHOWER the Peri Is for one hundred dollop($100)or less) LAVATORY ADDRESS !Vle eJ I certify that in the performance of the work for which this L permit is Issued, I shall not employ any person in any manner SINK 'I AN _ CITY TEL NO so as to become subject to the Workers Compemonon Lo DISHWASHER CONTRACTOR Dats�Ifcont - CLOTHES WASHER ADDRESS NOTI TOA I NT If, of making thin Certdicote of Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the labor Code you must forth- CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE UC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r- (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professiorts Code,and my license is in full force and effect 5 PER SYSTEM FINALtL DATE VAUDATION v License Number L¢ Classpc FINAL OF Contractor Date By V ❑ W I am exempt under Sec N B 8P C for this reason = Plan check fee Dote PLUMBING PERMIT ISSUING FEE S Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address " Cl U 5 9 Q Low for the following reason (Section 7031 5 Business and rons Code) City Tel No L1e s ytL �� , as owner of the property will do the work and the structure is not intended or offered for sale (SectionPoo Z O x 4, 70Business and Professions Code) - r CONSTRUCTION LENDING AGENCY o927-8a 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 Nome Larder's Address I certify that I hove read this application and state that the 10.above information Is correct I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the a e-mentioned property for ion purpose � � p na SEE REVERSE FOR EXPLANATORY LANGUAGE as am gsire of Permittee Date C Ii WORKER I have DECLARATION ,#W7A APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to call Insure or a conificate of Worker a Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) \ Policy No ° 33 („FWO �ac�faN+ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV ❑� Cemhed copy is hereby tum®had FOR APPLICANT TO RWO LL IN(PRINT OR TYPE) BUILD ❑ Certified copy is sled with the couInty building irbpeq,ori ADDRESS department 'Ir ^ LOCALITY I>— O NUMBER FIXTURE OR REM O FEE Date �� 2 Applkem�`—. 'C WATER CLOSET NEAREST CERTIFICATE OF EJ(EMPTON FR M WORT RB k BATH TUB CROSS ST COMPENSATION INSURANCE ASSESSOR (� (This Section need not be eomPlated If the work Involved by the SHOWER MAP BOOK qZ- PAGE 2-1 PARCEL Z1 permit u for one hundred dollars(8100)or lees) LAVATORY OWNER ck�+rl — r o I certify that In the performance of the work for which this permit _ is issued I Shell not employ any person in any manner so as to SINK become Subject to the Workers Compensation Laws ADORE88 Trc(a.u� DItN/ASHFA CITY ^ C-T TEL NO O f 33 Date ApplicantCLOTHES WASHER CONTRACTOR 1 Ii f •F � '� A NOTICE TO APPLICANT If after r Makingthis Certificate of l� Exemption you should became Subject to the Workers Compensation SWIMMING POOL RECEPTOR previsions of the Labor Code you must forthwith comply with Such ADDRESS provisions or this permit shell be deemed revoked LAWN SPRINKLER SYSTEM / LICENSED CONTRACTORS DECLARATION WATER HEATER CITY � "n TEL NO 0 3 a I hereby affirm that I am licensed under provisions of Chapter 8 STATE rl..J 8 (commencing with Section 7000) of Division 3 of the Business and �, Prot0nions Code and my license is In full force and effect GAS SYSTEM OUTLETS LICENSE NO f Cuss OUTLETS OVER DISTRICT NO PROCESSED BV /1- �p IS ,n} 5 PER SYSTEM VS License Number �/" Lie Class r D� I� f FNADA VALIDATION W Cardrector Dt't' t^"'A.,�"60ie /—/—S 2 — y ❑ I am exannipt under Sac FINAL ' Z p BY B AP C for this reason / V AC CT.i Data Z Plan check fee Poo. S nature PLUMBING PERMIT ISSUING FEE$ 5 i tTC�C 8 + ❑ TOTAL FEE ,� Q TOTAL hL 12th - 60 SINGLE FAMILY Plan check applicant = 4tiE(„ n< HOME OWNERAUILDER DECLARATION Name :NANGE .0 1 1 hereby affirm that 1 em exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and Profeaslon. Address Code) Cry Tel No r-1 1 as owner of the property will do the work and the slruclure is not Intended or offered for sale (Section 7011 Business 4-7 and Professions Code) , CONSTRUCTION LENDING AGENCY I hereby affirm that there to a construction lending agency for the performance o1 the work for which this permit Is Issued (Sec 3087 Civ C) Lantlera Name Lender's Address I certify that 1 have read this application and state that the above P111'.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 Stgnature of Perfnittee Date WORKERS COMPENSATION cafeDECLARATION corse APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate o4 convent to self 76,4o67A mauve or erhficate of Worken'Compensation Insurance, CE 917(REV 10/81) oro certrf copy thereof (Sec 3800 Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY • P❑olicy o Company Candied copy a hereby Turn lied FOR APPLICANT TO FILL IN(PRINT OR TYPE) AADIDLREu l Cern ied PY is filed wi t n budding Inspec /v h me NUMBER FIXTURE OR ITEM ® FEE LOCAL Dale AppliS WATER CLOSET NEAREST , �' A CERTIFICATE OF EXEM RO ERS' BATH TUB CRO55 ST OCA'/� COMPENSATION RANCE SHOWER OWNER (This sacNon need not be completed R the work Involved hit the Parrett Is for one hundred dollars(5100)or leu) LAVATORY ADDRESS !„+MAIL •\ I certify that in the performance of the work for which this - permit Is issued I shall not employ any person in any manner I SINK CITY TEL NO so as to become subject to the Workers Compensation Lows DISHWASHER Vt 4;5'_4 6 W CONTRACT C(M/•..r�/f/�WJi/7`/WTCT"r Date Applicant CLOTHESWASHER gDDRE /ys,sF NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers QrZ0 �� ,o4d7 ZVS Compensation provisions of the Labor Code you must forth- Cm/-j/�C�F�� TEL No 4d7/,�O LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE 7,15- UC deemed revoked WATER HEATER LICENSE NOS CLASS LICENSED CONTRACTORS DECLARATION DISTRICTD BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GA5 SYSTEM OUTLETS L_ is (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �j and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL _ _ VALIDATION d VLicense Number Lic Clcu DATE Q FIN Contractor Date BY O ❑ I am exempt under Sec 1 B 8P C for this reason us Plan check fee = Signature Dole PLUMBING PERMIT ISSUING FEE Elop # a s a e s 5 @.3 1 a 5 5 TOTAL FEE & 15y- Plan check applicant la a 1 &50 SINGLE FAMILY /"l+74F2 do HOME OWNER-BUILDER DECLARATION Name -90Sq�Q W I hereby affirm that I am exempt from the Contractor's License �1 a e a 1 6503 Law for the following reason (Section 7031 5 Business and Addr^'�7ZS C'/'7!/�z✓/f+ w Professions Code) Gry ,9 Tel No ) al 6-85 ❑ 1 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) 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 ) Lander s Name Lender s Address I certify that I have read this application and state that the Oil, information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby thorize representatives of this County to enter upon the coned property for inspection pis es _,F� SEE REVERSE FOR EXPLANATORY LANGUAGE ttee oro