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Home My Public Portal About6421 TRELAWNEY AVE_Plumbing__ Duo " Mm � 10� } APPLICATION FOR PERMIT DEPARTMENT OFF LOS " AND SAFSIR PLUMBING COUNTY OF LOS OMINUMM WM.J PDX,CHIEF ENGINme ROUGH PORURlB COMPLETE ^I �z �S`/ HEATER CESSPOOL DTIC TANK READY FOR DAT[IBSUKD PiRST INSPECTION d 8 �y� IBC 7 0 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB NAMK ADDRESS B ADDR E- LOCALITY NZARZOT 04, CITY TEL CROBSBP �J.� C No EtPI �' NAM[ // LOCATION OF SEPTIC TANS, OR CESSPOOL AMAIL DDRESS NORTH O CITY TKL No I AM THE LEGAL POSSESSOR OF THE ABOVE LOB ANGELES COUNTY CERTIFICATE OF QUALIPI TION I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE �'MN01 CORRECTIONS SOUTH DESCRIPTION OF WORK z 0 ATH TUB FURNACE � MOWER ^ISNWABHKR -LAVATORY vE>R10[RATOR ITCNKN BINK WATER SOFTENER R SINK SAND TRAP BINK F ^^R DRAIN WASH TRAY URINAL APPROVALS WAT®i CLOSET DRINKING FOUNTAIN DATE IMYRGTOR MAUX WATER NEATEN ^ENTAL LAVATORY ROUGH PLUMBING RK IIAY A^^APOUNTAIN GAS PIPING OUTL GAB VENT C'l> CKBBPooL 3 f TOTAL NUMBER OP FIXTURED EPTIC TANK Cmospoou BEPrICTANK HEWER F UTILITY CO NOTIFIED TOTAL FEE FINAL 76AE6/-CES17 12159 APPLICATION FOR PLUMBING PERMIT DIBW OF OIINTYG F .1 I-/.NI o1 GEM OUNTYgfialNEBR WILLIAM A JENSEN, SUP T OF BUILDING 11ADDRES21 OGY FOR APPLICANT TO PIIS IN EARE TCROSSr NUMBER FIXTURE OR ITEM WIEm WATER CLOSET ILM RATE TIID CIT! 7II. NO aHOWEa LAVATORY CONTRACTOR GP mm ADDRESS D®RWA>� C[f7 ` NO O Ra A LAUNDRY TOR REGISTRATION NO COUNTY CLOTBES WA8ffi �, B G P �00 PR 1 BY WATER NRA'IEB DISTRICT GAR 6lBTEM DTDUSTRLU WASTE APPROVAL DIBPECTION RECORD s�Y / N D r z „(/ FD '°a APPROVALS DATE INSPECTOR 3 SIGNATURE PERMIT S 2 00 UNDER SLAB WORK 646 TOTAL FEE O ROUGH PLUMBING 1 r EAS PIPING I HEREBY ACKNOWLEDGE THAT 1 NAY[ READ THIS APPLICATION GAB�� MD STATE THAT THE ABOVE IB CORRECT MD AGUE[ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAYS BE PLUMBING HOT WATER HEATER 1 XERES7 CERTIFY THAT I AN PBO [ELT REGISTG[D AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANO COUNTY AND RAT[ TY9SY CALIFORNIA OR THAT 1 AY [ GAL OWNER OF THE 1, Rtar(27 14D DESCRIBED RESIDENTIAL 1p UTILITY CO NOTIFIED SIGNATURE OF PERM' PINAL mP VALIDATION ROBERT A WOOD, u ■ G CASE SUPERVISING MECHANICAL ENG R (G33042 J& 8 5 D 800 (iV /yu, • WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm thpi I have a certificate of consent to self 7&4667A J� insure, or a ce tate of Workers Camperuotlon Insurance CE 817(REV 10/81) or a cero opy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli o Company Certified copy is he r shed ❑ Certd y is fit ith cou budding inspec- FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDIallILNG 42I /�/ /1/r]/ 4FY !T AWRE55 YL. /tLC GI^�W/V .J r ton t NUMBER FIKIURE OR REM ® FEE �� G 7/ LOCI Ll Date A WATER CLOSET NEAREST �s CERTIFICATE OF FX L ORKERS BATH TUB CROSS T &-/L/A COMPENSATION I URANCE OWNER (This section need not be completed R the work Involved by SHOWER MAIL the Parrett is for one hundred dollen (1180)or loss ) LAVATORY ADDRESS T` I certify that in the performance of the work for which this - permit is issued I shall not employ any person In any manner SINK CITY TEL NO so as to become subject to the Workers Compensation Lows D5H1N"SHER CONTR'"CTOR S40QON—MASANO(/lGP/,I Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS4 f-.r4T(Q �• Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM CITYA�so4ArAl TEL f"''c!A// 7�p with comply with such provisions or this permit shall be STATELIC �/7 deemed revoked WATER HEATER LICENSE NO 'V 015- CLASS LICENSED CONTRACTORS DECLARATION DI RICT NO 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 y and Professions Code,and my license is In full force and effect 5 PER SYSTEM FINAL VALIDATION G DATE i V License Number LIc Class OU FI �31 7.0 A m Contractor Date a a a a a Jc r ❑ I am exempt under Sec ) a - 1650 B 8P C for this reason Plan check fee Z Dore PLUMBING PERMIT ISSUING FEE E Q • it • 1 &505 Signature TOTAL FEE Y6 la ( Q 1 6-85 SINGLE FAMILY Plan check applicant �� • HOME OWNER-BUILDER DECLARATION IARATION Name `W^Yo9_;257 1 hereby off rm that I am exempt from the Contractor's Licensep Law for the following reason (Section 7031 5, Business and Addr, G E- Professions Code) Cnyp4s,4��/�Q Tel No 7? 14�69 ❑ 1, as owner of the property will do the work and the 00structure is not Intended or offered for sole (Section 704, 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 ) Lender's Name Lendar s Address I certify that I have read this application and state that the ► &nrd CarteCt I agree ro comply wnh all County e laws regulatinativesofthis CopertyforinspeSEE REVERSE FOR EXPLANATORY LANGUAGE . Da e OORKER S COMPENSATION R TION 2DOM DPW 9/9e APPLICATION FOR PLUMBING PERMIT I h6pbyArm that I have a certificate of consent to self Insure 75AM7A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) Policy No any COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV ❑ Certified copy m hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) eUILpNG E] Carolledcopy le filed with the county building Inspection ADDRESS dePatunant NUMBER FIXTURE OR ITEM 6 FEE LOCALITY ep Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTK)N FROM WORKERS9ATH TU8 CROSS ST COMPENSATION INSURANCE ASSESSOR (This section ft not be complated N the work Inrolred by the SHOWER MAP BOOK PAGE I PARCEL permit Is for am hundred dollars($100)or leen) LAVATORY ER (/L(/ I certify that in the performance of the work for which this permit le issued I shell not employ any person In any manner so as to SINK ADORE99 /{� become subject to the Workers Compensation Laws DISWASHER TEL NO Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If alter making this Certificate of Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR proelons of the Labor Code you must forthwith comply with such AGGRESS w provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter B WATER HEATER ll (commencing with Section 7000) of Drvlelon 3 of the Business and STATE LID 8 Professions Code and my license le m affectlull force end affect OAS SYSTEM OUTLETS LICENSE NO CLASS V OUTLETS OVER DISTRICT NOp m BY cc a PER SYSTEM �O Q License Number LIc Class �FI Contractor Data DATE l-S- 93 VALIDATION ❑ I am exempt under Sec FINAL / BV B 8P C Icr this reason Date Plan check fee Suture PLUMBING PERMIT ISSUING FEES ❑ TOTAL FEE -' SINGLE FAMILYPlan check applicant R'X 1 ._ HOME OWNER BUILDER DECLARATION Name 3,C7 I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 S Business and Professions Address Code) � I an owner of the City Tel No I III PL 39 - 30 ❑ property,will do the work entl the structure v'-ll r1I Is rot intended or offered for sale (Section 7044 Business TIE.ft jz 7' 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 3007 Civ C) 71 71R_ Lender s Name 4 iL,4 " 14.11 Lender a Address I carLfy that have read this application and state that the above , Information Is correct I agree to comply with all County ordinances and Slate laws regulating Plumbing and hereby authorize r aentatwes of this County to enter upon the above mentioned e Y for inepecbon p ee SEE REVERSE FOR EXPLANATORY LANGUAGE 7- 31-92- neb a of PerrnlRee 7 Date k WORKER S COMPENSATION D 6 LAIRATION 2040211 DA 9/91) APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a cerhhcate of Worker a Compensation Insurance or a cerbfled copy thereof(Sec 3800 Lab C) 1 COUNTY OF LOS ANGELES 'DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Policy No company ❑ Certifled copy rs hereby Nirmshad BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Elcerkued Dopy b Ned with dm county building Inspection FOR ��/ �F�Ll4t✓N�7 department NUMBER FIXTURE OR ITEM 0 FEE LOCALITY 7 1Y1P�E Date Appkcant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERSCROSS ST BATH TUB COMPENSATION corn ION INSURANCE MAPS BOOK PAGE PARCEL. _ (This section need not M completed N the cork Involved M Me SHOWER permit Is for one hundred dollar($100)or Mea) LAVATORYOWNER d y�i� ULV I certify that In the performance of the work for which this permit �,�� "� A , is issued 1 shall not employ any person In any manner so as to SINK ESS /j /�T�v7w N/� A/ become subject to the Workers Compensation Lam WSWASHER n. TEL NO ({�7-V Date Applicant CLOTHES WASHER CONTRACTOR �-I NOTICE TO APPLICANT If after making this Certificate of OLd� Eamptlon you should become subject to the Worker Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such AGGRESS provisions or this permit shall be deemed revoked LANK!SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER CRY TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 IL STATE LIC 8 (commencing with Section 7000)of Division 3 of the Business and Professions Code and my license Is In full force and effect OAS SYSTEM OUTLETS LICENSE NO CLASS OUTLETS OVER DISTRICT NO PROCESSED BY I= a PER SYSTEM ;r.91, a/ fL License Number Lb Claes O FINAL VALIDATION DATE —S-g? Contra" Date // y ❑ I aexempt under Sac BY Z m B$P C for this reeeon Dau Plan check fee ► Signature PLUMBING PERMIT tSSUING FEE$ ❑ TOTAL FEE o. r Plan Check applicant l s 5 SINGLE HOME OWNERRBUILDER DECORATION me ACCT.: RATN Na I hereby affirm that I am exempt from the Contractor a License Law for the following reason(Section 7031 5 Business and Professions Address _.7V Code) ❑ Ciry Tel No 1 ITET15 I u owner of the property will do the work and the structurerft is not Intended or offered for eels(Section 7044 Business TOTAL AL 39. and Professions Code) , OECK 39.3DCONSTRUCTION LENDING AGENCY 4yf tYASNy�sM s� I hereby affirm that there is a construction lending agency for the 4T491�L performance of the work for which this permit Is issued (Sec 3097, Civ C) 0000-M1 8/28/9.: Larder a Name 5249 1 Ali 8:01 Larder a Address I unity,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 reMisentatives of this County to enter upon the above mentioned pr y for inspecdon pu sane SEE REVERSE FOR EXPLANATORY LANGUAGE SI at a of Permittee Date