The URL can be used to link to this page

Home My Public Portal About6445 TRELAWNEY AVE_Plumbing__ ORKEth COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hdeb affmm that 1 have a certificate of consent to self 76A667A insure or a certificate of Workers'Compensation Insurance, CE 817(REV 10/81) or o nified copy thereof (Sec 38DO Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Po cy No Company Certified copy n he ho Certifi d c y is f ah t t mldtng mapec- FOR APPLICANT TO FILL IN(PRIrR OR TYPE) BUILDMG L may, ADDRESS A N/N� non NUMBER FIXTURE OR ITEM ® FEE LOCALITY GE C/ Dote t5 WATER CLOSET NEAREST ^ CER IFICATE OF PTIO F KERS BATH TUB CROSS ST �/ COMPENSATI SURANCE OWNER (This soction need not be canpleted H the work Involved by SHOWER MAIL 1 the pormH Is for ono hundred deilon($100)or loss) LAVATORY ADDRESS ' s I cenify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Worker 'Compensation Laws '/ ��/��40 DISHWASHER CONTRACT M_ /�/a/'r/r/N.T C.N Date Applicant CLOTHES WASHER LI'& 7W NOTICE TO APPLICANT If after making this Certificate of ADDRESS EOC/� at' /ter J-77 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR ��,�ss��LL ��ss ,,,,147 Compensation provisions of the Labor Code you must forth- CITYA LC1AW4 "'Y'• r 75t/8 with comply with such prowvons or this permit shall be LAWN SPRINKLER SYSTEM STATELIC deemed revoked WATER HEATER LICENSE 00/ CLASS A LICENSED CONTRACTORS DECLARATION DISTRICT BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /C` (commencing with Section 70DO)of Division 3 of the &niness OUTLETS OVER V and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL V IDATION n' DATE 0 License Number L¢ Class FINAL K Contractor Date BY O ❑ I am exempt under Sec W d B 8P C for this reason N Date Plan check fee �31 7 1 ({ z PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE # s s s s s 5 SINGLE FAMILY Pion check applicant I is s 1 6 5 0 HOME OWNER BUILDER DECLARATION Name&- mac, O &4#Me eO • • . 1 6505 1 hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and Address 725 &�-Al`aul r4 v/A6W I Q1 6-85 Professions Code) I Ory AQ�t,(jq Tel No'A'.(361 ❑ 1 as owner of the properly, will do the work and the structure is not intended or offered for sale (Section 1007041, 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 Gv C ) Lender's Name Lender s Address 1 certify that 1 have read this application and state that the polo information is correct I agree to comply with all County 4ncd StarereseniahproSEE REVERSE FOR EXPLANATORY LANGUAGE erm�nee Dote `Y� WO * COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hersTBy, affirmm*that I have a certificate of consent to self in- 10-006 DPW 4/90 sure,or a certificate of Workers'Compensation Insurance,or a 76A6e7A certified copy thereof (Sec 3Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS yU� Policy No Company ny _ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDING ddepartmen PY n filed with the county building inspection NUMBER FIXTURE OR nEM O FEE LOCALITY department LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB SSS ST COMPENSATION INSURANCE SHOWER OWNER �✓✓� /�.e./LLA (This section need net be coarpleted If the work involved by MAIL the pe,rmN Is for one,hundred dollars($100)er less) LAVATORY MAIL I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK Cltt �'� TEL NO 7 b as to become subject /to the Workers'Compensation Laws DISHWASHER CONTRACTOR ^",A_-1e_,e_ Date.l��z��lT Appucant Z�.l Ie, 14*eZ/LL.4 CLOTHES WASHER 6•w ADDRESS NOTICE ,y APPLICANT If, after making the Workers Ca of Ex- SWIMMING POOL RECEPTOR Ex- emption,you should become subject to the Worken Compan- Cltt TEL NO sobon provisions of the Labor Code you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby offum that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS O D 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER C and Professions Code, and my license is in full force and of 5 PER SYSTEM FINAL VALIDATION fact HOSE BIB DATE Y� License Number Lic Class C FINAL r U Contractor Date BY ! Q I am exempt under Sec rV B 8P C for this reason Plan check fee , M, 31 qT•c; Date PLUMBING PERMIT ISSUING FEE f �.� a I ITEMIG Signature TOTAL FEE A TOTAL 4 1 _ g5 SINGLE FAMILY t HOME OWNER BUILDER DECLARATION Plan check applicant HECK- 4I.J! I hereby affirm that 1 am exempt from the Contractor s LicenseName CHAHU� Low for the following reason (Section 7031 5, Business and Z Professions Code) Address S L4 A/E. I, as owner of the property will do the work and the Cary Gy Tet No —gyp 1_�OQQ-11,101 0/?1/9Y structure is not intended or offered for sale(Section 7044, Business and Professions Code) ► 5755 1 AM 7'n 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 ) Lenders Nome .�1K'1�'�G niArCIC.L.4 t Lender s Address /633 .57'EvEtiS S. G I certify 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 representatives of this County to enter upon the above ent,;ed property f r inspection purposes J/ �_�_yx SEE REVERSE FOR EXPLANATORY LANGUAGE Signature 0 f Permittee Date WORKER$ COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT y affirm that I hove a certificate of consent to self 7yro07A ,mwre o,,cerhbcofe of Workers Compensation Insurance CE 8I7(REV 10/81) or a certified thereof (Sec 3800 Lab c} COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Compony Certified copy is hereby furnished ❑ FOR APRICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county budding mspec- ADDRESS hon department NUMBER FIXTURE OR ITEM ® FEE LOG4LITY Date iApplipant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST LEJ"/o N COMPENSATION INSURANCE SHOWER OWNER LOv/ 9K/4.tc-4 (This sectlon need not be completed IF the work Involved by the permit is for one hundred dollop (1100)or less) LAVATORY MAIL 's✓n/f- I candy that in the performance of the work for which this ADDRESS 6V SLS (E[-J4 permit is issued I shall not employ any person in any manner SINK Civ Ir `f_1 TEL NO so as to become subject to the Workers Compensation Laws - o DISHWASHER I CONTRACTOR Date Applic uCLOTHES WASHER gppRE55 NOTICE TO APPLICANT ter making this Certificate of G�iL�.GsE-�-.4 aC.✓tiE Exemption you should ecome subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM Cm < TEL NO 644/ with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRIg'T NOO SSED e 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 r and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL ^ VALID ON y License Number Lic Class DATECo. FINAL 8 Contractor Date BY MIA ❑ 0 I am exempt under Sec B 8P C for this reason tt) Plan check fee Pilo, n.' JI Dote PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors License Address Law for the following reason (Section 7031 5 Business and Professions Code) City Tel No❑ :2676,1 {�I, as owner of the property will do the work and the , structure is not intended or offered for sale (Section # e e e e e 5 70" Business and Professions Code) CONSTRUCTION LENDING AGENCY ,( • - 22-50 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued e s s 2 2 5 0 P! (Sec 3097 Civ C ) 0330-87 Lenders Name Lenders Address I certify that I hove read this application and state that the above Information is correct I agree to comply with all County poll- ordinances and State laws regulating Plumbing and hereby authorize reprelentatives of this County to enter upon the above •phoned property for inspection purposes ' SEE REVERSE FOR EXPLANATORY LANGUAGE 7 .� z— Y7—Fs Signature of Permittee Date WORKER SDOMPENSAT10N 1of cement to 7"Aa"A DPW 9189 APPLICATION FOR PLUMBING PERMIT ll 70 OM I hereby bihrm That I have'e cenllicete of cement to self Insure or certificate of Worker a Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) - r Policy No Company OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV ❑ conned copy b hereby furnished I _ ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) �REy S Cerdhed copy is flied with the coumy building Inapembn depermMenl NUMBER FUTURE OR ITEIA p FEE LOCALITY Date Applicant WATER CLOSET CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB O ST COMPENSATION INSURANCEASSESSOR (This section need not be completed If the wort Involved by the f SHOWER MAP 8001( PAGE PARCEL Permit Is for arra hundred dollars(8100)or leu) OWNER LAVATORY I cbrtlty that In the performance of the work for which this permit f� Is Issued I shall not employ any person In any manner so u to SINK ,ppgESS become subject to the Workers Compensation Laws DIBWASHER - CRY G� TEL NO Dale/D'o�0 AppOce ' ` CLOTHES WASHER CONTRACTORNOTICE TO APPLICANT If er making this Certificate of Af10i►!� b Exemphon,you should become subject to the Workers'Compensatlon SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO LIC d I hereby affirm that I em licensed under provisions of Chapter 0 WATER HEATER V OUTLETSETs (commencing with Section 7000)of Division 3 of the Business end STATEProfessions Code and my license ra In full force and effect GAT TS OVER OUTLETS LLICENSE NO C1A65 ER DIBrR1cr No pJjROCESSED By ¢ S PER SYSTEMA . D P I — O License Number Uc Class V FINALVALIDATION W DATE a Contractor Dote fA ❑ I am exempt under Sec FINAL Z B AP C far this reason Date Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check appbcarn J SINGLE FAMILY i HOME OWNER-BUILDER DECLARATION Name AC CT. I hereby affirm that I am exempt from the Contractor•Ucens,Lew for the following reason (Section 7031 5 Business and Professions Address 3307 65.!,0 Code) ay Tel No i ITEM El1 as owner of the property will do the work anti the structure Is not Intended or offered for sale (Section 7014 Business110, TOTAL 65 . 50 and Professions Code) CASH 65.50 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the CHARGE .00 performance of the work for which this permit is Issued(Sec 3007, CIV C) A Lender s Name �p/ /I/.� .2/l.a+'7 MI-DOCI1 10710/?U Lansaw a Address /S33 SAT�vE.vf s. G �-0 1 Ail E:_Te I cenlfy that I have reed this application and state that the above 10.Information Is correct 1 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