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Home My Public Portal About6453 TRELAWNEY AVE_Plumbing__ QasT]TRcv d'kel i11L APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN IPRINT OR TYPEI BUILDING L�� J NUMBER FIXTURE OR ITEM B FEE ADDRESS �� 1W"WAJ16F 44- LOCALITY LG CE T WATER CLOSET NEAREST BATH TUB CROSSST &A762AJS SHOWER OWNER MV LAVATORY MAIL r1 ADDRESS &V.5Z 9GCALIJV16 SINK CITY E TEL NO DISHWASHER CONTRACTOR t. U CLOTHES WASHER ADDRESS IZ W C-AS / u/✓ SWIMMING POOL RECEPTOR CITY L TEL N04y�r/�Y LAWN SPRINKLER SYSTEM STATELIC WATERHEATER LICENSE NO 3 S"d CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR 551GNAWRE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT U d HOT WATER HEATER PLUMBING FIXTURES GAS TEST -20-79 / PL Plan check fee UTILITY CO NOTIFIED -AR5 it PLUMBING PERMIT ISSUING FEE S TOTAL FEE O fINAI Plan check applKant PLAN CHECK VALIDATION Nome Address CIry Tel No I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 1 /. II A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH All COUNTY ORDINANCES r]G V V AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION I HEREBY CERTIFY"AT I AM PROPERLY REGISTERED AND/OR LICENSED AS p R M • 5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE /� LEGAL OWNER OF AND INTEND TO RESIDE IN THE AW VE DESCRIBED RESIDENTIAL L q B - 1 /1L/y O PROPERTY SIGNATURE C • B • 1 Q O O j5 OF PHRMITTfiE 0207-79 DISTRICT NO PROC D BY 57.o8 INDUSTRIAL WASTE APPROVAL WORKS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT heseby affv shot I have a certificate of consent to self 7&AAWA insure or ertifimta of Workers'Compensation Insurance, CE 817(REV 10/81) or a cert copy thereof (Sec 3000 Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pati a Company Certified copy is here fur FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDING //Jr+J 7AEZ7Z^WN�" 97 Certified copy filed�Nit a mldmg inspec- ADDRESS {��fJ.7 F�CL!'r 7 lion 4elobrt t / NUMBER FIXTURE OR ITEM ® F{E Date l�Appji WATER CLOSET LOCALITY7,F"I gF' CITY C TIFI TE OF NEAREST EXEMP M RKERS BATH TUB CROSS ST OGEMA COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by the permit Is for one handed dellen($100)or Ins ) LAVATORY MAIL ' I certify that in the performance of the work for which this ADDRESS permit is issued I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CO 4C OR ,V_K4S.4A/0U! N Dote Applicant CLOTHES WASHER ADDRES'W3 �T.4 ST NOTICE TO APPLICANT If come making this the Workficate of SWIMMING POOL RECEPTOR ^ CompExemption sa you should become subject to the Workers Clir CTEL I�Q')75/8 Compensation with such of the Labor Code you must fonh- LAWN SPRINKLER SYSTEM with comply wlrh such provisions or this permit shall be STATE LIC LIC NO revoked WATER HEATER LICENSE 0 �!!// JCLASS LICENSED CONTRACTORS DECLARATION DISTRICT BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER > and Professions Code and my license is in full force and effect 5 PER SYSTEM FINALp VA DATION G License Number Lic Class DATE I V Fly OC Contractor Dote BV V ❑ 1 am exempt under Sec su d 8 8P C for this reason H Plan check fee Z Date Signature PLUMBING PERMIT ISSUING FEE$ (� TOTAL FEE Plan check applicant R 31 7.2 A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Nome E. p jl,� l Ui,+7i7re # s s s s s 5 1 hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and Addreu Z E• 1- 41N VICW 1 - - 1650 Professions Code) City Tel No 6/,99 ❑ I as owner of the property will do the work and the is s is 1 6 5 0 3 structure is not intended or offered for sole (Section , (116-85 70" Business and Professions Code) 1 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there iso construction lending agency for the performance of the work for which this permit Is issued (Sec 3097, Civ C ) Lender s Name Lender s Address I certify that I have read this application and state that the 100above information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing and hereby u is representatives of this County to enter upon the ve honed property for inspection p po SEE REVERSE FOR EXPLANATORY LANGUAGE Date j' WORKERS'COMPENSATION Corti DECLARATION APPLICATION FOR PLUMBING PERMIT thereby ajfvrlt Tflar! have a cartdnmfe of consent to self 7ey667A '1thsu/e r mcertihcate CLF Workers' Compensation Insurance, 0817(REV 10/81) or a cenaifiecicopy thereof (Sec 38DO, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished O Sul FOR APPLICANT FILL IN(PRINT OR TYPE) [4FW Certified copy is filed with the county building innpec- ® � Aq tion department NUMBER FIXTURE OR ITEM LOCALITY 12:7AI&E7 C, Dote AppliSant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CRosS ST �,Ov COMPENSATION INSURANCE SHOWER OWNER D/W/f s (This section need not be completed If the work Inwlaed by the Perntlt Is for one hundred dollars($100)or lass ) v LAVATORY MAIL RE55 I certify that in the performance of the work for which this ADD (� permit s issued t shall not employ any person in any manner SINK CITY TEL .�ys73 so as to becoml subject to the Workers'Com ensaI, Laws DISHWASHER CONTRACTOR Date �Adlif4pplicant L• CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers' Compensation provisions of the Labor Code you must forth- CITY TEL NO with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PRQtESSED 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 •J V o and Professions Code and my license is in full farce and effect 5 PER SYSTEM FINAL _ VALI TION License Number-L,, Class Y FI OContractor Dote F I am exempt under Sec W d B 8P C for this reason Date Plan check fee Z Signature PLUMBING PERMIT ISSUING FEE E �D p �2 0 6 6 A TOTAL FEE SD # a a a a is 5 SINGLE FAMILY Plan check applicant I a * 4050 HOME OWNER BUILDER DECLARATION Nome • - - 40,503 I hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5, Business and 04.20-85 of ions Code) City Tel No I, as owner of the property will do the work arid 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 Gv C ) Lender's Name Lender's AM, dress I certify that I have rood this application and state that the poll information is correct I agree to comply with all County ordinances and State lows regulating Plumbing, and hereby eyoorize representatives.ofVhs County to enter upon the ve-menho ed prop rty f +I mspecnon purposes SEE REVERSE FOR EXPLANATORY LANGUAGE d_/70l&_ Signature of Permittee Date DECLA WORKER I have a certificate of consent °P`t 9'� APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a cennicste al consent to self insure ` or a certificate of Worker a Compensation Insurance or a certified , copy thereof(Sec 3900 Lab C) - COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Policy No Company ❑ Combed copy is hereby hanlshetl f-0R APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS S N .r 1 /1 ❑ CerkOetl coq is filed with the county W9dnp Inspection ADDRESS G�//V department NUMBER FIXTURE OR REM O FEE LOCALITY 7—& L Date Applicant WATER CLOSET NEAREST CERTIFICATE OF SAFROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE IM E9�OOK PAGE PARCEL (This section need not be completed If the work Involved by the SHOWER 9 1. permit Is for ons hundred dollen($100)w Nes) LAVATORY 01YtER Pvsf7 N I candy that In the performance of the,work whl permit Is Issued, I shall not employ any person ann eo as to SINK MAIL v, N- become Subject to the Workers Compen tion •c•' L gBWASHER j CITYADDRESS e- 4 TEL NO Z Dete7/� �1ApplfCant CLOTHES WASHER CONiMCTOR NOTICE TO APPLICANT If alter me g t e art icale of 6-11- after you should become subject to the W Compeneatlan SWIMMING POOL.RECEPTOR provisions of the Labor Code you must forth comply with such ADDRESS 2- provisions or this permit shell be deemed revoked LAWN SPRINK-ER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER TEL NO d I hereby affirm that 1 am licensed under provisions of Chapter 9 ""7 (commencing with Section 7000)of DMsron 3 of the Business and GAB SYSTEM OUTLETS LICENSE NO / LIC Profesewns Code and my license IS In full force end effect OUTLETS OVER DISTRICT NO PROCESSED BY Q 6 PER SYSTEM Lkense f/umhe — D lf V TE VALIDATION Wa con Dene -, IL ❑ Tem ezamp Sec By fi'CT.t Date Z B 9P C for this reason 4I.tJ Plan check fee ,s _moi 33 Slgriearre PLUMBING PERMIT ISSUING FEE$ lI 100. I I fM ❑ TOTAL FEE37F b TOTAL 4 1 . S SINGLE FAMILY Plan check sppficant CHECK 't I•&5 HOME OWNER BUILDER DECLARATION Name r,Tpgl',]c •l�� I hereby affum that 1 am exempt from the Contractor a License Lew for the following reason(Section 7031 S Business and Professions Address Code) CRY Tel No [J'J[([I-QQ(IL 7/19/911,El I as,owner of the property, will do the work and the structure 1l .��t 1, is not intended or offered for sale(Section 7046, Business A 140 I tV ITV'I6 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 a Name Lender a Address I certify that I have read this application entl state that the above , Information is correct 1 agree to comply with all County ordinances and Stets la gu umbing and hereby authorize repreesntat a o Co to enter upon the above mentioned property In rposes SEE REVERSE FOR EXPLANATORY LANGUAGE 7I-7`Z Signature tN ftMft6bJ Date