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HomeMy Public PortalAbout9849 VAL ST_Plumbing__ r > _ KERS'COMPENSATION DECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT _,A . 'Mhat I have a certificate of consent to self in- 76A667A gore,or a certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) certified copy thereof(Sec. 3800, Lab. C. Policy Mo. Company COUNTY OF LOS ANGELES EPT. OF PUBLIC WORKS . tertified copy is hereby f fished. v,4 L swBUILDING J Certified co is fil ith the count building FOR APPLICANT TO FILL IN(PRINT OR TYPE) ,/ copy� y g inspection ADDRESS deportment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY LOCALITY Date ' Applicant WATER CLOSET(TOILET) V NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB O CROSS ST COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS SAMr—� AS `B©7r� I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in ny o SINK' CITY TEL.NO. as fo ecome ubje t the Workers'C �aw J-1 r DISHWASHER CONTRACTOR Da Appll.ca CLOTHES WASHER ADDRE V QC _TL NOTICE O APPLICANT: ' after .king this Cer' is of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the-Wo s Compen- CITY G f TEL. N . sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. _ ed. WATER HEATER LICENSE NO. 5 �J CLASS G LICENSED CONTRACTORS DECLARATION DISTR�NO. �y P CES BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS J `Q/ 9(commencing with Section.7000,)df Division 3 of the Business OUTLETS OVER and Professions Code, and y Ii se is in full force and ef- 5 PER SYSTEM FINAL /S/ Q VALIDATION a Lice: I*&V /� /_ DATE 6 C J License Number `f Lc. Class (/ YYJJ O V s FINAL ContractorKi4 o Date BY O ❑ I am exempt under Sec. W a B.&P.C. for this reason ► Plan check fee te: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE J SINGLE FAMI Plan check applicant p HOME OWNER-BUILDER D ARATION PP , 3 �7 �LIeU I hereby affirm that I.am exempt from the Contractor's License Name Law for the following reason (Section 1.5, Business and 1 Professions Code): Address I, as owner of the ITEMS pro ty, will do the work and the City Tel. No. (TOTAL 28 c 50 structure is not inten or offered for•sale(Section 7044, GASH 28■50 Business and Prof sions Code). CONSTRUCTION LENDING AG Y CHANGE oil I ' n hereby affirm that there is a constru lending agency for the performance of the work for ich this permit is issued 0WQ_M f 6/29/89 (Sec. 3097, Civ:C.). r -251 1 AM 10 34 Lender's Name Lender's Address 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 repretat' of this County to enter upon the above-m ori spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Per a Date i WORKERS'COMPENSATION DECLARATION AP LICATOON FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self i7&A667A insure, or a certificate of Workers'Compensation Insurance, 1 CE 817(REV. 10/81) , or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES ` ' Ir BUILDING AND SAFETY Policy No. Company I I Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS _ Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY ti Date Appl iga nt WATER.CLOSET NEAREST l CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE i OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundrod dollars($100)or less.) I LAVATORY MAIL ADDRESS 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner I SINK CITY TEL. NO. so as to become subject to the Workers' nsation Laws. , DISHWASHER a 0 CONTRACTOR Date ® pplicant I CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this 2 rtificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL.NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED.CONTRACTORS DECLARATION DISTRICT NO. P OCE$SED B I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 0 OUTLETS (commencing with Section 7000.)of Division 3 of the Business OUTLETS OVER O and Professions Code,and m license is in full force and effect. I 5 PER SYSTEM 6 Y FINAL VALIDATION License NumberSaw& Lic. Class C?4� DATE FINAL 10 Contractor BY. ❑ ! y t;2 I am empT under ec, U11 B.BP.C. for this reason Plan check fee Dote:. PLUMBING PERMIT ISSUING FEE$ Sa Signature i TOTAL FEE ,_0 1 Plan.check applicant i SINGLE FAMILY I HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5,, Business and Address Professions Code): I City Tel. No. ❑ 1, as owner of the property, will do the work and the i structure is not intended or offered for sale (Section 7d . 7044, Business and Professions Code.), I CONSTRUCTION LENDING AGENCY ff'o o.o o o 5 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 2 C o 1 G 5 0 (Sec. 3097,:Civ. C.). Lender's Name 1. 1 0-52 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 I ordinances and,State laws regulating Plumbing, and hereby I 1 authorize epres es of this County to enter upon the I above- to d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE , R i ature.of Permittee Date I � L ^ 76A667-CE#817 10-62 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRENS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUP'T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST S . ��f/ e4 2 NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRES SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SINS 1.25 ADDRE S DISHWASHER 1.25 C TY EL/. NO. STATE CdffTRACT9IfS LAUNDRY TUB 1.25 REGISTRATION NO COUNTY COUNTY [01CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 (� _y QO -7 1.50 INDUSTRIAL GAS SYSTEM OUTLETS WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD .\ 669 tA to z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK \ TOTAL FEE ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT -.rAND 8TATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL -COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES • •� '� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, D INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROP Tr. UTILITY CO.NOTIFIED SIGNATURE !1�2 n OF PERMITTEE FINAL '3,•-'cl- (%�:°�' ��r'G'di�! LIDATION ROBERT A.WOOD r CK. M.0. CASH SUPERVISING MECHANICAL ENG'R Lko 3 1 7' 01 RUG 2 6 5 D 3.5 0~ j 78A887--CE817-8-58 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES ' DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING D'. iOFlld A. LAMB>E, County ler ADDRESS O C TT D.'G81f'FIIi.Supt.o! wilding LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM { OWNER /40 WATER CLOSET p� RATH TUB Dmgm AD RFS p SHOWER CITY T TEL.NO LAVATORY CONT8ACT0 SIIYS ADDRESS ® l DDSHWASHER CITY TEL.NO LAUNDRY T CON. IIB OR'S Q2 STATE REGISTRATION No. COUNTY ❑ . CLOTHES WASBEB ,.DISTRICT GRI .ZONE WATER HEATER GAS SYSTEM nmUSTRIAL WASTE BBPHOVAZ tea' nvsPEcrION REcoRD r�u .SES d �GJ�nrD dT jE ,/a APPROVALS tea° $ I DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 2L ROUGH PLUMBING Ll TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOTWATER.HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I T LEGAL OWNER OF T E ABOY UTILITY CO.NOTIFIED DESCRIBED RESIDENTIA RO 7Y. SIGNATURE FINAL ROBERT A.WOOD. ®o VALIDATION UPERVISING MECHANICAL ENG'R CK. R.C. CASH 067691A, J;:J- 30 5 A 3.00 !' D.B.S.'17 25M SETS 2-47 r APPLICATION PPT IC A X1 ION FOR 1PT.lm9dII►!!� DEPARTMENT OF BUILDING AND SAFETY' l9r d/ �l/LiiA 1V i' A11LOiVAAS COUNTY OF-LOS ANGELES WM.J.FOX.CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DlgrrRiar NO. GROUP O E PERMIT O. ROUGH FIXTURES _I COMPLETE D BY READY FOR DA 1 ED HEATER _.CESSPOOL SEPTIC TANK R EIV FIRST INSPECTION AS• CCISCELLA EOU APPLICAW,.FILL IN HEAVILY WTIIWPD PORTION1 ONL/YJOB _ y ! E. NAME i/lr� ) �•��fJ�..% 9''� �j ADDRESS � ADDRESS /r✓ 'l r �j.td-�.!.-�a A..(. l _ .LOCALITY .0 4 NEAREST E CITY `l TEL.No. CROSS ST. - /r COUNTY - r- } CERT.No. EXPIRES. NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL � 3 ADDRESS NORTH O CITY c TEL.No. I AM THE LEGAL-POSSESSOR OF THE ABOVE LOS ANGELES COUNTY cERTiFic&TH OF QUAL IFI I 41-1 int-l^ PLUMBER 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER y CORRECTIONS SOUTH - - J DESCRIPTION OF WORK z BATH TUB FURNACE . Q. SHOWER DISHWASHER Q -LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK ------SAND TRAP LOP SINK' -------FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET ^RINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING -METER-GAS SODA FOUNTAIN nGAS PIPING GAS VENT I I CESSPOOL I 2-J TOTAL NUMBER OF FIXTURES M� SEPTIC TANK I I CESSPOOL SEPTICTANK "L.10 SEWER I _ S . UTILITY CO.NOTIFIED I I TOTAL FEE FINAL 'r/ JA�a�