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Home My Public Portal About9157 WEDGEWOOD ST_Plumbing__ � ORKER'S COMPENSATIONDECLARgTION i 7BAA667A 667APPLICATION /,PPLICA°�ION FOR PLUMBING PERMIT W I ht,qSY affir.'m that I have a certificate of consent to self insure, I'Y or a certificate of Worker's Compensation Insurance,oC a certified; copy tphhoIr ofASec.3800 Lab.C.) Policy`1d. Company ZAh COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ ,Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS 11 AA Certified copy Is filed with the county building inspection / vv pailment. • NUMBER FIXTURE OR ITEM G FEE LOCALITY�^� Q s Date Applicant WATER CLOSET NEAREST 1 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by theSHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER . I certify that in the performance of the work for which this permit MAIL is Issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY EL. Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such provisions.or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO y I hereby affirm that I am licensed under provisions of Chapter 9 STAWATER HEATER E LIC. a (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM I OUTLETS CET SE NO. CLASS (�) Professions Code,and my license is in full force and effect. OUTLEIS OVER DISTRICT NO. ROCESSED BY IM0 (rry' 5 PERYSTEM 0 License Number", Lic.Class�, -6- 09 FINAL V DATE // VALIDATION a Contracto Data CO) ❑ I am exempt under Sec. - BY FINAL Z BAP.C.for this reason Data: Plan check fee PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE 'F , Plan check applicant )t ' SINGLE FAMILY .�17r' is�,=111 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 Professions Address I Com` Code): City Tel.No. !l f l��- ��':� I,as owner of the property,will do the work and the structure' CHITA . 50 Is not intended or offered for sale(Section 7044, Business 2U°ti�:l 4 and Professions Code). ® CHANGE I� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the pertormahce of the work for which this permit Is issued(Sec.3097, cl][000-'[j(}0 5/13/91 Civ.C.) .59 ri'' AM '?-451 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 representatives of this County to enter upon the above-mentioned propertyor inspection purposes. QQ SEE REVERSE FOR EXPLANATORY LANGUAGE .� WRRTMtm't OF mmmNG Aim SAFETY 1 . APPLICATION FOS P�Mt'! OOuwff OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT N GROUP I ZONE PERMIT NO. .p PLUMBER f NTAN Mollvi CONTRACTO-l. RECEIVED BY RKADYFOR D TItINEUKD FIRST INBPECTION ES ADDRS 74 W Garvey - Monterey Park, Cali I '. & - A - C CITY ATbintic 2.4654 nL.qc mberlmd 5.104 BADDRUII.DESS INa r •� Y COUNTY LOCALITY LICENSE NO. )RES O - NEARKST PEDAIT PMVADDIRMS CRONE ST. NUMBER TYPE OF FIXTURE OR ITEN ER d WATER CLOSET(TOILET) 0.80 BATH TUB A 0.80 TEL NO. SHOWER 0.no HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS LAVATORY WARN BASIN 0.80lAPPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN BINK0.80 STATE LAWS REGULATING PLUMBING. ANGELES COUNTYAT I LICENS�SESS ON ITHE ABOVE AM THE LEGALJOWNKR D L06 LAUNDRY TUB OR THAT 0.80 OF THE RESIDENTIAL PRO ABOVE. GAB 8Y0TK UTLwm 0.80 EIGNATURK OF WATER HEATER A 0.80 PERMITTK BLOP SINK a 0.80 mmm=ON SECO10 FLOOR BINK 0.80 CS -�� S FLOOR DRAIN 0.80 DISHWASHKR a 0.80 ' -w— DRINKING FOUNTAIN a 0.80 ipr URINAL A 0.80 ri ee a HOUSKSKWER 0.80 % MIBCKLLANEOUS 0 0 APPSOV Dyfa INSPECTOR'S NAME ROUGH PLUMBING i iS OAS PIPING GAB VENT CL:NEPOOL A 1.00 CESSPOOL SEPTIC TANK) F BKPTIC TANK DRAIN ( ) PIT ( ) 1.00 SEWER PERMIT . 1.00 GAB TEST ' 'r.l��P— UTILITY CO. NOTIFIED ° TOTAL FEE FINAL 1 76A567 ' 'APPLICATION TION FOR PLUMBING BING PERdC IT 055.17 10.55 . DMSION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D..GRIFFIN,SUPT OF BUILDING ' LOCALITY r FOR APPLICANT TO FILL IN NEAREST CROSS ST. Vc— ZZ�L�/YI/�iai ` OWNER //A'i"!i*� d Ir/Q! DISTRI T 0. �$ $ ZONE READY FOR INSPECTION` MAIL Y+7 A _ L I '•. ADDRESS / ;INDUSTRIAL CITY I" TEL.NO. WASTE APPROVAL PLUMBER F] cwG- INSPECTION RECORD ADDRESS / CITY ' �LV9 p-TEL.N . r7l" V LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 I CLOTHES WASHER @ $1.00 WATER HEATER @ $1.00 GAS SYSTEM na $1.00 00 v APPROVALS DATE INSPECTOR'S SIGNATURE b , UNDER SLAB WORK PERMIT $ 1. 00 'ROUGH PLUMBING _ GAS PIPING L/ TOTAL FEE Di ' O v GAS VENT / I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 09-- I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR •. .GAS TEST R LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA - THAT 1 M THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIA PROPERTY. SIGNATURE OF PERMIT"fEE FINAL IOHN A.LAMBI 'COUNTY ENGINEER VALIDATIO ROBERT A.WOOD,CHIEF PLBG--LpI .ECTOR CK. N.O. CASH d•,'lW 0 9 u, NOv '7 - 3 �0 Q 0 /.�J /✓��// �i , 76 A 6.67—Y CE 817.8/68 /�:��iF ✓� . APPLICATION FOR PLUMBING PERMIT -j COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTY ENGINEER - . BUILDING AND SAFETY DMSION BUILDING 9/ JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) NEAREST CROSS ST. .NUMBER FIXTURE OR ITEM EACH FEE / OWNER WATER CLOSET 1.50 I BATH TUB 1.50 DRESS SHOWER 1.50 CITY TEL. NO. LAVATORY1.50 CONTRACTO SINK 1.50 ADDRESS DISHWASHER 1.50 CI17 _ ~ TEL. NO�*Sr 30( CLOTHES WASHER 1.50 STATE pr^OLIC LICENSE NO. ®i/ CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO.. GROUP ZONE P O S D BY LAWN SPRINKLER SYSTEM 2.00 Ll e WATER HEATER 1.50 INDUSTRW. v WASTE APPROVAL Z GAS 0 SYSTEM OUTLETS 1.50 INSPECTION RECORD OUTLETS OVER y� 5 PER SYSTEM .30 / a ' �f ,!"%�.,,�.•i''I ail+' � Plan check fee 25% of above. See reverse. , PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE APPROVALS - DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING. AddieS. /v GAS PIPING • GAS VENT Cit Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 9-14 v7/ f9,f 1 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED . LICENSED AS RUIRED BY LOS ANGELES COUNTY AND STATE OF I �- / CALIFORNIA OR T T 1 AM THE LEGAL OWNER OF,AND INTEND TO / 7/ �J �•r'�— RESIDE IN.THE ABO DESCRIB RESIDENTIAL PROPERTY. FINAL SIGNATURE :JACK R. ALLENV , SUPE I ING M HANICAL ENG-R. OF PERMITT PERMIT VAL DATI[®1V CK. M.O. CASH PLAN CHECK VALIIDAT CK. M.O. CASH