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Home My Public Portal About9230 WEDGEWOOD ST_Plumbing__ j WORKERS'COMPENSATION DECLARATION I76A667A I� hereby affirm that I have ir•certificate of consent to self I ce 817(2-66) APPLICATION FOR PLUMBING P E R M I T 'insure,or a certificate of Worker's'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab ) COUNTY OF LOS ANGELES BUILDING AND SAFETY policy No. Company C�' EYIWUE 2-V ]o Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDI 1,0 ADDRESSCertified copy is filed with t oTal un y building inspection NUMBER FIXTURE OR ITEM ® FEE LOCA't'ITy Dat d a t Applicant WATER CLOSET NEAREST ? BATH TUB CROSS ST. CERTIFICATE OF EXEMPTI FROM WORKERS' % COMPENSATION INSURANCE SHOWER OWNER (Thi 'j section need not be completed if the work involved LAV ATO R Y MAIL by e permit is for one hundred dollars ($100) or less.) ADDRESS > SINK CITI� .NO � 0 I certify that in the performance of the work for which this DISHWASHER C1 pe mit is issued, I shall not employ any person in any manner CONTRACTOR io-TICE as to ec a subject to the W hers'C m e ation Laws. CLOTHES WASHER ADDRESS O Applicant 20lt�WnLQ 49- TO APPLICANT: If, after ma ng this Certificate of SWIMMING POOL RECEPTOR CITY TEL.NO. ,270' W !`Exemption, .you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. �r� N 1 Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. CLASS G -5 Z with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DISTRr NO. P CESSED BY I LICENSED CONTRACTORS DECLARATION OUTLETS OVER V! r i I hereby affirm that I am licensed under provisions of Chapter .5 PER SYSTEM •9 (commencing with Section 7000)of Division 3 of the Busi- FINAL ^ p� VALIDAT N ness and Professions Code, and my license is in.full force and DATE effect. at y{(�' �', License Number �+ L'c.Class C-3 FINAL By Contractor ate lam exempt fro the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE D2 Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name nn 'r I hereby affirm that I am exempt from the Contractor's Address 2 A 5 Q 3 • License Law for the following reason (Section.7031.5, Busi- City Tel.No. ; o c a o .o ness and Professions Code): Las owner of the property, am exclusively contracting ! e ° 1 2 r 0 with licensed contractors to construct the project (Section 7044,Business and Professions Code). )/ o o �. 1Z , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency it for the performance of the work for which this permit is f issued(Sec.3097,Civ.C.). Lender's Name ' EAD in fil AL laic, 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the :abme- tioned property for inspection pur ose SignAeofrmittee Date h, wOFKIRB'•COAAP�NSATIONDECLARATION APPLICATION FOR PLUMBING PERMIT 1�I�here�y,affirm that I have a certificate of consent to self 78A887A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.8/88) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES • DEPT. OE PUBLIC WORKS . . Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS , 9230 Wedgewood St. tion department. NUMBER FIXTURE OR ITEM fg� FEE LOCALITY �( h ream Date Applicant WATER CLOSET r 0" NEAREST • ` CERTIFICATE OF EXEMPTION FROM WORKERS' �l BATH TUB tl CROSS SJ. ' COMPENSATION INSURANCE OWNER A. $ C. A. Villarruel (This section need not be completed If the work involved by MAIL SHOWER the permit Is for one hundred dollars($100)or less.) I LAVATORY U ADDRESS 9230, Wed ewood 'St. I certify that in the performance of the work for which this , permit is issued, I shall not employ any person in any manner SINK CITY Tem le Cit TEL.NO. so as to become subject to the Workers'Compensa ion Laws. DISHWASHER CONTRACTOR Owner Date '0 Z Applicant CLOTHES WASHER ADDRESS - NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit,sholl be STATE. LIC. deemed revoked. WATER HEATER 0 LICENSE NO, CLASS. LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ED BY 1 GAS SYSTEM OUTLETS � Y I hereby affirm that I am licensed under provisions of Chapter 9 V` U (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is.in full force and effect. 5 PER SYSTEM . FINAL v VALID ION License Number Lic. Class - DATE VVV FI :Contractor Date ❑ I am exempt under Sec. B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$, (J Sri Ab8:1,-1 A Signature �� TOTAL FEE o• o Plan check applicant .6645 x SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name O 41.0° I her affirm that I am exempt from the Contractor's License Address 9230 Wedgewood St. Law'for.the following reason (Section 7031.5, Business and Professions Code): City Temple City Tel. No. ® I, as owner of tl►e property,.will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). r" 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 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 abo e-mentionZdpperi for inspect' n purpooses.�j SEE REVERSE FOR EXPLANATORY LANGUAGE , Signature of Permittee Date WORKERS'COMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, I CE 817(REV. 10/81) �J or a certified copy thereof (Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES 1 BUILDING AND SAFETY PiN� 41 Policy No.m mop Company t Certified copy is hereby furnished. P.-) { (,� ! FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS 1 j Certified copy is filed with the county b ilding inspec- tion de arfinent. NUMBER FIXTURE OR ITEM C0? FEE LOCALITY I EM i1A NP Date J 1 Applicant WATER CLOSET NEAREST 1 r CER IFICATE OF EXEM I. FROM K RS' BATH TUB CROSS ST. COMPENSATION INSURANCE + SHOWER OWNER -(This section need not be completed if the work Involved by ) MAIL n the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 5 (, I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner SINK CITYChA TEL. so as to become subject to the Workers'Compensation Laws. DISHWASHER �^✓ CONTRACTOR a1 !, Ulf Date Applicant 1 CLOTHES.WASHERON n, w NOTICE TO APPLICANT: If, after making. this Certificate of ADDRESS �' /v Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR p� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY 15 %() TEL. NO. with comply with such provisions or this permit shall be STATED aLIC. �, deemed revoked. WATER HEATER LICENSE NO. �L.V �� CLASS G LICENSED CONTRACTORS DECLARATION DISTRICT NOS ESSE BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r.(//� /17 (commencing with Section 7000)of Division 3 of,the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VA ATION License Number -JWA1`1' Lic.Class c-ca DATE ✓ C L 3 FIN � L Contractor 00 5 j Date • B ❑ I am exempt under Sec. H B.BP.C. for this reason ;2686,4A u Plan check fee d Date: /� # o•0 0 0 0 5 V PLUMBING PERMIT ISSUING FEE$ a Z Signature TOTAL FEE ( o - 1650 SINGLE FAMILY' Plan check applicant o 0,0 i 65.05 HOME OWNER-BUILDER DECLARATION iName I hereby affirm that I am exempt from the Contractor's LicenseAddress 4, 5-a-8 7 Law for the following reason (Section 7031.5, Business and Professions Code): 'City Tel. No. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section f 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 I (Sec. 3097, Civ. C.). 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-me Toned pr rty for inspection purposes. i I SEE REVERSE FOR EXPLANATORY LANGUAGE i a ur fOor Date I l 76A667-CE#617 6-65 �! G�� r APPLICATION FOR PLU B PERMIT COUNTY OF'-LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND JOHN.A. LAMBIES COUNTY AFETY DIVISION OEER BUILDING LV p [,V COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY . ��- C. T v FOR APPLICANT TO FILL IN NEARESCROSS TT. / NUMBER. FI4TURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUR 125 ADDRESS SHOWER 1.251CITY TEL. NO. LAVATORY 1.25 ? �S CONTRACTOR`��,A� � A . � '�Dr, SINK 1.25 ` ADDRESS. •l (u k. (j c S tao DISHWASHER 1.25S CITY GV I ✓,n. I. , r,n TSL. NO. STATE LIC LAUNDRY TUB 1.25 LICENSE NO. 4. CLASS �0 C ASS 1 CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROC SED BY WATER HEATER 1.50 a GAS SYSTEM �� OUTLETS1:50 y INDUSTRIAL WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INS CTION RECORD V UJI N Z APPROVALS DATE INSPECTOR'S Sf GNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING r 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO .COMPLY WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMING, 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST •�� / CALIFORNIA.OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE D IBED RESIDE NT. pERrr. UTILITY CO.NOTIFIED _ SIGNATURE OF,PERMITTEE FINAL L� 7 lbI�6 /q IMATION CK. M.0. CASH LACO.1 4 6 3Z8 APR 21 5 D 1 6.2 5N 76A667=CE#817 6-65 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING {��I JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS rDai COLEMAN W. JENKINS. SUPT. OF BUILDING `sr LOCALTl'1' ��y��• .�� f . FOR APPLICANT TO FILL IN NEAREST C+ : •� NUMBER FIIf,TURE OR ITEM EACH FEE CROSS ST. - OWNER WATER CLOSET 31.25 GAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR ., SINS 1.25 ADDRESS 4Q S DISHWASHER 1.25CITYW, Coul j TEL.NO. STATE LIC LAUNDRY TUB 1.25 LICENSE NO. CLASS 'vC�• CLOTHES WASHER 1.25 DISTRICT NO. GROUPZONE PROCESSED,BY WATER HEATER 1.50 V T �, GAS SYSTEM OUTLETS 1.50 INDUSTRIAL IL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM ,80 INSPECTION RECORD U !• drvc� S� � 2 6yTd,�� o W a In Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE: READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND'AGREE TO COMPLY LCWAFORN COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER . IY CERTIFY THAT 1 AM PROPERLY RE6ISTEpED AND/OR PLUMBING FIXTURES AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST IA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO ,THE ABOVE DE RIBED RESIDENTIAL PROPERTY. UTILITY CO.REMITTEE FINAL vAL CK. M.O.M.0. CASH L a l '6 5 9%no JUN 9 5 D 3,5 0- �