Loading...
HomeMy Public PortalAbout5521 WELLAND AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have a• certificate of consent to self ce 817(s-ao) APPLICATION FOR PLUMBING PERMIT jnsure,or a certificate of Workers'Compensutioh Insurance,or a certified copy thereof(Sec.3800,Lab.C.) r COUNTY OF LOS ANGELES. 1 BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 5521-FEE® Welland Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM , Ave department. LOCALITY WATER CLOSET J Temple Cit 91780 Date Applicant NEAREST BATH TUB CROSS ST'. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER Mr & MrS. Monaco (This section need not be completed if the work involved LAVATORY MAIL by the permit is for one hundred dollars ($100) or less.) ADDRESS 5521 Welland Ave. O SINK CITY Temple City TEL.NO. 443 5045 v I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR so as.to�b���e�� �1 comeesubject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS U ` p Date Applicant SWIMMING POOL RECEPTOR a NOTICE TO APPLICANT: If, after mJdng this Certificate of CITY TEL.NO. U) Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NQ. PRO ESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER ` mob 6p/ I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM o 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL � VALIDATION ness and Professions,Code,and my license is in full force and DATE (J effect. FINAL / License Number Lic.Class BY Contractor Date I am exempt from the licensing requirements as 1 am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 7 acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic,or Reg.No. Date Plan check appl)cant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address 5521 Welland Ave. License Law for the following reason (Section 7031.5, Busi- City Temple City Tel.No. 443 5045 '1 1 &6 A ness and Professions Code): I, as owner of the property, am exclusively,contracting # 0 0 0 0 o 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). 2 0 0 .1 3.0 0 CONSTRUCTION LENDING AGENCY 000100:,c I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 9. 1 6-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Signatlisp.. Permittee Date - 7SA667-CE.#817 2-62 -=-TiEMP LyCIT ' APPLICATION FOR PLUMBING... PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER e BUoIIHDINM G AANB E SAFETY DIVISION SION ENGINEER ADDRESS a WILLIAM A.JENSEN, SUPT OF BUILDING ' LOCALITY FOR APPLICANT TO FILL IN CHOSES ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 DRESS, d/ SHOWER 1.25 CITY TEL. NO.. LAVATORY 1.25 CONTRACTOR ` SINK 1.25 ADDRESS -DISHWASHER 1.25 CITY: TEL. NO. LAUNDRY TUB 1.25 .-CONTRACTOR'S ' STATE ❑ . REGISTRATION NO. COUNTY ❑ CLOTHES WASHER. 1.25 'DISTRICT NO. GROUP X�; N E P SSED-BY WATER HEATER 1.50 f GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE-APPROVAL OUTLETS OVER 5 PER SYSTEM .90 4 INSPECTION RECORD /, rn .>w44''- )- at y C N , 6 --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 ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ( 1 f WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 3 I r• 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED A1401OR PLUMBING FIXTURES J _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE. OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCR ED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE • / d ,I OF PERMITTEE FINAL e;/f',--k3. ATION ROBERT A�WOOD CK. M.LIDO..' CASH SUPERVISING MECHANICAL ENG'R Lr �c2 2 1 7Zo" IAR 5 D 3.550 v WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby gffirm that I have a certificate of consent to self 20-0026 DPW 6/87 I hsu�, or a c*tificate of Workers'Compensation Insurance, 76AG67A or a certified f copy the rpeof(Sec. 3800, lab. C.) �� COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy NoJd'I-�90'"C�ompany ��Z�.L/'�J=1 Certified copy is hereby furnished. _7 BUILDING s j �[.�/ql.� © FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with'the county building inspec- NUMBER FIXTURE OR ITEM tion department. FEE 6 �I �( LOCALITY Date " r L Appligont � WATER CLOSET � .J NEAREST r di CERTIFICATE OF EXEMPTIO ROM WORKERS' BATHTUB CROSS ST. Zl✓ p/AD: COMPENSATION I URANCE OWNER K r/t- � ea (This section need not be completed if the work Involved by SHOWER J/" MAIL the permit is for one hundred dollars($100)or less.) LAVATORY p� O ADDRESS E rt�lliv��� I certify that in the performance of the work for which this ,J permit is issued,I shall not employ any penton in any manner SINK CITY T A`�J so as to become subject to the Workers'Compensation Laws. DISHWASHER `' CONTRACTOR �ol�af uJN_�T� u.�rrl6�pl� Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR �� Exemption, you should become subject to the Workers' CITY Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM I with comply with such provisions or this permit shall be STATE OC. deemed revoked. WATER HEATER LICENSE NO. r(j CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm-that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O (commencing with Section 7000)of Division 3 of.the Business OUTLETS OVER and Professions Code,and my license Is in full force and effect. 5 PER SYSTEM. FINAL VALIDATION L r1 s DATE License Number /9 f&3g Lic. Class �p q FINAL IM Contractor Date (��7��a' BY ❑ I am empt under Sec. U %&P.C. for this reason en Plan check fee � Date: PLUMBING PERMIT ISSUING FEE$ 107Z/ Signature ' TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License ._•.•- s Address Law for the following reason {Section 7031.5, Business and Professions Code): -7City Tel. No. x-3510 ❑ I, as owner of the property, will do the work and the structure is is not intended or offered for sale (Section s s I C, tt 7044, Business and Professions Code). , ® rh'r'E.l CONSTRUCTION LENDING AGENCY _:� I hereby affirm that there is a construction lending agency for fhe performance of ibe work for which this permit is issuedf'1 �-• NG o�'•_ (Sec. 3097, Civ:C.). :rH Lender's Name Lender's Address I certify that I have read this application.and state that the (156 i d AM 9 ON.L 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'propert for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa a of Permittee Date 76AB07-MO1710-60 APPLICATIO FOR PL BIND PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGE41M BUILDING AND SAFETY DIVISION BUILDINGJr 2 JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY `p• ' FOR APPLICANT TO FILL IN NEAREST I GROSS . NUMBER FIXTURE OR ITEM ' OWNER WATER CLOSET Z gay BATH TOB ADDRESS Z S� CITY - TEL NO. SHOWER 2_ LAVATORY CONTRACTOR ewl- SINS t 7-" ADDRESS 111117 /V• 1t1AP ,& . 4e DISHWASHER CITY TEL.NO.00 SrA LAUNDRY TUB + RCFOGMM ION NO. f D S-G COUNTY CLOTHES WASHER �L-�.� DISTRICT O. GROUP ZONE I PROESSEP BY J WATER HEATER j yip udy _ ( GAS SYSTEMs G INDUSTRIAL G" . WASTE APPROVAL } i 1 INSPECTION RECORD O- B $1.00 PER ITEM OR FIXTORS $ ! APPROVALS -y PATE INSPECTOR'S SIGNATURE UNDER SLAB WORK ' PERMIT $ 2 00 � _/•� TOTAL FEE tJ ROUGH PLUMBING GAS.PIPING f�4` �r _ �'r�s_✓_ "� I HEREBY ACKNOWLEDGE,THAT I HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT r ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER P A_/(" PLUMBING. 1 1� IS CERTIFY THAT 1 AM PROPERLY REGISTERED ,AND/OR PLUMBING FIXTURES �I�•/ f 7- LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ' f,='? �"'•'^ , CALIFORNIA OR THAT I AM THE LEGAL OW ER OF THE ABOVE " ••+�� "a! / 'DESCRIBED RESIDENTIAL PROP TY. v GAS,TEST UTILITY CO.NOTIFIED SOF PERMITTE FINAL ilaIf, ? 1 ;r�Jtff/ VALIDATION- ROBERT A!WOOD - cK M.0. CASH SUPERVISING MECHANICAL ENG'R 1 3.7 J L eko 1 7 6 6 f-SAP, 7 5 D .