HomeMy Public PortalAbout8734 WENDON ST_Plumbing__ WORKERS'COMPENSATION DECLARATION APPL.ICATI®N FOR PLUMBING PERMIT '
I hereby affirm that I have a certificate of consent to self 76A667A i
insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.. 10/81)
or a certified copy thereof(Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company__ � A NN 1i
Certified copy is hereby furnished. NUMBER FIXTURE OR ITEM /
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 9� `�(� a
BUILDING 9—
Certified copy is filed with the county building inspec-
LOCALITY ` E Qf.E�
ir
Date
tion department. FEE
�— gppliSant ■ ! WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST. v
COMPENSATION INSURANCE OWNER -�
(This section need not be completed if the work Involved by SHOWER
the permit Is for one hundred dollars($100)or less.) LAVATORY MAIL
�� L
I certify that in the performance of the work for which this ADDRESS
permit.is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
O�
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Cid
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
IZ2 G:_6064
Compensation provisions of the Labor Code, you must forth- CITY ea' TEL.N
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE s CLASS
deemed revoked. WATER HEATER LICENSE NO. -mss G
LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSEDYJ
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 15 , }
and Professions Code,and mi license is in full force and effect. S PER SYSTEM FINALVALIDATION 1L
_,5?
w License Number Lic. Class
■ FINAL. �_ O
Contractor Date �� BY U
❑ I am exempt under Sec. x-36 CL
B.&P:C. for this reason
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$ p Q
Signature
TOTAL FEE 2 �b
SINGLE FAMILY
Plan check applicant^ "3 5 64 A
.,._:
HOME OWNER-BUILDER DECLARATION Name 0 0 0 0 0 5
1 hereby affirm that I am exempt from the Contractor's License Add
Law for the following reason (Section 7031.5, Business and ov 2 - 2250
) City y Address
Professions Code �11E` Tel. No OR-,Q—(.0
❑ I, as owner of the property, will do the work and the o o 2 2,5 0-c=.•.
structure is not Intended or offered for sale (Section
7044, Business and Professions Code). O 7 2—n 3
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 1 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
j above-mentioned property for ins ction rposes. SEE REVERSE FOR.EXPLANATORY LANGUAGE
0
ignature of Per ittee Date
'IE�. - •1;
76A667-C-E#817 4-54 '
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT.OF COUNTY 'ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 8734 Wendon ,
JOHN A.LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING
LOCALITY, San Gabriel
FOR APPLICANT TO FILL IN NE S$$T.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER Mr. & Mrs. Leland Stephens
WATER CLOSET 31.25
MAIL . same
BATH TUB 1:25 ADDRESS
slsowER Ias. CITY TEL. No. 287 6905
LAVATORY I.n CONTRACTOR Bryant Htg. & Air Cond.
snYs 1.25 ADDRESS.13 50 E. Las Tuna s Drive
DISHWASHER 1.25 CIT, ban a rle TEL, NOZ86. -
114.1
LAUNDRY TUB 1.25 R GISTRATION NO. 221751 COITINAT�Y,
CLOTHES WASHER 1:25 DISTRICT NO.7GROUP /ZONE. CESSED BY
WATER HEATER 1.50 � l�f
1 GAS SYSTEM- OUTLETS I'� 1 'S 0 INDUSTRIAL �
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
10
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE. 3:150 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'GAS VENT
AND. STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
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 TNAT'1 THE LEGAL'OWNEF.R OINTEND TO _ .
RESIDE IN,THE ABOVE E CRIBED RESIDENTIAL R Y. UTILITY CC,NOTIFIED
SIGNATURE
OF PERMI' E
FINAL 740 1
ALIDATION ROBERT A.WOOD
CK. 1. M.o. CASH SUPERVISING MECHANICAL ENG'R
'� �: 3' � ISR 2 5" A :55 0og