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HomeMy Public PortalAbout9860 WENDON ST_Plumbing__ WORKERS' COMPENSATION DECLARATION 2DPW 4/87 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A6676A667A sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Dater Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS em ,tionyou should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR p y I p CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM d FINAL VALIDATION IL fect. DATE License Number Lic. Class J FINALU. Contractor Date BY >- VVV cc ❑ I am exempt under Sec. Cr B.BP.C. for this reason OPlan check fee ► d Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Low for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 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 (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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 76AS87�CE#b17 12-64 APPLICATION. FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A.LAMBIE. COUNTY ENGINEER ADDRESS �J COLEMAN W.JENKINS,SUPT OF BUILOING LOCALITY /� FOR APPLICANT TO FILL IN NEARESTOT. O �.' �✓[r e y m NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 r BATH TUB 1.25 DRESS 09_A6 49d CITY G G . TEL NO. SHOWER 1.25 LAVATORY 1,2 CONTRACTOR SINK 1.25 + ADDRESS DISHWASHER 1.25 C1TYAAw�+� ;v-ql TEL. NO.,;_- ATE 2K LAUNDRY TUB 1.25 EGIICONST1 AT ON NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PB=ESSED BY / WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL �. WASTE APPROVAL d OUTLETS OVER 5 PER SYSTEM .30 1P! TION,ECORD/I �. A 0 Cal 6'" ° 6 Q Lld V' d H Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 61:0GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY Lo---ELCOUNTY AND STATE OF GAS TEST CLOR THAT 1 AM THNER F.AND INTEND TORESIDEIN,THE ABOV DESCRI A OP RTY UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL ALIDATIO ROBERT A.WOOD M.0. CARR SUPERVISING MECHANICAL ENG'R L s Nov 30 5 0 6.00- q D.Li.B.1�%23M4ETB 7D-47 APPLICATION *^A�®� ww� �w_� DLIPARTMENT OF BUILDING AND :SAFETY A PLICA FOR tl COUNTY OF LOS ANGELES �$`� 1 WM.J.FOX.CHIEF ENGINE= NATURE ®1? INSTALLATIDN Dlffr.,IUF NO. GROUP . ZONE PERMIT 4, O. .ROUGH FIXTURES COMPLETE ✓ � Q A-' () HEATER o CESSPOOL SEPTIC TANK R=dffkD BY PIR RE DYINSFOTIO_N DATE ISSUED AS MISC AN�OUS 57- -qp APPLICANT �FILL �IN HEAVILY OUMINED PORTION ONLY Joe d. NAME '( Rr ty1 5� b� ADDRESS � `fid' �1� LYOC/ ©AJF Id ADDRESS J �. geG+' LOCALITY t�a ST CITY �. '; & TEL.NO. r3 tp CROII SS ST COUNTY' D CERT..No. ® � �o a� . S + mcPIRES q¢ �C NAME � ���y B . LOCATION OF SEPTIC TANK, OR SSPOOL 3 ADDRESS (/( �^= � r (r e�,� W[t NORTH O CITY l— . TEL.No. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICA 6 OF QUALIFICATION. frt r� PL.uNsmt I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z_ BATH TUB FURNACE ROWER DISHWASHER O -LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER -FLOOR SINK BAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSP R's NAMa ' WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I ETER GAS SODA FOUNTAIN OUTL GAS PIPING I GAS VENT q CESSPOOL�E I TOTAL NUMBER OF FIXTURES. y�Qv/ SEPTIC TANK CEBSPOOI REPTICTANK SEWER h • TOTAL FEE $ �® f UTILITY CO.NOTIFIED f FINAL --- 1y_ 2 ;p D.B.B.17 25M SITE 7D-47 l , APPLICATION r OR PEpD6Yi DEPARTMENT OF BIJILIDING AND SAFETY• PLUMBING { COUNTY OF LOS ANGELES WM.J. FOX.CHIEF ENGINEER NATURE O TNSTALLATIO DISTRI Ad . E -p ROUGH FIXTURES COMPLETE HEATER CESSPOOL F SEPTIC TANK EI ED BY READY FOR DATE I8SU6D FIRST INSPECTION , A& M 18CELLANEOUBEmmom APPLICANT FILL IN IIE INEDI PORTION ONLx4 JOB d, NAm Q p ADDRESS ,.r ADDRESS , „ R 2,t Q LOCALITY a )) NEAREST .CITY .No. (p b . CROSS ST. A �, CERT.No. EXPIRES NAME o t LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL NORTH G ADDRE88' CITY /d� 66IJJ 'l TEL.NO. I AM THEE LEG.SAI. P08S6880R OF THE ABOVE L08 ANGELES COUNTYRT,I`F'IC.6T6 R _�LIFICATION. PLUNDER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH DESCRIPTION OF WORK z BATH TUB FURNACE ii ROWER DISHWASHER O .LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER - DENTAL LAVATORY ROUGH PLUMBING I ETEo GAS -------SODA-FOUNTAIN OUTL GAS PIPING - GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL 0EPTIC'TANK SEWER S UTILITY CO.NOTIFIED I I TOTAL FEE I -- -- -- � FINAL 0.916.17 29N SETS 12.44 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY. COUNTY OF LOS ANGELES pL���'N� ' WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTR !SXNC. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETB HEATER CESSPOOL sEPTIC TANK I R EIV®BY RBADY FOR DA E 1 UED FIRST INSPECTION �� 6A8 MISCELLANEOUS /�✓'Pi/d'`� �./J.E�.o� APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB a NAME / •ryl�/�F' !r'�.� i'�rf fa f 1 f'' ADDRESS / v-} ADDRESS 1 i LOCALITY /-•--��r��//i IBJ_ A /y� /I ' NEAREST L CITY �/y�- Q?17r j/eyr-EL.No. CROSS ST. COUNTY ° i f CERT.NO. /EXPIRES NAME / .•/ LOCATION OF SEPTIC TANK, OR CESSPOOL 3 MAIL ADDRES8 NORTH O CITY .dC � t�' TEL.NO. 1 AM TIr1E LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTYCERTIFICATE OF QUALIFICATION. 4. PLUMBER 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH DESCRIPTION OF WORK BATH TUB FURNACEy 0 MOWER _ DISHWASHER --------LAVATORY REFRIGERATOR ITCHEN SINK WATER SOFTENER FLOOR OINK SAND TRAP LOP SINK - ^OR DRAIN ASH TRAY URINAL APPROVALS WATER CLOBET DRINKING FOUNTAIN, DATE INSPRcroR's NAYR WATER HEATER ------DENTAL LAVATORY ROUGH PLUMBING I I ,SER OUTL SODA FOUNTAIN GAS PIPING I I GAS VENT I CESSPOOL I I i TOTAL NUMBER OF FIXTURES SEPTIC TANK W LCESSPOOL SEPTIC TANK QD SEWER I I/ TOTAL FEE � 1 UTILITY CO.NOTIFIED � 0f•/� r � FINAL