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HomeMy Public PortalAbout9861 WENDON ST_Plumbing__ 76 A 667- CE 817 7'69 ; - `• APPLICATION FOR PLUMBINGYi�RMIT 11i Lb COUNTY OF LOS'ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS IJ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALrfY / FOR APPLICANT TO FILL IN PR NT OR TYPE) PNNEAREST �L CROSS ST. NUMBER FIXTURE.OR ITEM EACH FEE ' OWNER �G. P WATER.CLOSET. 1.50 MAIL BATH TUB 1.50 ADDRESS (,ue-m dU SHOWER 1.50 CITYle-vilogle.. LAVATORY 1.50 CONTRACTOR to J,3C4 I' , _ SINK 1.50 ADDRESS DISHWASHER' 1.50 CITY TEL. NO. CLOTHES WASHER 1.50 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE j PROCESSED BY LAWN SPRINKLER'SYSTEM 2.00 5�Q , WATER HEATER 1.50 INDUSTRIAL WASTE.APPROVAL GAS SYSTEM OUTLETS 1.50 © INSPECTION RECORD OUTLETS OVER 30 5 PER SYSTEM O IR9 O.. • �V�gyS e Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE APPROVALS DATE• INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING , Addres's GAS PIPING GfiS VENT City. Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANDS TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST ' .PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY,REGISTERED AND/OR UTILITY CO.NOTIFIED _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO _ RESIDE IN,THE ABOVE DESCRIBED RESICENTIAL PROPERTY. FINAL SIGNATURE ,TACK R. ALLEN,,;su PEavislN CH ANICAL EN'G'R. OF PERMITTEE me PERMIT VALIDATION cK. M.O. CASH, PLAN CHECK VALIDATION CK. M.O. CASH ::LR FRY13 5. D .3.5 ON 'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMOT r I h111111.1W-7, that I have a certificate of consent to self 76A667A 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 - Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS � � � � •'" Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY 1 WATER CLOSET 7' uL I Date Applicant NEAREST i CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 14 awl, COMPENSATION INSURANCE SHOWER OWNER id! (This section need not be completed if the(work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY �j ADDRESS U I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER .�/ t�`,,, ;• CONTRACTOR - Date ` �'� Applicant CLOTHES WASHER ADDRESS \ NOTICE TO APPLICANT: If, after making this Certificate o SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY •- TEL. NO. Compensation provisions of the Labor Code., you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO, CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL 0✓/� VALIDATION > DATE �- �' License Number Lic. Class O FIN (� Contractor Date B IX ElQ' I am exempt under Sec. OC> B.BP.C. for this reason W Plan check fee p, Date: PLUMBING PERMIT ISSUING FEE$ / Z 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 Address Law for the following reason (Section 7031.5, Business and Rrofessions 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 2586-1 A 7044, Business and Professions Code). Poo CONSTRUCTION LENDING AGENCY # 0 0 0 0-0 5 1 hereby affirm that there is a construction lending agency for _ -_- ( o 0 1 6 5 0 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 0 0 0 16505 f 1.04=86 Lender's Name 7.- -• '• � •� 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-mentionedpr perty for'nspection purposes. SEE•REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date `ter.WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT � rgby affirm that I have o 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 Certified copy is hereby furnished,❑ BUILDING j FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS LOCALITY 7 �(�e (�1 Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @FEE ,J ,/J J Date Applicant WATER CLOSET NEARESTr CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. "Zo l�a as_t COMPENSATION INSURANCE SHOWER ,s OWNER ��,CL (This section need not be completed If the work.involved by the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS v Z I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR ` 2 i Date,? �'jrnpplicant A��/.o7�-t7 A, CLOTHES WASHER ADDRESS NOTICE TO. APPLICANT: If, after making this Certificate of Exemption, you should become subject t6 the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO.. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO.GAS SYSTEM OUTLETS L5—.ax OCESSE BY v I hereby affirm that I am licensed under provisions of Chapter 9 l� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER >_ and Professions Code,and my license is in full force and effect. 5 PER.SYSTEM FINAL VA ATION IL DAT?6 6--" License Number Lic.Class 6u FIN ad Contractor Date BY ❑ I am exempt under Sec. LU� B.BP.C. for this reason Plan check fee DipDate: PLUMBING PERMIT ISSUING FEE$ S`Q P_2 0 6,4 A Signature TOTAL FEE D # o o 0 0 0 5 Plan check applicant SINGLE FAMILY ° 4 Q 5 0 HOME OWNER-BUILDER DECLARATION•, Name I hereby affirm that I am exempt from the Contractor's License o 0 0 4 0,5 0 v Law for the following reason (Section 7031.5, Business and Address 0 4L 2 0—8 5 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 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 !hat 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