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Home My Public Portal About4816 WILLMONTE AVE_Plumbing__ WOREAS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT f hereby affirm that I have a certificate of consent to self 20.0026 DPW 6/87 �j �insurq, or a certificate of Workers'Compensation Insurance, 76AG67A I ILII qr a 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) ADDRESS SI6 I LL M 0 M T P- Certified copy is filed with the county building inspec- q, tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appli4ant 1 WATER CLOSET bNEAREST S4 I ) //�� , CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. fOw�2 /TL v 5 ff COMPENSATION INSURANCE I SHOWER OWNER vG1eOMtCA - C 0 R—( 9 9 (This section need not be completed if the work Involved by o . d30X 15-0!;- the permit is for one hundred dollars(:100)or less.) ' LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this Z�l/_ g V permit is issued,I shall not employ any person in any manner SINK CITY eoS�Ass 643 TEL.NO. �'" 3 6 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR 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 TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM OP with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. �PROCESSED BY I hereby off irm•that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER I• !/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM. FINA Com/ VALIDATION a ' License Number Lic. Class DATE (, FINAL��/a�%� "V Contractor Date BY C _ C ❑ I am exempt under Sec. t. LL BAP.C. for this reason V Plan check fee D Signature Date: PLUMBING PERMIT ISSUING FEE$ ' TOTAL FEE- -� Plan check applicant ' SINGLE FAMILY 5 HOME OWNER-BUILDER DECLARATION Name � � a I hereby off irm that I am exempt from the Contractor's License Address A Law for the following reason (Section 7031.5, Business and Professions Professions Code): City Tel. No. I, as owner of the property, will do the work and the 1 ITEMS EMS structure is not intended or offered for sale (Section TOTAL OTAL 43. 00 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK 43.011 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGE '°00 (Sec. 3097, Civ. C.). I , Lender's Name 0000_CIOOI 0/25/911 Lender's Address 352 1 AN 3:10 I certify that I have read this application and state that the.I above inform tion is correct. I agree to comply with all County ordinances a diState laws regulating Plumbing, and hereby authorize entatives this County to enter upon the above- i y for Inspection p pose L O SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermittee Date APPLICATION FOR PLUMBING PERMIT , 1 COUNTY OF LOS ANGELES + DEPARTNINT'OF COUNTY ENGMM BUILDING AND SAFETY DMSION BUIIAING CASSATT a:Gains s�tEn. � ADDRESS !36914 LrJi�. �nnii o r S T. LOCALITY � . � c:� j T • FOR APPLICANT TO FILL IN NEAREST CROSS ST. �o uJ,s.� fi z✓sem .�`b . NUMBER FIXTCIRE OR ITEM WATER CLOSET OWNER vi r T MA>L BATH TUB ADDRESS SHOWER CITY TEL NO. LAVATORY CONTRACTOR t p e e gip:,j B 00>1 7',e S iv gig DISHWASHER CITY Fl )�. , r TEE.NO.G LAUNDRY TUB CONTRACTORB p STATE JA rMW:ASTE ISTRATION NO. /06-7.54-1/,$' COUNTY CLOTHES WASSEB GROPU� NE READY FOR INSPECTION WAY88 HEATERGAS SYSTEM USTRIAL APPROVAL INSPECTION RECORD' ' �/ �-ccrfl"s 16. � •uei> • .� �� f a ry � ROYALS , @ $1.00 nil ITEM DATE INSPECTOR'S SIGNATURE OR FDCTURE $ 1700 UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING TOTAL FEE . o� GAS PIPING LAHA BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT r 1� TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER d LL COUNTY ORDINANCES AND STATE LAWS REGULATING p G. PLUMBING FIXTURES y EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS•TEST D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE-; 'UTI.LITY CO.NOTIFIE13 ED RESIDENTIAL PROPERTY. URE44, FINALMITTE OBERT'A.WOOD. Or _ATION UPERVISING.MECHANICAL ENG'R H.O.. CASH L (,'O 7 5 6 3 .,;t�tJ 5 5 A - -9.00 76P16B7-CE817-858 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTNIENNT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION � �33 JOHN A.LAMIE. Cwmty �aees CASSATT D.GEM=,Snp t 01 S�aZg J FOR APPLICANT TO FILL IN REABEST G CROSS ST. NUMBER FIXTURE OR ITEM WATER CLOSET OWNER RATH TUB ADDRESS Y� Q ` SHOWER CITY TEL NO. LAVATORY CONTRACTOR smis immm 11349 E Miloam 8t.o DISHWASHER cm ArCadla TEL.NO. Hi 6 7588 TQB CONTRACTOR'S STATE REGISTRATION NO. 179122 COUNTY CLOTHES WASHER DISTRICT NO. GROUP ZONE PR CESSED BY WATER HEATER 1416p GAS SYST>OII nmuemn WASTE APPROVAL INSPECTION RECORD APPROVALS @ $$1.00�� $ DATE INSPECTOR'S SIGNATURE UNDER•SLAB WORK PERMITS 2 00 ROUGH PLUMBING TOTAL FEE G® GAS PIPINGI li I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT.WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES !� I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND .STATE OF CALIFORNIA OR THAT I AM THE LE OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIA OPERTY SIGNATURE FINAL OF PERMITTE ROBERT A.WOOD. ®p VALIDATION SUPERVISING MECHANICAL ENG'R CK. M.0. CASH L,AGo 0 s 7 86t; AUG 7 5 A :5.0 V R