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Home My Public Portal About5033 WILLMONTE AVE_Plumbing__ ION N/"that I have a certificate of consent to 7�67ADPW 9lag APPLICATION FOR PLUMBING PERMIT I hereby affirm"that I have a certificate of consent to self insure, or i�pertificate.jof Worker's Compensation Insurance, or a certified cop thereof(Sec.3800 Lab.C.) 710 Company G� COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy dg— ❑ Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ) ❑ ADDRESS 3 w, Al G- Certified copy is filed with the co ilding in ectlon depa ment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY ke, Date Applican `""'� WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION F WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER d' I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK ADDRESS 3 �/✓ d h�/ ®/ Lo become subject to the Workers'Compensation Laws. [� DISWASHER CITY ( TEL.NO. C o7,9 Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of ® 64,f Z/v�/___ Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such -Al provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY r TEL.NO !� I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER IL (commencing with Section 7000)of Division 3 of the Business and LICENSE NO. / LIC. Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS (,) OUTLETS OVER DISTRICT NO.� PROCESSED BY It �J 5 PER SYSTEM License Number3 S - /•�/ Lic.Class V /nom,f/ / FINAL VALIDATION III ContractortT'� b"am 2 DATE t Z^F ,Qj_ IL Date t L° v ❑ I FINAL Z I am exempt under Sec. BY B.&P.C.for this reason Plan check fee Date: Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE SINGLE FAMILY Plan check applicant AFI T=o` HOME OWNER-BUILDER DECLARATION Name 5ti} L = ,1:' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions AddresstNEED? s Code): _ �.; F1 1. Tel.No. TOTAL(T AL 4 -1 _85 5 I,as owner of the property,will do the work and the structure is not Intended or offered for sale(Section 7044, Business s; -L(_:�' t;i=85 and Professions Code). 00. CHANGE .00 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.) !I I!I^e i0i': 9/23/94 9 -7i3 s 'r•1 '�r 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 to laws regulating Plumbing, and hereby authorize dsent vas of thi oun to enter upon the above-mentioned arty for'nspe on u� SEE REVERSE FOR EXPLANATORY LANGUAGE 6 ra nr Parmittaa Data APPLICATION A �p�{� �e WORKER'S COMPENSATION DECLARATION 76A666 DPW 9189 q PPLIC p TION FOR PLV MBI.NG PERMIT 76A667A d'� /� 9 j�[ 'I hereby affir�i�that ti have a certificate of consent to self insure, or a-c$ff fc—Er.of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No � � ,ZA2/_q fCompany s TIT ,[� COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. �Y ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING DDR SS ied copy is filed with the CDDR SS �� ❑ Certified copy is filed with the c2nlybnginspection department. NUMBER FIXTURE OR ITEM FEE q /�f LOCALITY Date [ 3 -( Applicant WATER CLOSET 916 NEAREST ,CERTIFICATE OF EXEMPTION FRO ORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK Be�O y PAGE4A 3 PARCE permit is for one hundred dollars($100)or less.) OWNER 1 certify that in the performance of the work for which this permit LAVATORY AIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS ��3 become subject to the Workers'Compensation Laws. DISWASHER CI TEL.NO.Date Applicant �7 NOTICE TO APPLICANT: f, after making this Certificate of CLOTHES WASHER CONTRACTO a_r Q// Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS el provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER Cmr�C �N TEL.NOM ( (� 1 hereby affirm that I am licensed under provisions of Chapter 9 STATE ^ LIC.G (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. 7!2 CLAS () Professions Code,and my license is in full force and effect. R DISTRICT NO. PESS EaBY OUTLETS OVER �-• ._ / 5 PER SYSTEM �� C License Number, � � ` Lic.Class _ IC .6*6- FINAL DATE VALIDATIOI0,,E LLJ I� �� d Contractor �� Date FINAL TO AL 31-03 6'&c ❑ I am exempt under Sec. 'By C�'7Z J A- CHECK �il-a=;J i B.&P.C.for this reason w.Hi•CHANGE F Plan check fee ® _013 Date: Signature PLUMBING PERMIT ISSUING FEE$ :.b TOTAL FEE q9. 6> h(I_l�i±,—:JLI�+i to/ F18U5 'I = t Plan check applicant i Ari 113=37 4 SINGLE FAMILY • HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address 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 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 45n,tatives ofthisor ins io ur SEE REVERSE FOR EXPLANATORY LANGUAGE � f Permittee Da4e '76A667-CE817 12/59 APPLICATION FOR PLUMBING PERMIT, COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER B�TI�I�NG��M SAFETY �MSION BUILDING � O A. MBI COUNTY NGINEER ADDRESSO yy WILLIAM A.JENSEN,.SUP•T'OF BUILDING LOCALITY � c FOR APPLICANT TO FELL IN Naos T rJ NUMBER FIXTURE OR ITEM OWNl� WATER CLOSET MAIL. RATH TUB ADDRESS CITY TEL.NO. SHOWER L LAVATORY CONTRACTOR .vim �O 01. Sm ADDRESS lj Q DISHWASHER CrfY DAj ��w TEL. NO. J5� 1g)!R CONTRA TOWS STATE LAUNDRY TUR I REGISTRATION NO. 4oel_3'6 G COUNTY ❑ CLOTHES WASHER. DICT NO GRpldf' ONE P C ED BY WATER HEATER (�Jj GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 0 U ' PG 0 F . W - a " m $1.00 PER ITEM OR FIBTURE $ /Jf:OO AP 0 ALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 2 00 TOTAL FEE I f v ROUGH.PLUMHING GAS PIPING v AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS PENT STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I ARI PROPERLY REGISTERED AND/OR PLUMBING FIXTURES .LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST G CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL Ppw4p oUTILITY CO.NOTIFIED SIGNATURE OF PERMITTE FINAL ®■ ALIDATION ROBERT A.WOOD, cs. N.0. CASH SUPERVISING MECHANICAL ENG,R i�