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Home My Public Portal About9420-9422-9424 WOODRUFF AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION �eass�n I hereby affirm tlhat I have a' certificate of consent to self ,cE e+7(2-60) A P P L I C APT I Q.N FOR PLUMBING PERMIT +�: . I ^ insure,or a cernfiCaie oaf Workers'Compensation Insurance,or <' a cj rtified copy thereof(Sec.3800,Lab. [ a �� a-/ VI COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ompany n Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING !� Certified copy is filed wi the count building inspection NUMBER FIXTURE OR ITEM ® FEE ADDRESS " Datede art e t WATER CLOSET - LOCALITY C� Applicant NEAREST BATH TUB — CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER f s MAIL } (This section need not be completed"if the work involved LAVATORY ADDRESS 0- by by the permit is for one hundred dollars ($100) or less.) SINK O CITY C TEL. S� r U I certify that in the performance of the work for which this DISHWASHER C7_ ir permit is issued, I shall not employ any-person in any manner / CONTRACT ZC � O so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS l9 U Date Applicant SWIMMING POOL RECEPTOR d ' W NOTICE TO APPLICANT: If, after making this Certificate of CITY L.N _z y Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM Z STAT ��j LIC. C-36 Compensation provisions of the Labor Code, you must forth- _ LICENSE NO. �0f� l Z� CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS 2 DISTRICT NO. P'R CESSSoD BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER c 6.0, du I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL �-} VALIDATION ness and Professions Code, and my license is in full force and I DATE � °` C� effect. 1pp�� /�� I FINAL License u be L� Lic.Class BY Contract o Date I am exempt from the licensing requirements as I am a I Plan check fee / licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). I TOTAL FEE Lic.or Reg.No. Date- Plan check applicant HOME OWNER-BUILDER DECLARATIONName ,I I hereby affirm that I am exempt from the Contractor's Address License Law'for the following reason (Section,.7031.5, Busi- City Tel.No. 0 6 2 4 A ness and Professions Code): I, as owner of the property, am exclusively contracting I # 0 0 0 0 0 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). 2 0 - 61.00 CONSTRUCTION LENDING AGENCY P o a 0-61,006 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ( 08. 04-81 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 ;I SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representati s of this County to enter upon the Bove- enti. ed ro ert for inspection purposes. OVE ig ature o ermrtt a Date l 76 A 667—CE 817 8/68 r! _�la� .J APPLICATI FOR P PERMIT" COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE ' WATER CLOSET 1.50 OWNER MAIL +^ BATH TUB 1.50 ADDRESS 4 r #7011'( SHOWER 1.50 CITY TEL. NO. - a1 LAVATORY 1.50 CONTRACTO SINK 1.50 ADDRESS J-719 91 gf—de,!Sek DISHWASHER 1.50 CITY TEL. NO. % CLOTHES WASHER 1.50 STATE LI L I C E N S O. CLASS SWIM117ING POOL RECEPTOR 1.50 DISTRICT NO. GROUP I ZONEROCESSED BY LAWN SPRINKLER SYSTEM 2.00 r' r3 CD WATER HEATER 1.50 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 I— PECTION RECORD _�� W OUTLETS OVER 30 h 5 PER SYSTEM Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ` AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF • CALIFORNIA OR THAT I AM HE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DES IBED SIGENTIAL PROP RTr. FINAL SIGNATURE JACK R. ALLEN, SUPERVISING M€CHANICAL OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH I ►��',. 3 9 5 5R RAR 5 5 0 3.5 0--, c