HomeMy Public PortalAbout9421 WOODRUFF AVE_Plumbing__ t
W 0 R RS',COMPENSATION DECLARATION i ���������®N F®k PLUMBING PERMIT
••I here° affirm shot I have a certificate of consent to self 7SA667A
insur ,!or.Q certificate of Workers'Compensation Insurance, CE 817(REV.8/86) u
+or a•ferliWed cc" thereof(Sec. 3800, Lab. C.) I
w COUNTY OF LOS ANGELES DEPT. OF PUElLIC WORKS
P�oli'cy Nnif
Company :CNA 175. CO , ' ' ., •,, •:. `
NCed copy is hereby furnished. BUILDING
;r
�+ r FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS ', 942)'Woodruff
C rtified copy is filed with t e county building inspec- NUMBER FIXTURE OR ITEM
ti n department. If @ FEE LOCALITY
1 WATER CLOSET Temple City
Date Appligant = &MG- Plhg—. Trir, NEAREST
"CERTIFICATE OF EXEMPTIONi FROM WORKERS' BATH TUB CROSS ST. t
COMPENSATION INSURANCE SHOWER OWNER Dooninick Chi la
(Thi section nood not bo completed If the work involvad by MAIL 1133 Louise Ave
tho'permit is foi one hundrod dollars($100)or Goss.) LAVATORY ADDRESS '
I certify that in the performance,of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY Arcadia •TEL.NK446-6690
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR Owen Bros. Mg., Inc.
Date Applicant CLOTHES WASHER ADDRESS 4265 N. Baldwin Ave.
NOTICE TO APPLICANT: If, :after making this Certificate of SWIMMING POOL RECEPTOR
t Exemption, you should become ;subject to the Workers' CITY .El Mbnte TEL.NO. 443-0078
Compensation provisions of the Labor Code, YOU must forth-
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER NEATER LICENSE NO. 231 741 CLASS C36 20 ,
LICENSED"CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DICT t4 PROC ED BY
I hereby offirm,that I am licensed under,provisions of Chapter 9 //vVJI �VUu(
't ;(commencing with Section 7000)of Division 3 of,the Business OUTLETS OVER. IL
bnd Professions Code,and my license is in full force'and effect. 5 PER SYSTEM FINAL VALQD IOiN
DATE
.'License Number 231 741 Lic. ClasQ 20 -� lC
FIN
Contractor
Owen Bros. Pibg., Irly R-5-R7 B ' v
❑ ECJ
I-am exempt under Sec. IL
I• OT
B.BP.C. for th' reasof z
Plan check fee
Dat - IA — #A 7.7 7 3
j� PLUMBING PERMIT ISSUING FFE$
Signatur 6
TOTAL FEE I;( o,o ` EL 5 0
Plan check applicant o o -.2a rj'
SINGLE FAMILY p C a 2 7'• 8 7
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
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
I certify that I have read this application and state that the I
above Information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing,'and hereby
authArize representatives of is County to'enter upon the
bave-me i ed Rroperty f r is purposes.
SEE REVERSE G°®It EXPLANATORY LANGUAGE
L 8-5-87'
ignature of Permitted,/ Date
DEPARTDIMU OF COUWW ENGIINEEPLUMBING '1
R,
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COXT14TY OF LOS ANGELES
1j:DDRESS
LDIN �/ J ) /J
' WILLIAM J. FOX, COUNTY ENGINEER GL r,
LOCALITY00
,,�.,�
FOR 4PIPLIPANT TO FILL I NEAREST
ADDRESS
BUILDING A� JCir,��7~<</�� CROSS ST.
' ivy
100
LOCALITY , ' DISTRICTN0. GROUP ONE �sPER,{MIT`N0.
NEAREST " 4J .h (� �S✓ APs—
CROSS ST. R CEI ED BY Ready for Inspection DATE ISSUED
OWNER
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
•` CITY TEL.NO.
INSPECTION RECORD
e � ,
PLUMBER _ -
ADORES
TEL�.yNC.
LICENSE NO. CJ G+ I ®l.. !-7 COUNTY J
PERMIT FEES <
z_
4UM9ER TYPE OF FIXTURE OR ITEM FEE 17
WATER CLOSET(TOILET) @ 0.80 S
O
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
FLOOR SINK @ 0.60
FLOOR DRAIN @ 0.80
DISHWASHER @ -0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM.............. UTLETS @ 1.00
//Y—f—HEATER -R6r4 @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE OD
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE AGO V DESCRIBED ESIDENT PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE -
OFPERMITTEE.-•_. -.._.-a------...----. ..+ ..'v�!-r.'� _--p•- FINAL
ram
76A067 DBS 17 ra