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Home My Public Portal About9142 WOOLLEY ST_Plumbing__ WORKERS'COMPENSATION DECLARATION A PPLIC/tt,�� N F®® PLUMBING LA gp BING PERMIT I I hereby, affirm�{hat I have a certificate of consent to-self 1w 20-0026 DPW 4/90 i'�Q�I� �o�"A 8�i 1� e �i11/! ��! ?6A667A sure,ora certificate of Workers'Compensation Insurance,ora cer if'ed co th re (Sec. 800, Lab. C.) n OI , e `f-'S COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS POlicy o. Company Certified copy is hereby furnishe D-/ --Iv FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING I Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS departme T. @ FEE LocAunr Le- CJ-4 Date Applicant ' WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. jn kL,de_4_d� COMPENSATION INSURANCE SHOWER OWNER 6(,AJ0 Y I (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS j 0 �'• I certify that in the performance of the work for which this per- SINK CITY ��' T mit is issued, I shall not employ any arson in any manner so as to becomes 4(.1 ecfto the Worker penso ion Laws. DISHWASHER CONTRAC 0 Date Applicant r CLOTHES WASHER •^ , ADDRESS 15 � s Lee.& NOTICE O APPLICANT: If, after mating this C ificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY I.?(_ ) T . 4Hf r�I sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE /I `J LIC. C^ ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 0 and Professions Code, and my license is in full force and ef= 15 PER SYSTEM FINA VALIDATION fact. / t L / ZJD HOSE BIB DATE_ Aa License Nu r (Ji -_2 Lic. Class C� O FINAL V Contractor W41 — Date BY 2 O I am exempt under Sec. V B.BP.C. for this reason Plan check fee AGCLAT® S3760-644.10 ai Date: PLUMBING PERMIT ISSUING FEE$ 1 ITEMS SINGLE FAMILY TOTAL FEE D TOTAL 4-4 a 11131 HOME OWNER-BUILDER DECLARATION Plan check applicant CHECK 44.10 1 hereby affirm that I am exempt from the Contractor's License Name a O Law for the following reason (Section 7031.5, Business and CHANGE Professions Code): Address ❑ I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, af4 Business and Professions Code). 7663 i AC111:`4 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 a t rize representatives of this County to enter upon the e-m ntion d property for inspection puV-5-2 es. i SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Pe mitfee te D:B. „ 'SM BET9 12-43 - APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY - COUNTY OF LOS ANGELES �`� �' ' WM.J. FOX.CHIEF ENGINEER NG NATURE OF INSTALLATION falasTRICT NO. GROUP ZONE PERMIT O. ROUGH FIXTURES "COMPLETE _ I SEPTIC TANK �C READY FOR ., HEATER CESSPOOL � R BIVED BY DATE ISSUED FIRST SP ION I n AS- M18CELLANEOUSEEDI �� ® SESSION 0 ME APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY Joe d, NAME �-Ly� yn'i(J ADDRESS / D m ADDRESS D �/ �iGL/ �/ LOCALITY NEAREST CIm _@ h.t,•� &A TOEL.No. CROSS or. lL.., � L�•t1r COUNTY / T CERT.No. v EXPIRES NAME LOCATION OF SEPTIC TANK, OR CESSPOOL z' . MAIL NORTH" C ADDRESS CITY / /f/iL G TEL.No.: I AM THE L AL POSSESSOR OF TTHABOVE LOS G ANELES COUNTY CERTIFICAMO�UL'T.l.% fT10 PLulaesR I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. .= y OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK _z BATH TUB -FURNACE lY NOW ER —DISHWASHER O - LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER —FLOOR SINK BAND TRAP -SLOP SINK FLOOR DRAIN r7WAT ASH TRAY URINAL APPROVALS ATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME ER HEATER DENTAL LAVATORY I. I ROUGH PLUMBING ETER GAS SODA FOUNTAIN GAG PIPING I I ouTL GAS VENT CESSPOOL I OTAL NUMBER OF FIXTURES SEPTIC-TANK ESSPOOSEPTIC TANK _SEWER / .S TOTAL FEE. A 1+�0 UTILITY Co.NOTIFIED FINAL 0071—-7 / �/ r.. Lr✓ APPLICATION FOR PLUMBING PERMIT 1 )BS-17 10-59-17 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING JOHN A.LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING �JE �+ LOCALITY IQ G� FOR APPLICANT TO FILL INNEAREST r- Icc CROSS ST. OWNER �1 J DISTRICT NO. GROUP ZONE READY FOR INSPECTION MAIL ADDRESS 7 J D 0 �. INDUSTRIAL CITY TEL.NO. WASTE.APPROVAL PLUMBER J, INSPECTION RECORD ADDRESS /� CITY I/7 PP 7 TEL.N 1^ Z 51-0-5 LICENSE NO, NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET(TOILET) @ $1:00 $ BATH TUB @. $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING ^ GAS PIPING TOTAL FEE T� GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY 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 ANGELE COUNTY AND STATE OF CALIFORNIA OR THAT I p LEG OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTI 0 SIGNATURE OF PERMITTEE FINAL IOHN A.LAMBIE.COUNTY ENGINEER _ VALIDATION ROBERT A.WOOD.CHIEF PLBG. INSPECTOR CK. M.O. ,jj SH/ �11ACo7 6 8 4` :APR30 3 2.00 m