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HomeMy Public PortalAbout4834 ARDEN DR_Plumbing__ 76A667-CE817-8-57 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY L„ FOR APPLICANT TO FILL IN NEAREST +A CROSS ST. y w c NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL.NO. CONTRACTOR LAVATORY SINK ADDRESS c �G DISHWASHER CITY TEL.NO. LAUNDRY TUB CONTRACTOR'S STATE El REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT GR 6LP ZONE kEADY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a APPROVALS @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE OR FIXTURE $ UNDER SLAB WORK ROUGH PLUMBING PERMIT S 1 00 a GAS PIPING EI TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ". UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATU RE OFPERM TTEE- � .� FINAL ROBERT A. WOOD. ©< ALIDATION SUPERVISING MECHANICAL ENG'R K. M.0. CASH L,G 2 2 0-3 2.0. MAR 20 3 A 3.0 0 M WORKERS'COMPENSATION DECLARATION 7GA667A I hereby affirm that I have a' certificate of consent to'self CE 817 (z-eo) .APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY • Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING n ADDRESS Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ! FEE - department. WATER CLOSET LOCALITY d Date Applicant NEAREST i BATH TUB CROSS ST. C CERTIFICATE OF EXEMPTION FROM WORKERS' _ COMPENSATION INSURANCE SHOWER OWNER C LAVATORY MAIL (This section need not be completed if the work involved ADDRESS ( s �- by the permit is for one hundred dollars ($100) or less.) SINK. CITY TEL. NO. I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR 0 so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS 0 Date ApplicantLU SWIMMING POOL RECEPTOR C. NOTICE TO APPLICANT: If, after making this Certificate of CITY. TEL. NO. to Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- ' LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT N16 PRO ESSED BY LICENSED CONTRACTORS DECLARATIONS'.U OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL / ness and Professions Code, and my license is in full force and DATE A0 r c"a VALIDATION effect. FINAL _ License Number Lic.Class BY °mom Contractor Date I am exempt from the licensing requirements as I am a Plan check fee 2 licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE 3,)- d Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name 110101,0 I hereby affirm that I am exempt from the Contractor's Address 493q License Law for the following reason (Section,7031.5, Busi- City` Tel. No < '5 2 1. 1 A ness nd Professions Code): U as owner of the property, am exclusively contracting 0 0 0 0 0 5 F with licensed contractors to construct the project 2 o,- 3250 (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY ° ° ° 3 2 5 0 C5 I hereby affirm that there is a construction lending agency L7 1.2 —8 2 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the :abWov ,onemr e rinspection rpos s. 2 Signat e o Permittee Date