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Home My Public Portal About5149 ARDEN DR_Plumbing__ DBS1l 87,0-59 APPLICATION F®R"-PLUMBI G PERM-9T DIVISION OF BUILDING•AND 'SAFETY Department of County Engineer County' of Los Angeles "ULD' ULD1 NG / . Y JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS - CASSATT D..GRIFFIN,SUPT OF BUILDING - LOCALITY T �/��. C /7 FOR APPLICANT TO FILL INNEAREST- /� CROSS ST. ~ OWNER i��D 0-A LR 19 DISTRICT NO. GROUP.1 ZONE READY FOR INSPECTION MAIL'ADDRESSo� _'• Qt J3 SO. Tlf ��•r _ - 4 I J/ INDUSTRIAL CITY '✓ EL. NO. - - WASTE APPROVAL a ey ' ' Uig ,erg o. j PLUMBER INSPECT30N RECORD 442 V. Fleetw6c.d ,Pl. ADDRESS Ea 14 CITY en oI3 TEL. NO. LICENSE NO. NUMBER TYPE OF FIXTURE.OR ITEM - FEE f/ I %O111 WATER CLOSET (TOILET) @ $1.00 BATH TUB , - - @ $4.00. A .. _d' V'lH_A R✓�, ��6d G, SHOWER @ $1.00 LAVATORY'(WASH BASIN)' @ '$1.00 KITCHEN SINK _ @ .$1.00 . DISHWASHER '@. $1.00 I _ LAUNDRY TUB OR TRAY $1.00 CLOTHES WASHER _ @' $1.00 - WATER HEATER @ $1.00' - GAS SYSTEM, @. $1.00 - i APPROVALS -. - DATE : INSPECTOR'S SIGNATURE ' UNDER '2 WQ)i�y{RK - PERMIT, 1 OO".$ ... ROUGH PLUMBING ' GAS PIP,ING " TOTAL'FEE - - .GAS VENT _ I HEREBY ACKNOWLEDGE THAT I HAVE' READ THIS APPLICATION' AND STATE-THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY i"HOT WATER.HEATER - f 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 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1AM THE LEGAL' OWNER..OF THE ABOVE UTILITY CO.NOTIFIED AA DESCRIBED RESIDENTIAL PROPERTY•SIGNATURE" S/ OF PERMITTE INAL �l C JOHN.A. LAMBIE. COUNTY ENGINEER. 14ALIDATION ROBERTA.WOOD, CHIEF PLBG. IN CK. H.O, - CASH J ':1 4-9 2'0 FEB 25 3- A 1 0.0 0 ;L WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT L I here�iy affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) 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 .4gJq(S_Aj Certified copy is filed with the county building inspec- ADDRESIV. tion department. NUMBER FIXTURE OR ITEM a FEE LOCALITY Date Applicant WATER CLOSET NEARESTwoweh /� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS'ST. uL 2` U je'� £ 9 f eo L=-!V COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER 6 ,00 e /1; t P,-a�' the permit is for one hundred dollars ($100)or less.) ' LAVATORY ADDRESS y uV e S'(,J I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY i 1,2r- 0,4 TEL. NO. so as to become subject to the Workers'„Compensation Laws. DISHWASHER 7 7 � CONTRACTOR O�gsrao,�J r DateApplicanY� CLOTHES WASHER NOTICE TO APPLICANT: If, der making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. O SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER � and Professions Code, and my license is in full force and effect. 5 PER SYSTEM DATEL VqION d License Number Lic. Class FINAL 0 Contractor Date BY IU 4J JIM ❑ 1 am exempt under Sec. B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 1 ID 50 ® J�2 9 b 0 A Signature TOTAL FEE /� # 0 o o 0 6 5 Plan check applicant SINGLE FAMILY ) 0 0 2 8 5 0 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address o 0 - 2a505 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 0 9,20-85 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 0111.above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab ov entionedkpyroerty for inspection purposes. 9 —S - SEE REVERSE FOR EXPLANATORY LANGUAGE ignatuiAle of Permittee Date WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hereby affirm that I have,a certificate of consent to self 76A667A nsurr.,'0r'o certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING EJ Certified APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY / WATER CLOSET r 7` Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNERz (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less,) LAVATORY ADDRESS l N s I certify that in the performance of the work for which this ermit is issued, I shall not employ an person in an manner / O TEL. NO. C/ P P Y Y P Y SINK �� SN CITY �^ / /� � T�r s/sio so as to become subject to the Workers'Compensation Laws. DISHWASHER C ` T7 CONTRACTOR Date Applicant X�l'9 CLOTHES WASHER' ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY O. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER *()V4 LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION v DISTRICT NO. ,IP CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS00 (/J� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALI TION DATE 0 License Number Lic. Class F I Contractor Date I am exempt under Sec. B.BP.C. for this reason Date: Plan check fee PLUMBING PERMIT ISSUING FEE$ Q Signature =--2 3 0.Q A TOTAL FEE ISo # 0-00005 Plan check applicant SINGLE FAMILY I ° ° 2$,Jr 0 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License o o'o 0Law for the following reason (Section 7031.5, Business and Address 0 6 2 Professions Code): City Tel. No. LJ 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the Agnva ioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE f Irermittie Date i