HomeMy Public PortalAbout4903 ARDSLEY DR_Plumbing__ OBS-17'Z.
DAPPLICATION FOR PLUMBING PERMIT 7
BS.; DIVISION OF BUILDING AND SAFETY 1
Department of County Engineer
' County of Loa Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUP'T OF BUILDING e
LOCALITY 1
FOR APPLICANT TO FILL IN NEAREROSS ST. ! 1 ! 61
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OWNER fie,% L /�i �` DISTRICT NO. GROUP ZONE READY FOR INSPECTION
MAIL ) - f
ADDRESS "� 1 f�
- •1 F`."yy/ f R �. INDUSTRIAL
CITY Z PC4 � '� I TEL. NO., '� y/ ` WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS �"-
I�
CITY TEL. NO. _
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
i
LAUNDRY TUB OR TRAY
I
CLOTHES WASHER
1
I
TOTAL NO. @ 0.e0 APPROVALS
DATE INSPECTORS SIGNATURE
CAS SYSTEM OUTLETS @ 1.00
-- _ UNDER SLAB WORK
WATER HEATER @ 1.00
ROUGH PLUMBING _
PERMIT S 1 00 GAS PIPING
TOTAL FEE I 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 n
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGYLATING _ PLUMBING FIXTURES 4 .Ce
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED
CALIFORNIA OR THAT 1 AM THE-LEGAL OWNER OF THE ABOVE -
DESCRIBED RESIDENTIAL PROPERTY' 1�
SIGNATURE
OF PERMITTEE FINAL ti'J I c....-.
WILLIAM J. FOX, COUNTY ENGINEER VAY.IDATION
CO3 3 3 7 u MAY 3 3 3.4 � n
BY
r �p DEPUTY
P
76A667-CE�-'817 6-65 6J�
1.
APPLICATION FOR PLUMB N ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING G
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS /D s J� e
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY � l`a /y�yA r ,,I
FOR APPLICANT TO FILL IN NEAREST T. P, G i I & 'Yu
NUMBER FIXTURE OR ITEM EACH FEE
OWNER AD 0
WATER CLOSET $1.25 MAIL
t BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY �D y` TEL. NO.
LAVATORY 1.2S CONTRACTORL42 )I 1 y° l0 01—
SINK'
-.SINK' 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
STATE LIC
LAUNDRY TUB 1.25 LICENSE NO. CLASS
CLOTHES WASHER 1.25 DISTRICT NO GROUP z qJ4 E PRO SSED B
WATER HEATER 1.50
}
GAS SYSTEM _OUTLETS 1.50 ( INDUSTRIAL a,
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
H
U
LU
a
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMB NG,I
TOTAL FEE
GAS PIPING-&W&A& 3�rU'
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 M TME LEGAL WNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE CRIBED RESI TIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE •/
FINAL
ALIDATIC -1
CK. M.O. 1 CAS
i
LI XJU 0 6 1 8 n MAR 18 5 D 3, 0! c
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT f,1—II1
I hereby affirm that I have a certificate of consent to self 76A667A I I
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) u
or acertified copy thhereoff7(Sec. 3800, La C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
IV
Policy No. 3 u@ompany 7Ze Ili 6,v
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING O 172c�Sle
Certified copy is filed with the county building inspec- ADDRESS
tion department. _ NUMBER FIXTURE OR ITEM @ FEE
`� }� LOCALITY e /� r
Date �r ` Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER NTN
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 5; e
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. 3776
so as to become subject to the Workers Compensation Laws. DISHWASHER
CONTRACTOR o 12 ON
Date Applicant CLOTHES WASHER ADDRESS W-?/
�
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR 7 �
Exemption, you should become subject to the Workers' CITYTEL. NO.y/,y! t[ X(
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM �� /P ,` 1
with comply with such provisions or this permit shall be STATE C/./ /7 7 LIC.
deemed revoked. WATER HEATER LICENSE NO. U3 J 3- CLASS C 3
LICENSED CONTRACTORS DECLARATION y DISTRICT NO ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS �� Q
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force andel effect. 5 PER SYSTEM FINAL /5'Z �i VALI ATION y;
License Number C/ z
U`3 7 3� Lic. Class C v DATE �J 0
O
Contractor 00NAJy 'c Date FI ;2.4 7 6 2 A
0.'
❑ I am exempt under Sec. #,o.o 0 0 0 5 OO
B.&P.C. for this reasonPlan check fee ;��o o l 650 L
Date: o o o 1 6 5 0 5 N
PLUMBING PERMIT ISSUING FEE$ //) Z
Signature
TOTAL FEE 16 06,03-86
Plan check applicant
SINGLE FAMILY
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 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
authorize representatives of this County to enter upon the
above-mentioned property fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign�Permittee Date