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Home My Public Portal About4904 ARDSLEY DR_Plumbing__ 76A667 •CE#817 4-64 . APPLICATION FOR UMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER le- WILLIAM BUILDING AND SAFETY DIVISION ADDRESS v JOHN A. LAMBIE, COUNTY ENGINEER A. JENSEN, SUPT OF BUILDING LOCALITY P �. FOR APPLICANT TO FILL IN NEAREST i_„ 4 Zg CROSS sr. of NUMBER FIXTURE OR ITEM EACH FEE OWNER Qr\ WATER CLOSET S1.25 /" ', MAIL BATH TUB 1.25 ADDRESS �c�G r SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO.16 CONTRACTOR' STATE LAUNDRY TUB 1.25 S -7 7`y it' COUNTY [IREGISTRATION NO. Z /'v CLOTHES WASHER 1.25 DIST ICT NO GRO�IP ZONE P SSED BY WATER HEATER 1.50 t zit GAS SYSTEM�OUTLETS 1'S0 Il, INDUSTRIAL APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD (J O H V W a U) I I I I i APPROVALS DATE INSPECT9,R'S SIGNATURE PERMIT $ 2 00 UNDER,$LAB WORK - ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP (CATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN STATE OF GAS TEST VE DE9C �RESIDENTIAL P CALIFORNIA OR THAT I AM THE LEGAL OWNER IO F. INTEND TO RESIDE IN, THE ABORO UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL VAL ROBERT A. WOOD M.0. CK. M.0. cnsH SUPERVISING MECHANICAL ENG'R 7 7 c r ry 76A667 - bEe17 5/70 APPLICATION FOR PLUMBING MIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING.J JOHN A. ILAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W JEINKINS SUPT OF BUILDING LOCALITY 10'T. FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST CROSS ST. (i + NUMBER FIXTURE OR ITEM EACHFEE OWNER WATER CLOSET 1:50 MAIL BATH TUB 1.50 ADDRESS �?-- SHOWER 1.50 CITY TEL. LAVATORY 1.50 CONTRACTO j SINK 1 ' V ADDRESS n DISHWASHER 1.$. CITY ` TEL. NO. CLOTHES WASHER 1.50 STAT LIC LICENSE NO. Com- CLASS' SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP I ZONE PSED BJy LAWN SPRINKLER SYSTEM 2.00 -.•� �� ' � C��s� WATER HEATER 1.50 INDUSTRIALS al WASTE APPROVAL O0 GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD OUTLETS OVER - - ,30 5 PER SYSTEM 6d.B N z b Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING F'EE..S 00 TOTAL FEE Jr� APPROVALS DATE INSPECTOR'S SIGNATURE .ry. Plan check applicant UNDER SLAB WORK Marne . r �4QJ ROUGH?PLUMBING Address " - GAS PIPING' GAS VENT City.AEC, - Tel. No. ()4,, C HOT WATER HEATER I 'HEREBY ACKNOWLEDGE Tj4AT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOV IS CORRECT AND AGREE TO.COMPLY PLUMBING FIXTURES - WITH ALL' COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST - PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO S RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL ',SIGNATURE - .TACK R. ALLEN, SUPERVISING M CHANICAL ENG'R. OF PERMITTEE t ,:., PERMIT VALIDATION IION C K. M.O. CASH PLAN CHECK VALIDATII CK. M.0. CASH Lta.2484&-- s 2.2 D - 6.50- 1. WORKERS'COMPENSATION DECLARATIONDARI•poP0 0Gv�[�0�10 � PERKY 0 ��C�Q��OO �1 FOP, 4tereby affirm that I have a certificate of consent to self 76A667A '*,k,, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) � ertified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES / BUILDING AND SAFETY fo?.S ol�n-Sy . S r� y Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS NUMBER FIXTURE OR ITEM @ FEE LOCALITY tion de artment. C E � • Date ; Applicant %LX,, WATER CLOSET NEAREST CERTIFICATE OF EXEMPTIOIVFROM WQ KERS' BATH TUB CROSS ST. ��vfiC COMPENSATION INSURANCE OWNER (This section need.nof be completed if the work involved by SHOWER the permit is for one hundred dollarMAIL s ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK' CITY C TEL. NO,��.S � so as to become subject to the Workers'Compensation Laws. DISHWASHER ///��,,, CONTRACTOR/ , LA S Date Applicant CLOTHES WASHER ADDRESS lJ ' // NOTICE TO APPLICANT: If, after making this Certificate of 2-SE /V. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. N Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM /M O.' �7'��/ with comply with such provisions or this permit shall be STATELIC. deemed revoked. WATER HEATER LICENSE NO. �S7 CLASS [ ' LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUT OVER ' and Professions Code,and m y license is in full force and effect. 5 PE Y EM �/ FINAL L+ VALIDATION � `! G• V 7f �O DATE rJ 0 License Number `I S7 2/16 Lic. Class �+, ,, FINAL . 0 Contractor 52V_A1� Date BY J ❑ I am exempt under Sec. Y/3.j y B.&P.C. for this reaso Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ A) Sv Signature TOTAL FEE Plan check applicant - SINGLE FAMILY � 2'8 9,7 A HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Fi o o.o o o 5 Law for the following reason (Section 7031.5, Business and Address J. • 2 c o 3'�`5 Professions Code): City Tel. No. ❑ I,-as owner of the property, will do the work and theJ Q,O 6)structure is not intended or offered for sale (Section r ; 7044, Business and Professions Code). 0"7 2 3-84 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 authorizerep sentatives of this County to enter upon the above-menti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7 43 Sign ot 117-f Perreee Date