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Home My Public Portal About4909 ARDSLEY DR_Plumbing__ 76A667-CE#817 2-66 APPLICATION FOR PLUMBING P RMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /j JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (/ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS S NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADD Q Cly TEL. NO. SHOWER 1.2S LAVATORY 1.25 CONTRACT SINK1.25 ADDRESS oG(1 DISHWASHER 1.25 CIT TEL. NO. '�6) LAUNDRY TUB 1.25 STATE LIC LICENSE NO. CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 -5—d GAS SYSTEM OUTLETS 1.50 INDUSTRIAL >- WASTE APPROVAL o OUTLETS OVER 5 PER SYSTEM .30 _ INSPECTION RECORD U z CD H U LLI CL. Cn Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 OO UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIR Y LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR TH I A THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE AS V DE ED R SI ENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE �] OF PERMIT T FINAL !�•�(��" � ? VALIDATION JACK R. ALLEN CK. M.0, CASH SUPERVISING MECHANICAL ENG'R. OCT 1 6 5 D 3.5 0 WORKERS'COMPENSATION DECLARATION20-0026 DPW APPLICATION FOR PLUMBING PERMIT 4/87 CCC��tttlll I hereby, affirm that I hove a certificate of consent to self in- 76A667A l sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) Iu1 certif copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC'WORKS c o. Company / 4K Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS cs e department. NUMBER FIXTURE OR ITEM @ FEE �( LOCALITY eh7 Date V Applicant, Z WATER CLOSET(TOILET) NEAREST G► CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB_ CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section,need riot be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I-shall not employ any person in any manner so SINK CITY TEL. NO. as to become subject to the Workers' Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS SWIMMING POOL RECEPTOR G G emption, you should become subject to the Workers'Compen- CITY �i/ TEL. NO� sotion provisions of.the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE T LIC. ed. , WATER HEATER (oloG LICENSE NO. 0133-6/10 O CLASSY:JXI LICENSED CONTRACTORS DECLARATION / DISTRICT NO. IAC SED BY I hereby affirm that I am licensed under provisions of Chapter !' GAS SYSTEM OUTLETS 00 � G' 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my License is in full force and ef- 5 PER SYSTEM FINAL VALI TION feet. DATE ^� License Number Lic. Class O FU IN � Contractor Date B O I am exempt under Sec. B.&P:C. for this reason pop- -Plan check fee g Date: PLUMBING PERMIT ISSUING FEE$ V 450 , Signature TOTAL FEE 22 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and ,. Professions Code): Address ❑ zv +.�_� I, as owner of the property, will do the work and the Cit Tel. No. _ structure is not intended or offered for sale Section 7044, Business and Professions Code). r'..=i•iW. 22 .50 CONSTRUCTION LENDING AGENCY 22 2 �.: I,hereby affirm that there is a construction lending agency for °=° `'3E' the performance of the work for which'this permit-is issued tw: as (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 t is County to enter upon the abov a tioned prgpert inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Perm frt e6 Date ---7