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HomeMy Public PortalAbout4940 ARDSLEY DR_Plumbing__ \76A667 (.CE7-817) - 5/73 " APPLICATION FOR PLUMBING. PERMIT• COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDINGADDRESS © HARVEY T. BRANDT, COUNTY ENGINEER =LOCALITY ,O FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS.ST. NUMBER FIXTURE OR ITEM @ FEE ' OWNER 1 , .WATER CLOSET 1.75 BATH TUB 1.75 -ADDRESS- 75 DDRESS SHOWER 1'. f' CITY p�j / TEL. NO. LAVATORY 1.75 CONTRACTOR SINK `ry - '�`;�\+ 1.75 /' ADDRESS % �`/' I DISHWASHER 1.75. G`� CITY � v._ .- TEL. N O.� .. y_►�'/.,� CLOTHES WASHER 1.75 STATE % LIC LICENSE N �� ! CLASS /3 SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. G. O�1P ZONE FROCESSED$Y LAWN SPRINKLER SYSTEM 1.75 F ss •)� WATER HEATER 1.75 INDUSTRIAL _ WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 �� INSPECTION RECORD o OUTLETS OVER a... rZp 5 PER SYSTEM 30 1'x,[.'7,74, 1 %,QZ9J*1A! 97,,ale 1Lt-n+'... O Alm52 1 " ' a Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEES 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant UNDER SLAB WORK i Name ROUGH PLUMBING Address - GAS PIPING - City Tel. NO. 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 PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST e _ - r 4 l-m,j I HEREBY CERTIFY THAT I AM PROPE GIS EKED AND/OR '7 ,UTILITY CO. NOTIFIED' LICENSED AS REQUIRED BY LOS NG S C C7 .T D S?ATE OF CALIFORNIA OR THAT I AM T L G _ W R OF, A D IN TO ' / RESIDE IN THE ABOVE DESC ED ESI IAL PROPE TY. FINAL SIGNATURE - OF PERMITTEES PEI T VALIDATION CK. M.O. CASH SH PLAN CHECK VALIDATION K .0. CA / 1 2 6121 3 its 5 01 1.7 5 w� - P76A667 CCE-817) - 5/73' (/n APPLICATION FOR PLUiMBING Rill" COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING. ADDRESS' l/ HARVEY T. BRANDT, COUNTY ENGINEER -LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST. ofo� CROSS ST. 7 s NUMBER FIXTURE OR ITEM @ FEE YL WATER CLOSET 1,75 OWNER MAIL BATH TUB l..75. 'ADDRESS SHOWER 1-.75 CITY TE NO.' • w. LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS � f DISHWASHER 1.75 5 '-CITY ;` G �� 'NO. CLOTHES WASHER 1.75 f STATE LIC ��11 LICENSE NO: CLASS" 9� SWIMMING POOL RECEPTOR 1.75 DISTR+EPT NO. GROUP F CESSED BY LAWN SPRINKLER SYSTEM 1.75 , WATER HEATER 1,75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 / OUTLETS OVER INSPECTION RECORD CD 5 PER SYSTEM .30 O ' H CIO Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEES .3 00 TOTAL'FEE - APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant UNDER SLAB WORK Name ;may ROUGH PLUMBING Address GAS PIPING Tel. NO. . f - GAS VENT City t rHOT WATER HEATER I EREBY 'ACKNOWLEDGE THAT H VE READ THIS APPLICATION AND STATE THAT THE ABOVE I&PCORRECT AND AGREE TO COMPLY PLUMBING FIXTURES L� �• WITH'.. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,.AND INTEND TO - RESIDE IN THE ABOVE OESCRIBEED-RESIDENTIAL PROPERTY. FINAL i SIGNATURE OF PERMITTEE - PERMIT VALIDATION cK` M.O. CASH PLAN CHECK VALIDATION^ CK.` M.O. CASH — v Vit' %�' DEC 5 D 8.2 5 A WORKERS' COMPENSATION DECLARATION APO PUCAMN FOR PLMMMIG .PeRMOT `1 hereby d'ffirm that I have.a certificate of consent'to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A IL JI or o certified cop ,t/h�ereo (Sec. 380(O,LLLob. **C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC'WORKS' Policy No. IT^ '� 0mpany-lrJ/ ❑ Certified copy is hereby furnished. : "�f/ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑" Certified copy is filed with the county Ejuilding inspec-. ADDRESS tion department. ,f � NUMBER FIXTURE OR ITEM @, FEE CALITY Date Applicant'6Jh AWAt L NOEAREST CL WATER CLOSET CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the-work involved by SHOWER h MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY .' ADDRESS " 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner. SINK , _ CITY L..NO. ,. so as to'become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR Y Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' '-'T ' Compensation provisions of the Labor Code, you must forth CITY C. NO. with comply with such provisions or this permLAWN SPRINKLER SYSTEMit shall be STATELIC. deemed revoked. WATER�HEATER LICENSE NO. q1V4 3CLASS v LICENSED CONTRACTORS DECLARATION DISTRICT N_ ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 11. (commencing with Section 7000) of Division 3 of the Business OUTLETS.OVER L, d�� and Professions Code,and my license is in'full force and effect.., 5 PER-SYSTEM. FINALsq( VALIDATION 3' 6 License Number � Lic. Class C' DATE O," FINAL p Contractor 1(f KMA L�U Date J, L BY p ❑ I am exempt under Sec. W B.&P.C. for this reasonIILI, Plan check fee (' �, Date: PLUMBING PERMIT ISSUING FEE$ O® V Signature TOTAL FEE -i-D ` Plan check applicant SINGLE FAMILY. - HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Low for the following reason•(Section 7031.5, Business and Professions Code): :. t City Tel. No. _,_ :,_!A_;^!, ❑ 1, as owner of the ro ert will do the work and the ;"rs1 P P Y, x #;, structure is not intended or offered for sale (Section 7044, Business and Professions Code). 9^ fr9_ 0_ ;50 CONSTRUCTION LENDING AGENCY ;4 HC` ), P V I n . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued st"t (Sec. 3097, Civ. C.). Lender's Name iri_i • 4:r�.f. Lender's Address .7- :. t. • `+rcr 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 S to laws regulating Plumbing, and hereby authorize repr entatives of this County to enter upon the above-menti ed'pro erty-for i pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature erm e& Date '