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Home My Public Portal About10826 ARROWOOD ST_Plumbing__ 76A667-CEBI7 3-59 APPUCATION FOR RLUMBNG PE,RM91[ COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER a BUILDING AND SAFETY DIVISION BUILDING G� JOHN A. LAMBIE, Count. Engineer ADDRESS �C 7t✓ CASSATT D. GRIFFIN, Supt of Building LOCALITY _ FOR APPLICANT TO FILL IN NEAREST �LT CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL. NO. ' 8 CONTRACTOR LAVATORY SINK ADDRESS 3 DISHWASHER CITY N-0 A-/ 2Y wa rl CONTRAC R'S / r"., STATE LAUNDRY TUB REGISTRATION NO. 3 0 � 7 � COUNTY ❑o y CLOTHES WASHER DISTRICT NO. GROUP ONE I PROCESSED Y G / WATER.HEATER —T GAS SYSTEM INDUSTRIAL WASTE APPROVAL ' e INSPECTION RECORD Tif a $1.00 PER ITEM P OR FIXTURE $ I s APPROVALS DATE INSPECTOR'S SIGNATURE ERMIT $ 2100 w UNDER SLAB WORK 1 —11 ? TPOTAL FEE II ,p� ROUGH PLUMBINGd-1 2 - !' !!^L.•'� — --ti_," Ey GAS PIPING �' s '/ 'Lb �—i• —� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Y AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT = WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. _ HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ��'� G /'�-"�'""�•.�„__� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LE AL OWNER OF THE ABOVE DESCRIBED RESIDENTIA PROPERTY. UTILITY CO.NOTIFIED SIGNATURE //Jj�, • 3 OF PERMITTEE ° FINAL !" ®P AUDATION ROBERT A. WOOD, (cx M.O. CASH SUPERVISING MECHANlCA4ENG'R �� !AP,0 6 6 1 ;2 S FEB 17 5 A 9.C?0 WORKERS'COMPENSATION DECLARATION20-0026 PW 487 APPLICATION FOR PLUMBING PERMIT I Hereby:affirm that I have a certificate of consent to self in- 76A667A n sure,or d certificate of Workers'Compensation Insurance,or a' CE 817(REV. 8/86), `dull certified capy thereof (Sec. 3800, Lab. C. e COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No� z7 Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING / Q Certifi d co y is filed with the county inspection ADDRESS Z(j c�/At�C ✓/g depa men . NUMBER FIXTURE OR.ITEM @ FEE LOCALITY WATER CLOSET(TOILET) l� Date 2 Applicant Ja>� NEAREST CERT FICATE OF EXEMPTION FROM WORKE BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER - OWNER ova (This section need'not.be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITY TEL. NO. as to become subject to the Workers' Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making.this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE C� LIC. ed. WATER HEATER LICENSE NO. 3ZSlp CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. CC�yp,p/iffP__ROC''ESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS D 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL 7 VALIDATION DATE �` License Number Lic. Class O V FINAL I9 Q Contractor t LC- Date BY 0 I am exempt under Sec. B.BP.C. for this reason ► g Plan check fee Date: PLUMBING PERMIT,ISSUING FEE$ �3 Signature - TOTAL FEE v 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 a;" i rCM ' Professions Code): Address G f ,C H:,+ El 1, as owner of the property, will do the work and the City Tel. No. �(?,( structure is not intended or offered for sale(Section 7044, + T Business and Professions Code): pi s—_ —s Poo. 1 13 CONSTRUCTION LENDING AGENCYr1•}y% 1 : C � I hereby affirm that there is a construction lending agency for C � iia u the performance of the work for which this permit is issued ':' (j)y'>__ (Sec. 3097, Civ. C.). Lender's Name Lender's Address 75 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-me ' rap for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit "Dat'