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Home My Public Portal About10781 BLACKLEY ST_Plumbing__ 76A667 (CE-617) - 1/75 c� �� r- lJ APPLICATION FOR.PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION. MAKE CHECKS PAYABLE TO: BUILDING r ADDRESS pP n C _OC HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY 1 �1 l.� FOR APPLICANT TO FILL IN (PRINT OR TYPEI NEAREST CROSS ST. :1C NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 2.00 OWNER MAIL BATH TUB 2.00 'ADDRESS p SHOWER 2,p CITY ��', �� C{T TEL. NO. LAVATORY 2.0 CONTRACTOR PR R�I tFg-e SINK 2.0 ADDRESS iQq•`� f- ^D DISHWASHER �� CITY � TEL. NO. CLOTHES WASHER 2.40 STATE /�1 G f3 CLIC LASS LICENSE NO. oC l 1 b SWIMMING POOL RECEPTOR 2. p DISTRICT NO.GROUPZONE CESS D B LAWN SPRINKLER SYSTEM 2. 0 S. O r->�)— / WATER HEATER 2. 0 INDUSTRIAL WASTE APPROVAL pr GAS SYSTEM OUTLETS 2. 0 INSPECTION RECORD U OUTLETS OVER 5 PER SYSTEM O CL ll. � / z /K r u .. Plan check fee See Reverse PLUMBING PERMIT ISSUING FEES 3 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant .�� UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGGAS TEST PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED ' LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATURE l^�, cc>)OFPERMITTEEPERMIT VALIDATION M.0. CASH PLAN CHECK VALIDATION CK. M.0. CASH 8.1 3 sFP .i9:, s 7:5 0 os3 •76A667 APPLICATION FO R PL uM B IN G ,■ E i ■M I T 7 . DBS-17 3.55 1 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles WM.J. FOX. COUNTY ENGINEER BUILDING n� I ADDRESS /�•/( (/ CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY !/�— FOR APPLICANT TO FILL IN NEAREST f� p CROSS ST. OWNER,00A ."4 J �1W 1-& �, DISTRICT NO. G P ZONE RE Y FOR INSPECTION MAIL ADDRESS / �� F"` f�'K--t I *601 ' �J� qrL . NDUSTRIAL coo CITY /i�[ Pk,,4' d'I TE'YN O. 60P TfX 'WASTE APPROVAL PLUMBER EL..-F INSPECTION RECORD ADDRESS CITY TEL.'NO. LICENSE NO. f / /• NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) $ BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER ' LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO. @ o so aL 4_0 APPROVALS DATE INSPECTOR'S SIGNATURE O GAS SYSTEM OUTLETS @ 1.00 UNDER SLAB WORK • Q"' +b WATER HEATER @ 1.00 PERMIT S 1 - ROUGH PLUMBING / 00 - - GAS PIPING - - TOTAL FEE GAS VENT I,HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION* HOT WATER HEATER AND STATE THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY v WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY-LOS ANGELES COUNTY-AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL" OWNER OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PR ERTY. j __0111 4- , SIGNATURE' dq((iN ,/'��1✓�V� OF PERMITTEE FINAL WILLIAM J. FOX. COUNTY ENGINEER VALIDATION R. A. WOOD, CHIEF PLBG. INSPECTOR P1Ca6 8 5 7S ' AUG 18 31 3.40 u) 76A667 (CE-817) - 1/75 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUADDRESSILDING .J O HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY G /i FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST _ CROSS ST. NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 2 0 OWNER 'J�JfZC/f�t MAIL BATH TUB 2. 0 ADDRESS 7 / /,3 -41LGL-le- SHOWER 2. 0 -CITY A L� C/� TEL. NO. LAVATORY \12. 0 CONTRACTOR SINK 2. 0 ADDRESS /,3r R , L�li rc< 67 DISHWASHER ry)2 0 CITY ��/�,�!// �� TEL. NO.y�j/J - 7l/C�/,2 + CLOTHES WASHER 2. 0 STATE LIC LICENSE NO. 3ov Y, � CLASS G' SWIMMING POOL RECEPTOR 2, p DISTRICT NO.GRO�P ZONE P OCESSED BY LAWN SPRINKLER SYSTEM ® ' / WATER HEATER 0 p INDUSTRIAL WASTE APPROVAL pr GAS SYSTEM OUTLETS 2. 0 INSPECTION RECORD CD OUTLETS OVER An 5 PER SYSTEM O (� •U q /(, iso cv d')2 x JT�N moi- � �+-+�.• a"1.. GO z Plan check fee See Reverse { PLUMBING PERMIT ISSUING FEE $ 0 TOTAL FEE _ (� APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City ' Tel. No. GAS VENT J 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 i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. , FINAL f ' SI GNATU RE OF PERMI TTEE- PERMIT VALIDATION cK. Ni,o. cnsH PLAN CHECK VALIDATION CK. M.O. CASH WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,-pfform that I have a certificate of consent,to self in- 76A6667A PW 4/90 / g- sUreT or a cerh'ficate of Workers'Compensation Insurance,ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELE DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE - LOCALITY �� /� �•i�C� Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST- ' COMPENSATION INSURANCE OWNER SHOWER �� (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.)' LAVATORY - ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so -SINK CITY TEL NOy�y • JI " as to become sub ct to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant • CLOTHES WASHER ADDRESS�7 NO CE TO APPLICANT If, after m ing this Certificate of Ex- emption, you should become subject to the Workers'-Compen- 7 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITY_ TEL NOJ"yf/J� ly with such provisions or this permit shall be deemed revok- STATE ( /A- ' �J LIC. �/ ed. TER HEATER LICENSE NO. CF'v /��/ CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER. and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fete. / r9 i. HOSE BIB DATE 0 License Numbe Lic. Class /�S�_ � 0 FINAL V Contractor Dat BY F-1O I am exempt under Sec �. s' '•V B.&P C. for this reason 0-1- all, W Plan check fee ® 0. N Date: PLUMBING PERMIT ISSUING FEE$ Signature " TOTAL FEE G ` 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 ❑ j, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered foi 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 m I certify that I have read this appJication and state that the O above information is correct. I agree to comply with all County t-) 4y t» ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- lone pro a ty for inspection pur 6ses. SEE REVERSE FOR EXPO NATORY IANGU#GE Sig t re of P e r m i ftee ate t 8 o WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereb�affirm th''bt I have a certificate of consent to self 76A667A "insure",-ar a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished. F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE f� LOCALITY T- M L e t'' L D Date .Z Applicant WATER CLOSET ✓ NEAREST G CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 4R ME - COMPENSATION INSURANCE l SHOWER OWNER 14R $ MRS U��tU �S (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORYAN MAIL ADDRESS f £ S T I certify that in'the performance of the work for which this IF permit is issued, I shall not employ any person in any manner SINK CITY T ( k_ TEL NO so as to become subject to the Workers Compen$ation Laws DISHWASHER ,/✓/j CONTRACTOR - 1 J 6 Date —3 SApplicant- • ' - CLOTHES WASHER �` ADDRESS NOTICE TO APPLICANT If, after,making this Cerhficat of— �� Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR111 Compensation provisions of the Labor Code/you must forth- LAWN SPRINKLER SYSTEM CITY TEL NO. �,� with comply with such provisions or thist permit shall be ISTATE LIC. deemed revoked. WATER HEATER LICENSE NO CLASS C^-3 16 LICENSED CONTRACTORS DECLARATION. DISTRICT NOP ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /�C/ e (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (f 0 and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL DATE` VALI ATION 0 License Number�{Je� [!� Lic.•Class —3�j T Apa e FINAL 129O 14 Contractor E�'(J�t/E /�l/p167II��Dat' BY — t- U I am exempt under Sec. � B.&P.0 for this reason M� - Plan check fee ► �t PLUMBING PERMIT ISSUING FEE$ Signatur _ -,- � TOTAL FEE Sb 2359.•1 A SINGLE FAMILY Plan check applicant , HOME OWNER-BUILDER DECLARATION Name SEPU # o 0 0 0 0 5 I hereby affirm that I am exempt from the Contractor's License Address DuILo vt71 1 I o - 465 0 Law for the following reason (Section 7031 5, Business and Professions Code) City CA T . No y� o - 46505 ' ❑ I, as owner of the property, will do the work and the2.0 4`$5 structure is not intended or offered for sale (Section Pilo7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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 pr e*rtorins &npurposes If SEE REVERSE FOR EXPLANATORY LANGUAGE F Signature o i Date