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HomeMy Public PortalAbout9306 BLACKLEY ST_Plumbing__ 76A667 CE#6F7 10 67 • APPLICATION FOR PLUMBI G PER COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING q 3O JOHN A LAMBIE, COUNTY ENGINEER ADDRESS "� COLEMAN W JENKINS SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN PR NT 0R TYPE) If CROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1 50 O� MAIL BATH TUB 1 50 ADDRESS ' SHOWER 1 50 CITY TEL NO LAVATORY 1 50 3 Oa CONTRACTOR SINK 1 50 ` 5(� ADDRESS DISHWASHER 150 _5L CITY TEL NO 4,C44-Z*— rnn CLOTHES WASHELIC R 1 50 I S'Q STATE ��� y / CLASS LICENSE NO / SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GRO PR CE ED B © �' LAWN SPRINKLER SYSTEM 2 00 _ - 0 C ! WATER HEATER 1 50 1 SO INDUSTRIAL U WASTE APPROVAL 0=O GAS SYSTEM OUTLETS 1 50 �� INSPECTION AE RD - U OUTLETS OVER Lu 5 PER SYSTEM 30 � Z Plan check fee 2S% of above See reverse PLUMBING PERMIT ISSUING FEE 8 S2� 000 .� TOTAL FEE y lJ APPROVALS DATE I CTOR S,,0115RATURE Plan check applicant UNDER SLAB WORK - Name ROUGH PLUMBING Address GAS PIPING GAS VENT /r.9 7 -,J Cl[Y Tel NO HOT WATER HEATER . en'4 A_p vrni� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES 9. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING 1 HEREBY CERTIFY THAT I 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 RESIDE IN THE=ED RESIDENTIAL PROPERTY FINAL / 97921 SIGNATURE JACK R ALLEN, SUPERVISIN HANICALENG'ROF PERMITT PERMIT VALIDATION cK M O CASH PLAN CHECK V IDATION CK M O CASH L&4=5 o s� 1RY 2 D 1 8. 0- 76A667 (CE-817( - 1/75 APPLICATION F R PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER �— LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE( NEAREST CROSS ST NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 00 MAIL 93L�la �Li3CLC BATH TUB 00 ADDRESS SHOWER 00 CITY, _ EL NO LAVATORY 00 CONTRACTOR &� �+Y / /�/� ( i C- v G SINK 1� 00 ADDRESS DISHWASHER 200 CITU CLOTHES WASHER 200 OO STATE L CENSE NO C>�.��' CILASS �— ` SWIMMING POOL RECEPTOR 2 00 DISTRICT NO GROUP ONE CESSED BY LAWN SPRINKLER SYSTEM 200 WATER HEATER 2 00 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 2100 3 INSPECTION RECORD o� OUTLETS OVER O 5 PER SYSTEM 30 v O I-- c..J W CL N Plan check tee See Reverse PLUMBING PERMIT ISSUING FEE S TOTAL FEE /0 APPROVALS DATE INSPECTOR 9 91 GN ATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HOT WATER HEATER iHEREBY 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 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 DESCR_LPED RESIDFpNTIAL PA7P&R7Y FINAL SI GNATU RE w OF PERMITTEE PERMIT VALIDATION cK M o CASH PLAN CHECK VALIDATION CK M 0 CASH 3 2 1rnrr 21 5 D 10.5 0 A�8 � ✓P WORKERS' lCOMPENSATION DECLARATION 20-0026DPW4/87 APPLICATION FOR PLUMBING PERMIT I hereby, affirm th9 have a certificate of consent to self in- 76A667A `7 sureOor a c@r�fica*0^YVorkerp'Compensation Insurance,or a CE 817(REV. 8/86) U certified cop thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING q 3 Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date ApplicantL , WATER CLOSET(TOILET) f D NEAREST CERTI KATE OF EXEMPTION F OM W KERS' f BATH TUB /'y CROSS ST. COMPENSATION INSURANCE v 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- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO os to become subject to the Workers Compensation: Laws. ��`dJy� DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS i NOTICE TO APPLICANT: If, after,making this Certificate of Ex- C, emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation '-visions of the Labor Code, you must forthwith comp- CITY TEL. NO. p y p" LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STAT !! LIC. ��cc ed. WATER HEATER LICENSE NO. ✓ CLASS`�b { �" LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESS D 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 `'v fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �! LIDATION >_ DATE CL License Number Lic. Class C2© -Ci 8 O U /( FINAL cc Contracto '9 pate 4�2BY O ❑ I am empt under Sec. Z Q B.BP.C. for this reason ► Plan check fee Date: PLUMBING PERMIT ISSUING FEE $ Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant c I hereby affirm that I am exempt from the Contractor's License Namea Law for the following reason (Section 7031.5, Business and A•4T°g -Professions Code): Address 3307 28.50 I_as owner of the property, will do the work and the City Tel. No. 1 ITEMS structure is not intended or offered for sale(Section 7044, Business and Professions Code). , TOTAL 2` ' �al� a.a m CONSTRUCTION LENDING AGENCY CHECK 23.50 I hereby affirm that there is a construction lending agency for 4, o{= the performance of the work for which this permit is issued CHANGE .HN Srr (Sec. 3097, Civ. C.). Lender's Name 0000 101 10/ 4f8? Lender's Address 6054 1 AM11-*16 I certify that I haver d this application and state that the above.informati n is rrect. I agree to comply withal I County ► ordinances on Sta laws regulating Plumbing, and hereby auth re s atives of this County to enter upon the ab ve-mentn roperty for in ion purposes. , O SEE REVERSE FOR EXPLANATORY LANGUAGE I Signature r ittee e