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Home My Public Portal About9405 BLACKLEY ST_Plumbing__ 7GA667 17 9-49 ® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J FOX; CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT O GROUP Z�ajV% PERM � PLUMB "� �+��-- • RECEIVED BY READY FOR/ ®/DjATE ISSUED ,. FIRST IN 'PECaION S, ADDRESS ♦ VA lP,�`.'I UL BUILDING v /� TEL NO ADDRESS CITY /w �+�..��J Gtl�Gn Q� �+ COUNTY LOCALITY 12Z ��• LICENSE N V EXPIRES NEAREST PERMIT FEES CR oss ST NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) Q O 50 I S I ADDRESS BATH TUB Q O Sol I CITY TEL NO SHOWER Q O 501 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) Q O SOI AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q O 501 STATE LAWS REGULATING PLUMBING I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q O Sol I ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE GAS SYSTEM OUTLETS Q O 501 I ,J SIGNATURE OF WATER HEATER Q O 50 I� PERMITTEE FFFFFF�� <'+ • r- -��-.-, -atQ '*"I"-�� SLOP SINK Q O 501 I INSPECTION RECORD FLOOR SINK Q O 50 FLOOR DRAIN Q O 50 DISHWASHER Q O 501 DRINKING FOUNTAIN Q O Sol IURINAL Q O 501 I ,J HOUSE SEWER Q O 501 1 ` < MISCELLANEOUS I I I I I I � I � I I APPROVALS DATE INSPECTORS NAME ROUGH PLUMBING GAS PIPING GAS VENT 1 CESSPOOL Q 1 00 I__/ 100 CESSPOOL j SEPTIC TANK I I SEPTIC TANK I DRAIN ( ) PIT ( ) Q 1 OOI I SCWER PERMIT I 1 00 GAS TEST f UTILITY CO NOTIFIED I /� TOTAL FEE I $� I\J-o FINAL �� i 7CIA667 17 9-49 ® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES 1 WILLIAM J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT I`r, GROUP I ZONE PERMIT NO PLUMBER El • k5 tjQ A.1 RECEIVED BW, READY FOR' DATE ISSUED FIRST INSPECTION ADDRESSBU ILD �r� '�...�/ ADDREIN CITY ZLO /Q TEL NO (/��SJt / SS R if COUNTY —LICENSE NO EXPIRES /1/e + O-,� LOCALITY NEAREST PERMIT FEES CROSSST �( NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER ,8 MAIL � WATER CLOSET (TOILET) Gn O 50 I$ I ADDRESS BATH TUB Q O 50 I� CITY TEL NO SHOWER Q O 501 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) Q O 501111 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q O 50111 STATE LAWS REGULATING PLUMBING I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q O 501 ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER o _�I OF THE RESIDENTIAL PROPERTY DES I ED ABOV GAS SYSTEM--%.?—OUTLETS (a O 501 SIGNATURE OF 1 WATER HEATER Q O Sol PERMITTEE SLOP SINK Q o Sol INSPECTION RECORD 1 FLOOR SINK Q O SO FLOOR DRAIN n O 50 1 DISHWASHER Q O 501 1 DRINKING FOUNTAIN Q O 501 IN),Pll ),Pll ll AT URINAL (a O 501 J IHOUSE SEWER Q O 501 1 \ t Q MISCELLANEOUS 1 APPROVALS DATE INSPECTOR S NAME ROUGH PLUMBING / 1 GAS PIPING 1 GAS VENT CESSPOOL Q t 00 I1 CESSPOOL 1 SEPTIC TANK I 1 SEPTIC TANK 4f DRAIN ( ) PIT ( ) Q t 00 I SEWER PERMIT too GAS TEST I may\, UTILITY CO NOTIFIED TOTAL FEE $ , FINAL �� ' v c 76A667,,(CE-,817)-8-71 7 ,,.APPLICATION FOR PLUMP' NG PE IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER LDING n �/ BUILDING AND SAFETY DIVISION ADIDRESS 9��I ST. LOCALITY Na 45, `` C1v�n�IJ2 FOR APPLICANT TO FILL IN (PRINT OR TYPE) CROSS SST 0 NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1 75 OWNER JpF-(_ ,$ ,4X3I-Z6 MAIL BATH TUB 1 75 ADDRESS 9`40-5 /3G.}��=C. S7- SHOWER 1 75 CITY j ,4.04,0 C j7 TEL NO Z$ J3 7-57- LAVATORY 1 75 7� CONTRACTOR 0Gt11jeQ 67V/1-bee-- SINK 7V/1-bee--SINK 1 75 ADDRESS 5��,e /}j '09 DISHWASHER 1 75 CITY TEL NO CLOTHES WASHER 1 75 ZQ STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1 75 DISTRICT G ZO E CE D BY LAWN SPRINKLER SYSTEM 1 75 G WATER HEATER 1 75J INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1 75 INSPECTI_ EC ORD OUTLETS OVER 30 ^ 5 PER SYSTEM Z, r 0 W A. _ V1 z Plan check fee See reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DOTE, SPECTO SIGNATURE Plan check applicant UNDER SLAB WORK /v z- Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES ( n WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING GAS TEST I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED BOO LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF A CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DE RIBED RESIDENTIAL PROPER T FINAL SIGNATURE OF PERMITTE PERMIT VALIDATION cK M o CASH PLAN CHECK VALIDATION CK M osH >Law,7062SEP13 5D 13.50- a 'WORKERS' COMPENSATION DECLARATION 'APPLICATION FOR PLUMBING PERMIT I me b of m that I have,a certificate of consent to self in- 760026 DPW a/87; + In Y, 76'667( a sur' or a c:c ificate of Workers'Compensation Insurance,ora CE'817(REV 8/86) " certified-copy thereof (Sec 3800, Lob' C ), Policy No Company- COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 'Certified copy is hereby furnished { Y FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �� Certified copy is filed with the county building inspection ADDRESS NUMBER FIXTURE OR ITEM department @ FEE LOCALITY Date k Applicant WATER CLOSET'(TOILET) NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE' - OWNER d' l ° s v {o, r ry SHOWER e w (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less ) LAVATORY ' ADDRESS _ Icertify that in the performance of the wor,k•for which this per- r _ �mrt'is issued] shall not employ any person i?any manner so SINK,' • „ .,CITY "TEL NO as to becomefsubject to the.Worker"O )ens" ' u ion w DISHWASHER" i CONTRACTORAW Date Applicant CLOTHES WASHER�4 ADDRESS NOTICE TO APPLICANT It after making this Certificate of Ex= SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL NO �Q 7 cation provisions of the Labor Code,you'must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions-or,this permit shall be deemed1revok- STATE LIC' f„ .ed • WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY GAS SYSTEM OUTLETS I hereby affirm that I am licensed under provisions of Chapt er 9(commencing with Section 7000)of,Division,3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5+PER SYSTEM T I'FINAL VALI N fect A nn /J�/d oL O License Number"l7 � >� Lic Class� - -Z" FIN 0 Contractor Date ^ �� BY O 6 1"' ❑ I am exempt under Secr W B &P C for this reason IPlan check fee pop. a ! d w 4' ,v Date a PLUMBING PERMIT ISSUING FEE$ I v Signature t TOTAL FEE SINGLE FAMILY 6 r `HOME OWNER-BUILDER DECLARATION Plan-check applicant �L�T g J _ . , I hereby affirm that I am exempt from the Contractor s License Name Law for the following reason,(Sechon 7031 5„Business and ”` S3i'I' " ��`" t Professions Code) Address 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, TOTAL Business and Professions Code) r PON. �1"k ( CHEC I r{r1 CONSTRUCTION LENDING AGENCY"` a I hereby affirm that there is a-construction lending agency for CANG the performance of the work for which this permit is issued r (Sec 3097, Civ C,)_ �t}j V313/89 Lender's Name 33244 i Arl Viio'Ct'� Cender's Address a :" s a• y I'certify that I have read this application and state that the r 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 bov - e t o pr ty f inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' OMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT r I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certifi�L� Se7c 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No fipany — �"� ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING E�—Zertified copy is filed with the county building inspec- (/ l� do Id . invent NUMBER FIXTURE OR ITEM Q FEE ADDRESS LOCALITY Date Applicant WATER CLOSET NEAREST C RTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER r r` (This section need not be completed if the work involved by MAIL the permit 1s for one hundred dollars ($100)or less ) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL r so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR �l Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS ! Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM t Q with comply with such provisions or this permit shall be STATE LIC /7 C� deemed revoked WATER HEATER LICENSE NO CLA C LICENSED CONTRACTORS DECLARATION DISTRICT OCESS BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and a ec� 5 PER SYSTEM FINAL 'fir�/ o DATE !y VALIDATION O License Num er Lic Class tJ FINAL Ilm sr�r O Contractor Date BY F-1I am exempt under Sec V W 11%. Vf B &P C for this reason 1111111. Z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from'the Contractor's License Address Law for the following reason (Section 7031 5, Business and z 4 2 7,6 A Professions Code) City Tel No ❑ 1, as owner of the property, will do the work and the 0,0 o 0 0 5 structure is not intended or offered for sale (Section 7044, Business and Professions Code) , 2 ° ° 3 0,5 0 CONSTRUCTION LENDING AGENCY o o o 3 0,5 0 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 $ Q 5—8 3 (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 ove-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE nature of ermittee