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Home My Public Portal About9477 BLACKLEY ST_Plumbing__ DBS-" APPLICA'T'ION FOR PLUMBING PERMIT .� DBS-17 10-83 D,,I,ISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles - BUILD 1 NG!Z JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY r` FOR APPLICANT TO FILL IN NEAREST % /Q CROSS SI- OWNER TOWNER DISTRICT NO GROUP j &j.E READY FOR INSPECTION MAIL � ADDRESS INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBER. CD INSPECTION RECORD ADDRESS CITY ::599 v EL. NO d tJ LICENSE NO. / if 0 d l NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ $100 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1 00 KITCHEN SINK @ $100 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 WATER HEATER @ S100 GAS SYSTEM @ $1 00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK P PERMIT $ 1 00 ROUGH PLUMBING 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES ' ` I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST' LICENSED AS REQUIRED BY LO ANGELES COUNTY AND STATE OF CALIFORNIA OR THA I A H Li OF TPE ABOVE UTILITY CO NOTIFIED DESCRIBED RES N OP R SIGNATURE �J� r� OF PERMITTEE off FINAL JOHN A. LAMBI . COUNTY ENGINEERVALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR CK. m 0. CASH rkCo 6 5 6 4'U'0_ MAY 31 3 5.0 0 1 _ D.B.S.17 25M SETH I0-47 APPLICATION FOR PBI" \�DEPARTMENT OF BUILDING AND SAFETY PLUMBING/{ �r COUNTY OF LOS ANGELES 1 i`. WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT UP PERIVIMNO. ROUGH FIXTURES V COMPLETE 0 HEATER I,— CESSPOOL I—I SEPTIC TANK RECEIVED'/ABY pIRST6INSPFECTION DATH (ISSUED AS ✓ MISCELLANEOUS " �l ! APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY , JOB a, NAME ADDRESS I�//� m ADDRESS ,� n • n _ // _.�' LOCALITY Jafi 2_-& A s /�7��,r � , NEAREST LS CITY ( / TEL.No. CROSS ST. COUNTY'O'• CERT.No. EXPIRES NAME _ LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL ry s / 3 ADDRESS �T_2. NORTH O � , EL` - CITY �T' No. I AM THE LEGALZ POSSTSSOR OF THE ABOVE LOS ANGELES COUNTY ClkRTIFICATE OF QUALIFICATION. PLUMDHR I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. 0" V( OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z_ 1JlBATH TUB ^' FURNACE IIHOWER DISHWASHER D <y _AVATORY REFRIGERATOR " KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS ' vATER CLOSET DRINKING FOUNTAIN DATE r/ INSPECTOR'S NAMQ WATER HEATER DENTAL LAVATORY ROUGH PLUMBING 1 METER I GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBELOFFIXTURES SEPTIC TANKCESSPOOIPTIC TANK SEWER TOTAL FEE UTILITY CO.NOTIFIED I u FINAL ,ia",J�'ORkERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT f� by affirm that I have a certificate of consent to self 76A667A iris, e, or a certificate of Workers' Compensation,Insurance, CE 817(REV 10/8)) or ci certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES- BUILDING-AND SAFETY Policy NoCompany ��. ❑ Certified copy is hereby furnished - ❑ FOR APPLICANT TO FILL IN,(PRINT OR TYPE) BUILDING�} Certified copy is filed with the county building inspec- ADDRESS "7 112174 C / tion department NUMBER FIXTURE OR ITEM @`. FEE LOCALITY-_/�/��I WATER CLOSET. 1 ` Date Applicant NEAREST a CERTIFICATE OF EXEMPTION FROM WORKERS' ' BATH TUB CROSS ST COMPENSATION INSURANCE, OWNER (This section'need not be completed i{the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS L A-e—kL_Q 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 TEL NO S so asbecome subject to`the„Workers'Compensation Laws DISHWASHER J i CONTRACTOf�� e_L! OU Date Applicant CLOTHES WASHER ADDRESS, NOTICE TO APPLICANT If,-,after making this Cerhficafe of .2C> I ®'/.) 2d• Exemption, y6u should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor-Code, you must forth- LAWN SPRINKLER SYSTEM CITY®��. 'S r�, TEL NOG $ � with "comply with such provisions or this permit'sha,ll be .. STATE rD LIC deemed revoked WATER HEATER LICENSE NO39U,-0 41 CLAS o c 4 L 3 LICENSED CONTRACTORS DECLARATION DISTRICT NO P CESSED 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 effect 5 PER SYSTEM FINAL VALIDATION License Number v - Lic Class�Y(4iP �� ` — DATE V FINAL cc O 0 , Contractor Date BY ,'�/j j2Si ”""T ❑ I am exempt under Sec B &P C for this reason Plan check fee - Zs — Date PLUMBING PERMIT ISSUING'FEE$ Signature TOTAL FEE p " Plan check applicant SINGLE_FAMILY HOME OWNER-BUILDER DECLARATION Name , I hereby affirm that I am exempt from the Contractor's License Address 3(� Law'fo" the following 'reason (Section 7031 5, ,Business and 7,8 A, Professions Code) city Tel No }f 1', as owner of the property,'will do the work and the ' structure is not'intended or offered for sale'(Sectiori" 2 . . 3"0.,50 7044, Business and Professions Code) , s' ' CONSTRUCTION LENDING AGENCY• � • •° . _ Eor o 0;-3 I hereby affirm that there is a construction lending agency,for - the performance of the work for'which this permit is issued 97 � , - � - • (Sec 30 , 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 ent24 upog,the above-mentioned property form echon purpo s ,/ SEE REVERSE FOR EXPLANATORY LANGUAGE S ature of PeoSittee Da