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Home My Public Portal About9527 BLACKLEY ST_Plumbing__ 7'_• E 76A687G ICE 817-AI- 1 1/76 Cz - APPLICATION F'O PLUM ING.PERMIT COUNTY OF LOS ANGELES - DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION, a FOR APPLICANT TO FILL IN,(PRINT,OR TYPEC -BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET'. LOCALITY 42 BATH TUB NEAREST e ;CROSS ST , SHOWER 1 ~ OWNER r LAVATORY MAIL r ADDRESS SINK CITY TEL NO 5 DISHWASHER CONTRACTOR { �-' CLOTHES WASH ER2 , ADDRESS � SWIMMING POOL RECEPTOR 94 CITY, TEL NO LAWN SPRINKLER SYSTEMSTATE . ttTT�� p WATER HEATER LICENSE NO Ci+P655 f 'GAS SYSTEM OUTLETS "� DISTRICT NO GROUP ZONE PRO ED BY OUTLETS OVER S PER SYSTEM INDUSTRIAL WASTE APPROVAL 0 INSPECTION RECORD V' CI% f78- 0 Plan check fee PLUMBING PERMIT ISSUING'FEE$ ` TOTAL FEI;, Plan check applicant Name APPROVALS DATE� INSPECTOR S SIGNATURE � - UNDER SLAB WORK Address" ��Jf �'^�' �• '�-"� ROUGH PLUMBING by Tel' No ��-io32 GAS PIPING ` I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT _ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY,WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND,STATE OF CALIFORNIA OR THAT I AM THE GAS TEST ✓ •i? ,�'� ' LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY - UTILITYCO NOTIFIED ' SIGNATURE OF ITTEE—O_ FINAL PLAN CHECK VALIDATION CK Mo CASH PERMIT VALIDATION cK M o CASH J 2.4*6"'MAR 6 `Y�: C) gds r - O$ 1 76A667 17 25M SETS 7-40 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WM.J. FOX.CHIEF KNOINEER PLUMBING NATURE OF INSTALLATION DISTRICT NO. GROUP O E PERMIT ^ R I rNO. ROUGH FIXTURES COMPLETE --:t4� Al S/ 7 HEATER _ CESSPOOL I-I SEPTIC TANK RE 1 BY READY FOR DATE ISSUED AS MISCELLANEOUS FIRSTbb1I�NASPfCTION APPLICANT FILL IN HEAVILY OUTLINED PORTION TTO..==NLY 7 NAME Altadena Plumbing Ser. IIIc -11)13 ADDRESS 2121 E. Blackley ® ADDRESS 876 E. Mariposa Street LOCALITY Temple Cit g D CITY Altadena TEL.No?y4-1136 cRo 8 Cloverley COUNTY- 1561114Wm. A. Elliot LICENSE NO. EXPIRES NAME LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL 3 ADDRESS NORTH O CITY TEL.No. •. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. N D Vi OWNER -1 CORRECTIONS SOUTH J DESCRIPTION OF WORK 1 BATH TUB FURNACE ROWER DISHWASHER O -JAVATORY REFRIGERATOR l KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP L_CESSPOOI OP SINK FLOOR DRAIN ASH TRAY URINAL APPROVALS ATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME ATER HEATER DENTAL LAVATORY ROUGH PLUMBINGTER OA8 SODA FOUNTAIN OUTLfiAS PIPINGOAS VENT.6 7CESSPOOL TAL NUMBER OF FIXTURES 4 OSEPTIC TANK SEPTIC TANK SEWER �0 UTILITY CO.NOTIFIED TOTAL FEE FINAL DEPARTMENT OF COUNTY ENGINEER PLUMBING 1 i DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING �� AC WILLIAM J. FOX, COUNTY EN[31NEER ADDRESS � FOR APPLICANT TO FILL IN NEARESTLOCALITY ,/�. BUILDING / CROSS ST. ADDRESS ��2� �. �/aG/Y'�:y S� �1 1 DISTRICT NO. GROUP ZONE PERMIT /NO. LOCALITY ire ry�,p l� Lr. / y 6– - � // /—/ 7?// C� NEAREST G/o U �/ CEI ape O OWNER CROSSST� � � y _d RECEIVED Ready for Inspection DATE ISSUED MAIL H.��7 �` �� WASTE � � ADDRESS �•``o� S� WASTE APPROVAL CITY re^"1e_ C.-1V TEL.NO. INSPECTION RECORD PLUMBER ADDRESS CITY TEL.NO. ❑STATE LICENSE NO. ❑COUNTY J PERMIT FEES z NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET(TOILET) @ 0.80 : 90 a p BATH TUB @ 080 ' SHOWER @•0.80 910 LAVATORY(WASH BASIN) @ 0.80 $.0 KITCHEN SINK @ 0.80 LAUNDRY TUB OR TRAY @ 0 80 SLOP SINK @ 0 80 FLOOR SINK = @ 080 FLOOR DRAIN @ 0.80 DISHWASHER . @ 0 80 DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 GAS SYSTEM.....l......OUTLETS @ 1.00 Q WATER HEATER @ 1.00 MISCELLANEOUS APPROVALS ' DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK i PERMIT $ 1 00 ROUGH PLUMBING TOTAL FEE ;o GAS PIPING K a 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DDEESCRIBB,EED^ RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATUOF PERMRTTEE.-._f/.=, Y_:_.._ s'`'A:S'i_.'_k WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I hglie o,cer ificate of consent to self in- 76A666 DPW a/87 d 76A667A ' sVre, or a cenlficate of Workers'Compensation'lnsurance,or a CE 817(REV. 8/86) - r i by thereof ec. 3800, Lab. C,1 t COUNTY OF LOS ANGELES DEPT. OF PUBLIC W RKS olic o. Company ,4 c � Certified copy is hereby furnished.. / � FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed'with the county building inkpection ADDRESS . depart t. NUMBER FIXTURE OR ITEM @ FEE LOCALITY, "^ �( WATER CLOSET,(TOILET)1. . Date Applicant , NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCESHOWER OWNER (This section need not be completed if the work involved by, MAID the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS ,F,2 14-C I certify that in the performance of the work for which this per 'SINK mit is issued, I shall not employ any person,in any manner so CITY / �F° TEL. NO. as to become subject to the Workers'Compensation Laws.•" DISHWASHER . _ CONTRACTOR Date Applicant, CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS ` SWIMMING POOL RECEPTOR (�j emption,you should become subject to the Workers'Compen- CITY @ J f TEL. NO. 3w/ sat,ion provisions of the Labor.Code, you must forthwith comp-- LAWN SPRINKLER SYSTEM r ly with such provisions or this permit.shaCll be deemed revok- STATE LIC. 5- a2d ed. % WATER HEATER LICENSE NO. D37 CLASS C_ LICENSED CONTRACTORS DECLARATION DISTRICT NO. �/ ESSED BY i hereby affirm,that,I am licensed under provisions of Chapter GAS SYSTEM �. OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER PER SYSTEM V (DATION and Professions Code, and..my license is in full force and ef- 5 FINAL fete. ? sc� _ DAT License Number � Lic, Class �� 0 O U ,�� FIN M Contractor Date B 2 9 0 6,8 A o 0 ' I am exempt under Sec. # o 0 0 0 0 5 B.&P.C. for this reason. Plan check fee ( .o o 6 5 a Date: PLUMBING PERMIT ISSUING FEE$ 5 O.x O O.O U Signature TOTAL FEE SINGLE FAMILY O 2,2 6-88 HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that lam exempt from the Contractor's License Norrie Law for the following reason (Section 7031.5, Business and Professions Code): Address. I, as owner of'the property, will-do the work and the City Tel. No.'- structure is not intended or offered for 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 I certify.thot 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 abo - entio,ned prop ty for insp purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Perrimittee Date