HomeMy Public PortalAbout9542 BLACKLEY ST_Plumbing__ 78A687 ICE-8171 - 1/75 ' , / / ) )'T / ,
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO- fNOEA7FE
HARVEY T. BRANDT, COUNTY ENGINEERFOR APPLICANT TO FILL IN (PRINT OR TYPE( . G I l
NUMBER FIXTURE OR ITEM @ FEE
r 0 OWNER
WATER CLOSET MAIL M
BATH TUB 0 ADDRESS X J 1C
SHOWER L
n f)� p CITY ,-ti TE i- O
LAVATORY �j 2 %OIt0 CONTRA ✓ r N �� L
SINK 2 1 lo 0 ADDRES
J 0920 E. GRAND AVE.DISHWASHER 2100 CITU Y L C/" 1(0,7
CLOTHES WASHER 21P0 STATE 'LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 40
DISTRICT NO GROUP ) NE O SED BY
LAWN SPRINKLER SYSTEM pp tS! Q f`� 2/ 7:;? � , ,_�.d'
r r,/
WATER HEATER10 d INDUSTRIAL
WASTE APPROVAL a
GAS SYSTEM OUTLETS 2 00 NSPECTION RECORD U
OUTLETS OVER
5 PER SYSTEM
v
W
CL
Cn
Plan check fee See Reverse J
PLUMBING PERMIT ISSUING FEE $ bo
TOTAL FEE
APPROVALS DATE INSPECTOR 9 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 REGULATING GAS TEST
PLUMBING
I 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 INT-END TO �l
RESIDE IN THE ABOVE DESCR� (DENTIA PROPERTY.
FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALIDATION cK •0. CASH
PLAN CHECK VALIDATION CK M 0. CASH
REA�Y FSR F�� gK2
x=12 . :5 e 7.5 0 °
,� Y
1r I COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY `� j
WILLIAM J. FOX, County Engineer
FOR APPLICANT T❑ FILL IN 5 O. GROUP ZONE PERMI .
PLUMBER t4 RECEIVED BY READY FOR DATE ISSUED
la zoa d' FIRST INSPECTION
ADDRESS ��"F.,.
OITY� BUILDIN13
TEL NO. #47'1
T �a /
COUNTY LOCALITY
LICENSE NO. �/} EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
/ MAIL
=r WATER CLOSET(TOILET) 0.50 $ t/CJ ADDRESS
BATH TUB C♦1 0.50 CITY TEL. No.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
Z LAVATORY (WASH BASIN) @ 0.50 �ij (� APPLICATION AND STATE THAT THE ABOVE I5 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
t CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O.SO ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
13A9 SYSTEM
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
OUTLETS 0 0.50 A �J )'
SIGNATURE OF ��
WATER HEATER Q 0.50 Q Q PERMITTEE_, i/
SLOP SINK @ O.SO INSPECTION RECORD
FLOOR SINK Cs& 0.50
FLOOR DRAIN Q 0.50 ( /v#,4r �
DISHWASHER 0.50
DRINKING FOUNTAIN @ O.SO
URINAL @ 0.50 'I
Q
HOUSE SEWER @ 0.50 _Z
MISCELLANEOUS
Gc/ O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING I /
V
GAS PIPING 14 '4p- ✓,
� r
GAS VENT 2
CESSPOOL @ 1,00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 i SEWER
PERMIT 1,DO GAS TEST ,I���
UTILITY CO.NOTIFIED _ �e �a r` i
TOTAL FEE $/ 2.Q FINAL
76A667 DBS#17 6-52
+
WORKER'S'COMPENSATIONate of consent to ,76�;APW 989 APPLICATION FOR PLUMBING PERMIT
f'hereby affirm Olt I have a certificate of consent to self insure, a t r
or a certificate of Worker's Compensation Insurance, or a certified -
copy thereof(Sec 3800 Lab C)
2- � COUNTY OF LOS ANGELES' DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV:
Policy No ompany _ )
LTJ• Certified copy is hereby furnished BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) - ADDRESS ac 9 `l 1 fir[i• a f, '
Certified copy is filed with the county building in ection
department NUMBER FIXTURE OR ITEM Q FEE
• t LOCALITY -
Date / 2 Applicant ` WATER CLOSET NEARESTF f`
-CERTIFICATE OF EXEMPTION FROM WORKERS' _ CROSS ST �J u/ t ,
7
COMPENSATION INSURANCE BATH TUB ASSESSOR
(This section need not be completed if the work involved by the SHOWER MAP BOOK �5 Q PAGEQQ, PARCEL,Q� y
permit is for one hundred dollars($100)or less.) t OWNER
I certify that in the performance of the work for Which this permit LAVATORY ,
is issued, is
not employ any person m a'ny manner so as toMAIL
SINK ADDRESS (�
become subject to the Workers'Compensation Laws r_
f' DISWASHER r CITY TEZ NO'
i
Date Applicant CLOTHES WASHER CONTRACTOR /
NOTIC TO APPLICANT If, afte making this Certificate of % 6, {i•7-/ :
Exemption,you'should become subject-to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor,Code, you must forthwith comply with such ADDRESS 266
provisions or this`permit shall be deemed revoked LAWN SPRINKLER SYSTEM ..��---
LICENSED CONTRACTORS DECLARATION CITY TEL NO j`f,'331 7 / }
J WATER HEATER d
I hereby affirm that I am licensed under provisions of Chapter 9 STATE LIC `
(commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS _ /`� LICENSE NO 3 - CLASS kJ U
Professions Code,and my license is in full force and effect ) �7
OUTLETS OVER DISTRICT O PROCESSED BY
5 PER SYSTEM
License Number `e'7 Z3 Lic ClassFINAL
7 �� _2 y t DATE —Z VALIDATION_ _ , „� W
'J /yn Y 'f
Contractor- « d• /`�F-�//!Z Date' -" _ N
❑Jr _
I am exempt under Sec + BY AL i 1 'G"•`_
T)_ ;fit_
B&P C for this reason - - ,
ate
Plan check fee
2 2— - - a� 7.5" �r 5_y„»_• � _-`-=
'PLUMBING yPERM1T ISSUING FEE$
Signature t..P(:•+{G E
_rl J TOTAL FEE
` - Plan check applicant
X SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name =Y
hereby affirm that I am exempt from the Contractor's License Law2.1
for the following reason,(Section 7031 5, Business and Professions Address
Code)
City Tel No.
I, as owner of the property,will do the work and the structure
is notintended or offered for sale (Section 7044, 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 \ J
property for-inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date `