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HomeMy Public PortalAbout9553 BLACKLEY ST_Plumbing__ 76A667-CE817 11-57 APPLICATION FOR ,PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ., -� , JOHN A. LAMBIE, County Engineer ADDRESS 1 s S o. C14 " & C>iSSATT D. GRIFFIN. Supt of Building LOCALITY Ls - FOR APPLICANT.TO FILL IN NEARESST. NUMBER - FIXTURE OR ITEM WATER CLOSET OWNER MAIL BATH TUB ADDRESS 7,';? ! SHOWER CIEj TEL. NO. LAVATORY CONTRACT 4-, SINS ADDRESS ' DISHWASHER CITY TEL. NO. G� YS� -3 LAUNDRY TUB CONTRACTOR'S STATE REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRI NO. I GRQIIR READY F R INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD ♦♦ APPROVALS $1.00 PER ITEM / .ark DATE INSPECTOR'S SIGNATURE / OR FIXTURE $ (/Y UNDER SLAB WORK PERMIT $ 1 —00} ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE,READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER 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 LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 'AM THE LEGAL OW R 0 THE ABOVE UTILITY CO .NOTIFIED DESCRIBED RESIDENTIAL PROPERTY IGNATURE F PERM ITTEFINAL . /6ak ROBERTA. OOD. OF VALIDATION SUPERVISING MECHANICAL ENG'Ft CK. Id.0. CASN - •, -[_AC04 8 8 9 m SEP 16 5 A 2.00 M" ' Y 76A667-CE817-8-57 APPLICATION FOR PLUMBING PERMIT COUNTY OF•LOS ANGELES DEPARTMENT OF COUNTY ENGINEER- BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY Temple' em City t► FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM - 9, WATER CLOSET OWNERMAIL BATH TUB. ADDRESS SHOWER CITY TEL.NO. T,, s. LAVATORY CONTRACTOR L+arl Pei Standle Inc SINK ADDRESS 201 ' N O DISHWASHER CITY TEL.NO. GI 4.1.559 , LAUNDRY TUB CONTRACTOR'S STATE REGISTRATION NO. 11+9236 COUNTY ❑ CLOTHES WASHER DISTRICT Ng GROUP ZONE READY FOR INSPECTION 1 WATER HEATERr GAS SYSTEM. INDUSTRIAL WASTE APPROVAL INSPECTION RECORD & - v APPROVALS @ $1.00 PER ITEM DATE INS_P,E,C—TO'R'_S,SIGNATURE 7 OR FIXTURE $ 7e00 UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING r. r GAS PIPING 7 "� TOTAL FEE a GAS VENT I HEREBY ACKNOWLEDGE THAT I 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 FIXTURES - PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST --'� LICENSED AS REQUIRED BY LOS ANGELE COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEG OWNER -OF THE,ABOVE UTILITY'CO NOTIFIED DESCRIBED RESIDE_NZ4L PROPE SIGNATURE OF PERMITT 'FINAL_ ROBERT A. WOOD. ©s VALIDATION SUPERVISING MECHANICAL ENG'R CK M 0 CASH Ls "' ' WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT affirm that I have a certificate of consent to self 76A667A or a certificate of Wbrkers' Compensation Insurance, CE 817(REV. 10/81) r ce ig T jlie of�S 800, b C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY c�Policy o ((!�, 1CQfompany Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building mspec_ ADDRESS /^ L �//�tion d parime t. �7 NUMBER FIXTURE OR ITEM ® FEE LOCALITY 'Dater Applicant n�V� '64PRS' WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE D OWNER SHOWER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY t T NO / so as to become subject to the Workers'Compensation Lawsit DISHWASHER CONTRACTOR / Date Applicant CLOTHES WASHER ADDRESS G C r NOTICE TO APPLICANT If, after making this Certificate of -C• Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY co . /�l V , TEL N�� with comply with such provisions or this permit-shall be STATE �11J LIC deemed revoked. WATER HEATER LICENSE NO� �� CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO�� R SSED BY affirm I hereby arm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS vy cy. (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL 0 DATE VAL ATION License Number;U 7079 Lic Class 6-1- FINAL 7 O Contractor$�/g✓�� ��l'�?s Date .z C BY ❑ V Lu I am exempt under Sec. H BAP C for this reason ► Plan check fee Date. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE � D Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions Code): City Tel. No ;2 4 0 9 7 A ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , # 0 0 0 0 0 5 7044, Business and Professions Code) 1 4 Q 5 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for o o,0 4 Q 5 0 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) '0 2 2 4_8 6 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, an hereby au ze repres tat es of this County to enter pon the ab v -mention d ro ert for inspection pur ses SEE REVERSE FOR EXPLANATORY LANGUAGE lure U, D t