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HomeMy Public PortalAbout9707 BLACKLEY ST_Plumbing__ 76A667 (CE-817) - 5/73 APPLICATION FOR, PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF'COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING 'ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER .. LOCALITY' FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. a NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 OWNER MArr ,/ •, BATH TUB 1.75 AIL DDRESS 9707r�'/�4..-(,•- j�'(�-�,•, SHOWER 1.75 CITY �V•i / C.c1 EL' NO. LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 _ rT •CITY "TEL. NO. , CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1,75 DISTRICT NO. GROMP iNE- jRESSED�BY LAWN SPRINKLER SYSTEM 1.75 Gam/) WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL "- GAS SYSTEM 'OUTLETS 1.75 INSPECTION RECORD OUTLETS OVER 5 PER SYSTEM .30 S U ♦91/.-,J2. a 4 Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE i APPROVALS DATE INSPECTOR'S 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 TP,COMPLY PLUMBINGiFIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. - GAS TEST !•0IT 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR TH THE LEGAL OWNER OF, AND INTEND TO /) RESIDE IN THE AB E DESCR ED RE IDENTIAL PROPERTY. FINAL SIGNATURE OF PERMITTEE PERMIT V LIDATION CK. M.0. CASH PLAN CHE IDATION CK. M.0. CASH / ` . 6. 0 8C"-"r1PR 2 u 4.7.5 ago 76A667 (CE-817)-4/72 APPLICATION FOR, PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 9-7o-7 MAKE CHECKS PAYABLE TO: ADIDRESS { 7 o �QG HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. AIAO NUMBER FIXTURE OR ITEM @ FEE OWNER Qe WATER CLOSET 1,75 7S MAIL BATH TUB 1,75 ADDRESS 113 7o71,e),- SHOWER SHOWER 1,75 �CJ` CITY C+ `,t TEL. N . ;L ,, 6 tf If LAVATORY 1.75 �5 CONTRACTOR 0 SINK 1.75 ; ADDRESS DISHWASHER 1,75 CITY TEL. NO. / CLOTHES WASHER 1.75 STATE LIC 7 LICENSE NO CLASS SWIMMING POOL RECEPTOR 1,75 DISTRICT N . GROUP ZONE F ESSED Y LAWN SPRINKLER SYSTEM 1,75 k•— ©& �— , y ��• WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL GAS.SYSTEM _ OUTLETS 1.75 INSPECTION RECORD V OUTLETS OVER 30 5 PER SYSTEM O 1--• C.J W a H Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE zz 751- APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name �O e ROUGH PLUMBING —1+/ .y$11:4,11j Address 7Q 1e-c le GAS PIPING City Tel.'No. S_'9co GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE TH T 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 PLUMBING. GAS TEST I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO _ RESIDE IN THE ABOVE DES BED RESIDENTIAL PROPERTY. FINAL SIGNATURE OF PERMITTEE PERMIT VALIDATIO / cK. M 0. CASH PLAN CHECK VALI TION CK. M.O. CASH ! (' 7 473, JUrd 1 0 5 D 1 1 .75Z WORKERS'COMPENSATION DEICLARATION� 76A667A I hereby affirm that I have a' certificate of consent to self cE 617 (z-eo) APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation-Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) 7/ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. - Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Q 4,cJ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE department. If WATER CLOSET LOCALITY �Q Cir 4 Date Applicant NEAREST BATH TUB CROSS ST. y!Q� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER :" OWNER Tb Cor4e__4 (This section need not be completed if the work involved LAVATORY MAIL ADDRESS Q ��¢� } • by the permit is for one hundred dollars ($100) or less.) / n SINK CITY TEL. N rtify that in the performance of the work for which this DISHWASHER U e mit is issued,'I shall not employ any person in any manner CONTRACTOR so,as to become subject to the Workers' Compensation- aws. CLOTHES WASHER Date�T Applicant !7AA!I Ce ADDRESS 0 SWIMMING POOL RECEPTOR U NOTICE TO, APPLICANT: If, after making this Certificate of CITY TEL. NO. tL Exemptionyou should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. U) Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS Z ith comply with such provisions or this permit shall be WATER HEATER .3 deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR CESS_ f/ EDBY� LICENSED CONTRACTORS DECLARATION OUTLETS OVER . �L I hereby affirm that I am licensed under provisions of Chapter. 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE /� . effect. / FINAL License Number • Lia Class BY ' Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name O �r S I hereby affirm that I am exempt from the Contractor's Address < 70 6QC—k License Law for the following reason (Section 7031.5, Busi- City e (e E^ Tel.No. JS. pp 6 @382. 1 A ness and Professions Code): I, as owner of the property, am exclusively contracting # o o o o o 5 with licensed contractors to construct the project (Section 7044, Business and Professions Code). 2 ° ° 1 9.00 CONSTRUCTION LENDING AGENCY ° 1 9,O O U I'hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 1.2 1 8 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 SEE REVERSE FOR EXPLANATORY LANGUAGE authorize representativ s of this County to enter upon the abov Toned pr rty for' spection purposes. oz-OZ9 ign re of Permittee Date