HomeMy Public PortalAbout10628 BOGUE ST_Plumbing__ 56A667 APPLICATION FOR ,PLUMBING ■ Pae RDt IT .�
CE 617 B-56 UILDING AND SAFETY DMSION
Department of County Engineer
County of Los Angeles FADDRESS D I NG `06 t� t7
JOHN A. LAMBIE:COUNTY ENGINEER +�CASSATT•O.GRIFFIM,SUPT OF BUILDINGLITY
FOR APPLICANT TO FILL IN CROSS ST.
OWNER DISTRICT NO. GROUP ZOE READY FOR INSPECTION
/
MAIL
ADDRESS
INDUSTRIAL
CITY T NO. WASTE APPROVAL
PLUMBER �� �o�� I/NS,PECTION RECORD
ADDRE
CITY EL. NO T
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE ��-
WATER CLOSET (TOILET) @ $1.00 $ O O d✓y>� v V Y L�
BATH TUB @ $1.00 1/ 102) 110, / ¢
z _ SHOWER @ $1.00 O - v
LAVATORY (WASH BASIN) @ $1.00 Ori + �
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00 Cit a. c--
LAUNDRY
-
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.Q0
x GAS SYSTEM @ $1.00
APPROVALS .,,,
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
ROUGH PLUMBING �1'.f' "� lip' �(s4�L ✓,/�:Oji
PERMIT $ 1 00
GAS PIPING
TOTAL FEE d0 GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT VI(P.TER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING. y [/
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST �'' �O /•(4%�" - 2a. '
LICENSED AS REQUIRED BY LOS ANGELES CO T ND STATE OF
CALIFORNIA OR THAT A( THE LEG THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTI ^ ,
SIGNATURE
OF PERMITTEE FINAL
ROBERT A.WOOD,
JOHN A. LAMBIE, OUNTY ENGINEER VALIDATION SUPERVISING MECHANICALENG'R
CK. M.0. CASH
,� 5 382�
DEC 27 3 1 0.00tr
76AS67C (CE-817E3) -9/75 - � ✓`
APPLICATION FOR PLUMBING .PERMIT'
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE) ABDUILDING
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL. NO.-V(/1,/-,5-V17
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS O
SWIMMING POOL RECEPTOR
CIT TEL. NO.�'
LAWN SPRINKLER SYSTEM
STATE /��.r�V LIC
WATER HEATER LICENSE NO. 12(OJCLASS �% 7�
DISTRICT NO. GROUP ZONE RO SED BY O
GAS SYSTEM OUTLETS d - / V
OUTLETS OVER
5 PER SYSTEMINDUSTRIAL C V
WASTE APPROVAL y�
a
INSPECTION RECORD Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE IN5PECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. NO. GAS PIPING
a
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT D
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALI FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDE AL PROPERTY. UTILITY CO NOTIFIED
SIGNATU RE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M,O. CASH
9 8 y 5 ,p. 7.5 0Q:.:;
•WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81)
or a certified copy thereof (Sec. 3800, Lab C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No9U S-1-5-963 ompany
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �
!llFCertified copy is filed with the county building inspec- ADDRESS �l✓� ��
?� tion depart NUMBER FIXTURE OR ITEM Q FEE LOCALITY �,
WATER CLOSET
Date Zent._ Applicant NEAREST .:
CERTIFICATE OF EXEMPTI FROM RKERS' BATH TUB CROSS;ST
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by SHOWER
the permit is for'one hundred dollars $100 or less. MAIL
p ( ) ) LAVATORY ADDRESS
I certify that in the performance of the work.for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL NO
so as to become..subject to the Workers'Compensation Laws. DISHWASHERvv ��
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR �1� L �
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL NOC Z
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO . 3 CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO P OCESSED Y
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
✓L(j
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER � a
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL
' ,p � �� •� - U� DATE l � VALI ATION u
License Number Lic Class ad
FINAL O
Contractor �AtDate 14/7- BY II-.
t,J
❑ I am-exempt under Sec H
B BP.0 for this reason ,
Plan check fee
Date. PLUMBING PERMIT ISSUINGFEE$ ,5e
Signature - ;23;0,4 9!R!
SINGLE FAMILY TOTAL FEE
Plan check applicant # o o o o o 5'
HOME OWNER-BUILDER DECLARATION Name J o o 3 Q 5 0'
I hereby affirm thot,l am exempt from the Contractor's License Address
Law for the following reason (Section 7031 5, Business and o o o 3 Q 5 0'v
Professions Code): _City Tel. No. 0027-85
❑ j, as owner of the property, will do the work and the
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 that I have read this application and state that the 11011i.above information is correct I agree to comply with all County,
ordinances and State laws regulating Plumbing, and hereby
authorize representatives o Jthis County to enter upon the
above-mentioned.proper f r inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
SignotyF of Permilttde 7 Date