HomeMy Public PortalAbout9924 BOGUE ST_Plumbing__ 76A667-CE617 12/59 T F.MPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY T�+IVISION BUILDING
JOHN A. LAMBIE, COUNTY tNGINEER ADDRESS L� Q
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY V
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET �, , MAIL I c
p
BATH TUB ADDRESSY
CITY
SHOWER J (. ,4 TE . NO. ''
.
LAVATORY CONTRACTOR
ADDRESS
SINS
DISHWASHER CITY TEL. NO.
CONTRACTOR'S STATE ❑
LAUNDRY TUB I REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NONE NE E D BY
WATER HEATER —5 r � 2
GAS SYSTEM � INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD >.
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@ $1.00 PER ITEM
OR FIXTURE $ / APPROVALS DATE INSPECTOR'S SIGNATURE
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PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE -
FINAL
OF VALIDATION ROBERT A. WOOD,
CCs. B.0. CASH SUPERVISING MECHANICAL ENG'R
I
76A667�CE-817) - 1/75
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 TY PEI NEAREST '
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
WATER CLOSET
2.00 OWNER
MAIL
BATH TUB 2.00 ADDRESS
SHOWER 2.00 CITY TEL. NO.
LAVATORY 2.00 CONTRACTO CG ip�
SINK 2.00 ADDRESS
DISHWASHER 2.00 CITY TEL. NO.
CLOTHES WASHER 2.00 STATE LIC
SWIMMING POOL RECEPTOR LICENSE NO. Dl CLASS
DISTRICT NO.JGROUPJ ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL •
GAS SYS OU LETS df INSPECTION RECORD U
OUTLETS '
VER 30 O
5 P a _ TEM
W
a
_ N
Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ a
TOTAL FEE
APPROVALS DA E /INS ECTOR'S SIGNATURE
Plan check applicant / UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
I
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 �f
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGy6
PLUMBING. . GAS TEST 1 4
I HEREBY CERTIFY THAT M PROPER REGISTERED AND/OR UTILITY CO. NOTIFIED Gr
LICENSED AS REQUIRED B LO ANGELE OUNTY AND STATE OF
CAL(FORNIA OR THAT I T LEGAL ER OF, AND INTEND TO
RESIDE IN THE ABOVE ES E ESI'• T AL PROPERTY. FINAL -
SIGNATURE _
OF PERMIT
PERMIT VALIDATION /rClp M.0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH V ;
4 0 h"iAY 6 Z) u 1. U.5 U ��c
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT .
I here*ty,i4ffirm thgt I have a certificate of consent to self 76A667A ,
insure, or(a certificgte of Workers' Compensation Insurance, CE 817(REV. 8/86)
or a certif+ed copy thereof (Sec. 3800, Lab. C•)f COUNTY OF LOS ANGELES - DEPT. OF PUBLIC WORKS
Policy No.7 Company � Y QI�
VC
ertified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ertified copy is filed with the county building inspec- ADDRESS
NUMBER FIXTURE OR ITEM
�ti7on dlepar[�t�me``��nt. /��� �n C°? ..FEE
Date—«6—CLAppligantt9z ^ / 1Uo��L !NATER CLOSET LOCALITY 1
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB . CROSS ST.
COMPENSATION INSURANCE OWNER
(This-section,need not be completed If the work involved by- SHOWER fit'
the permit is for one hundred dollars,($106) or less.) LAVATORY' MAIL
I certify that in the performance of the work for which this ADDRESS
UE
permit is issued, I shall not employ any person in any manner SINK - CITr� � TEL NO 7
so as to become subject to the Workers'Compensation Laws. DISHWASHERr
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT- If, after making this Certificate of (,
Exemption, you should,become subject' to the Workers' SWIMMING POOL-RECEPTOR i
Compensation provisions of the'Labor Code, you must forth- CITY TEL NO
with comply with such provisionsLAWN SPRINKLER SYSTEM, or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO
CLASS
LICENSED CONTRACTORS DECLARATIONDISTRICT NO. P ESSED Y
I hereby affirm that I am licensed under provisions-of Chapter 9 GAS SYSTEM 2 OUTLETS
(commencing wi+h Section 7000) of Division 3 of the Business OUTLE750VER `-
and Professions Code,and my li nse is in full force and effect. 5 PER SYSTEM
G`� DATE 1i�`-, VA ATION
License Number 41ALic Class
FIN L V
Contract o Date 55_ T/7 BY
❑ I am exempt u der Sec d
B.BP.C. for this reason Plan check fee
Date:
PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEEIbis
Plan check applicant
�6.67,4.A
SINGLE FAMILY #-0 0 0 0 0 5 .
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractors License Address :( ° °�� 5
Law for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No0 0.o rj 0
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section , O 3 �.6 8 7,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirrim 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
aboveentioned pr perry for inspection purposes.
cam/ SEE REVERSE FOR EXPLANATORY LANGUAGE
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