Loading...
HomeMy Public PortalAbout9332 BROADWAY_Plumbing__ 7BAS67-CE817�5B APPLICATION FOR PLUMBING PERMIT �I COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 7 BUILDING AND SAFETY DIVISION BUILDING ✓3� JOHN A. LAMBIE, County Engineer ADDRESS L spLc CASSAT7 D. GRIFFIN, Sup t of Building _ LOCALITY FOR APPLICANT TO FILL IN NEAREST SS rNUMBERR FIXTURE OR ITEM OWNER WATER CLOSET MAIL / BATH TUB ADDRESS CITY TEL. NO. SHOWER CONTRACTOR LAVATORY SINE ADDRESS T DISHWASHER CITY J I A�.-L� TEL, NO. b CONTRACTOR 5 STA'[E LAUNDRY TUB REGISTRATION NO. —� COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP I 77QNE PR GESSED BY WATER HEATER S —T GAS SYSTEM - INDUSTRIAL WASTE APPROVAL INSPECTION RECORD CFi✓ G /AI/--F/fIT L RR C,')APErT/NG 7"f//_f' A14141 IO 0 51.00 PER ITEM OR FIXTURE $ O 00 APPROVALS- /�,,'P DATE INSPECTOR'S SIGNATURE PERMIT $ Z 00 UNDER SLAB WORK TOTAL FEE y OD ROUGH PLUMBING?, ,-7 -� A PYI/YA///R//1 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 HOT WATER HEATER ) /t�� PLUMBING. _ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ` LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST /.YSI 7�9'Y/Jd1/ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED F wi L SIGNATURE OF PERMITTE FINAL 760 1 t- Mh ®. ALIDATION ROB RT A. WOOD, Cr H.o. WH SUPE YISING MECHANICAL ENG'R W� /Irlop D7�'40 �dL03763 '� FPR 4 5 A 1. 2.00 r WORKERS'COMPENSATION DECLARATIONrsAssrA I bere6affirm that I have a: certificate of consent to self cE.eii (z-9e) APPLICATION FOR PLUMBING PERMIT msure, or a certificate of Workers'Compensation Insurance,or ' a certified copy thereof(Sec. 3800,Lab.C.) lx;tllau p l l ��� COUNTY OF LOS ANGELES - BUILDING AND SAFETY - Policy.No. om any _ 4) Certified copy is hereby furnished. _ FOR APPLICANT TO FILL IN (PRINT OR TYPE) - BUILDING Certified'co NUMBER FIXTURE OR ITEM _ O FEE AO DRESS �, �- copy is filed with t to county building inspection de ar r yt. LOCALITY ��f1Vt/�n k�c��ICS WATER CLOSET ID. de Applicant — v NEAREST BATH TUB - 'CROSS ST. CERTIFICATE-OF'EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAIL f� (This section need not be completed if the work involved LAV ATORV - ADDRESS CL by the permit is for one hundred'dollars ($100),or less.) SINK O ' - CITY nLlti C.1T TEL.NO. ZS U 1 certify that in theperformanceof the work for which this .DISHWASHER cc permit is issued, 1 shall not employ any person in any manner CONTRACTOR V,K s O so as to become subject to the Workers' Compensation Laws'. CLOTHES WASHER U Date .Applicant ADDRESSi-�O W SWIMMING POOL RECEPTOR ' NOTICE TO APPLICANT: If, after making.this Certificate of CITY- m.� ©r }u TEL. NO. �Z N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE . LICz Compensation provisions of the Labor Code, you must forth WATER-HEATER jM' LICENSE NO. CLAS. Sr�1 fQr with' comply with such provisions or this permit shall be .r• deemed revoked. GAS SYSTEM OUTLETS DISTRIC 3-b"0. PROCESSED BY LICENSED CONTRACTORS DECLARATION ' OUTLETS OVER hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM (commencing with Section 7000) of Division 3 of the Busi- FINAL/ VALIDATION ZO ass and Professions Code,,and my license is in full force and DATE .. ! / L ffect. 13 pC z cla CFINAL ✓ icenae Number Cie. Class BYr onttactor 1 ✓hS Date / /,7_ I am exempt from:the licensing requirements as I am a Plan check fee - �'iGX r47 t" licensed architect of a.registered professional engineer PLUMBING PERMIT ISSUING FEES -acting in my professional'capacity (Section 7051, Bus- r n iness and Professions Code). TOTAL FEE c,or Reg.No. Date Plan check applicant HOME OWNER-BUILDER'DECLARATION Name ' 4hereby affirm that I am exempt from the Contractor's Address Ilcense Law for the following reason (Section.7031.5, Busi- City Tel. No. Iss and Professions Cade): - 1, as owner of the property, am exclusively contracting 23-OJ.9 A ' with licensed contractors to construct the project (Section 7044, Business and Professions Code). - - CONSTRUCTION LENDING AGENCY - _. - 2 hereby affirm that there is a construction lending agency ` r the performance of the work for which this permit is ued (Sec. 3097,Civ.C.). °�° ° 1 2 Jr 0 cx i finder's Name - IZ17-81 mder's Address certify that I haveread this application and state that the 'rove information is correct. I agree to comply with all County SEC REVERSE.FOR EXPLANATORY LANGUAGE dfi ances and State laws regulating Plumbing, and hereby ithorize represen tives of this County to enter upon the ave-menti ned erty for inspection purposes.,11I o iSignature of Permittee —V Date'