HomeMy Public PortalAbout9617 CRAIGLEE ST_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
DISTRICTO. GROUP ZONE PER ,
FOR APPLICANT TO FILL IN % l & /3
PLUMBER ,� REC 1 ED BY READY FOR DATE 199UED
`�� FIRST INSPECTION
ADDRESSZa UILDI
ADDRESS CITY TE Nu. �� ADDRESSS
COUNTY LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER i
/ �"� MAIL ——
WATER CLOSET(TOILET) � 0.50 s �p L/ ADDRESS
BATH TUB P_ 0.50 CITY TEL. No.
SHOWER @ 0.50 �lyQ1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LAVATORY (WASH BASIN) 0.50 !' !I
---111" --a AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 _ZAND STATE LAWS REGULATING PLUMBING.01
1 CERTIF-Y THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O.SO Wo ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
jj OF THE RESIDENTI P P Y DESCRI ED ABOVE.
�— GAS SYSTEM—OUTLETS ® 0.50
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECO
FLOOR .SINK @ O.SO
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50 —/ L
DRINKING FOUNTAIN @ 0.50 �e �}'��' j
URINAL @0.50 _P � J`? ,. 6 (/\ /z A/1-/-/ J
HOUSE SEWER Q 0.50
MISCELLANEOUS
17
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING `
GAS VENT I'Z
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT 1.00 GAS TEST -
IZJA UTILITY CO.NOTIFIED .. jo
TOTAL FEE � �
AFI NAL
76A667 DBS$ 17 10/52
WORKER'6COMPENSATION DECLARATIOIJ 20.0026 DPW 9189 �PPUCAMN FOR PLUM NIG PERNT
76A667A �I u�u�p If`f�1f �J
I he affirm that I have'a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec. 3800 Lab.C.) ' ® C "
Lyr� �/3y� CompanY��/� �'�� L` COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
47
❑ Certified-copy is hereby furnished.
F-1
- FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS
department. ` NUMBER - FIXTURE OR ITEM - FEE
LOCALITY
Date Applicant / WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKE BATH TUB CROSS ST. ( c
COMPENSATION INSURANCE ASSESSOR.
(This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE O/�- PARCEL O/D
permit is for one hundred dollars($100)or less.) - NER y "
I certify that in the performance.of the work for which this permit LAVATORY f'► 1
is issued, I shall not employ any person in any manner so as to SINK MAIL
become subject to the Workers'Compensation Laws. ADDRESS
DISWASHER CITY TEL.NO.= G
Date Applicant CLOTHES WASHER 4<ONTRACTOR -
NOTICE TO APPLICANT: If, after making this Certificate of / / S' •C,^'G //LfL
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR p
provisions of the Labor Code, you.must forthwith comply with such ADDRESS
provisions or this permit.shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY t C U/7 TEL.Nbo:a Gl a y a
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section'7000 of Division 3 of the Business and STATE LPC. 0
( 9 Section)7000) LICENSE NO. CLASS
Professions Code,and my license is•in full force and effect. - GAS SYSTEM OUTLETS U
OUTLETS OVER DISTRICT NO. R.RO6EF,.4D BY
5 PER SYSTEM �O - 0
License Number t� �� T Lic.Class
, U
FINAL ({/,� VALIDAT101�!?� CV
S.G:C IJIJ�- 11 r DATE 3-2 q _ _-�
Contractor T Date i _ ¢ ro
❑ FINAL '`'' z1 "-a Z
1 am exempt under Sec. et7 BYr-t? �w!�
B.&P.C.for this reason
Plan check,feeGa=st
Date:
Signature PLUMBING PERMIT ISSUING FEE$ �� Lf
❑ TOTAL FEET+ JJ'fJ/ A.
_ r
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Address
Code):
❑ City Tel. No.
I, 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
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 above-mentioned
property for inspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE -
Signatur of PerWee ee Date