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Home My Public Portal About10108 DAINES DR_Plumbing__ 76AS67 DSS 17 11-60 APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY / COUNTY OFF LOS LOS ANGELES I WILLIAM J. FOX, CHIEF ENGINEER DISTR CT GROUP I ZONE RMI FOR APPLICANT TO FILL IN PLUMBER • RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION p ADDRESS p' �r BUILDING % CITY 'F} TEL No. ADORE98 r COU NTY / LOCALITY LICENSE NO. EXPIRES � pp NEAREST �P kV� PERMIT FEES CROSS ST. G NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER D. ' f MAIL ADDRESS WATER CLOSET(TOILET) @ 0.50 $ e"O BATH TUB @ 0.50 O CITY d`C DS t TEL No. `SHOWER" @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT I O O AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50AND STATE LAWS REGULATING PLUMBING. ro t CERTIFY THAT I POSSESS THE AS E VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICEN W. OR I M T LEGAL OWNER OF THE RESIDENTIAL P 'OR ES ED A VE. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE OF WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 13.50 INSPECTION RECORD FLOOR SINK @ 0.50 / FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 HOUSE SEWER @ 0.50 MISCELLANEOUS APPROVALS DATTEEy' INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1,00 CESSPOOL SEPTIC TANK., SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 I SEWER PERMIT I 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE IS �! Z' / FINAL Y WORKERS'COMPENSATION DECLARATION 0026 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A666DPW 4/90 sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. 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 WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter } 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER a. and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION U fect. HOSE BIB DATE J W License Number Lic. Class FINAL ly Contractor Date BY r2 0 1 am exempt under Sec. cc B.BP.C. for this reason Plan check fee a Date: PLUMBING PERMIT ISSUING FEE$ H Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. . 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 ► 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ~WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I here'y',,ogiftn.that hhade a certificate of consent to self in- 76A667A sure,or a tzttificate of Workers'Compensation Insurance,or a certifFVd'copy thereof (Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM ea FEE t LOCALITY Date Applicant / WATER CLOSET(TOILET) �il NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. ' COMPENSATION INSURANCE SHOWER -OWNER JO rr N MA��I (This section need not be completed if the work involved by MAIL � the permit is for one hundred dollars ($100)or less.) / LAVATORY ADDRESS S�IfJ� LA r"vd7 v r— I certify that in the performance of the work for which this per- SINK CITYTEL. N mit is issued, I shall not employ any person in any manner so ()LE- �� as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be.deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �� f� A 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Piofessions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE License Number Lic. Class 1 O FINAL c U Contractor Date BY ig 0 1 am exempt under Sec. CCTas U 3313 B.&P.C. for this reason 1401.0 Plan check fee a , 1 ITEMS y Date: PLUMBING PERMIT ISSUING FEE$ Q TOTAL 140 — 00 � Signature SINGLE FAMILY TOTAL FEE 6yO CHECK 140.010 HOME OWNER-BUILDER DECLARATION Plan check applicant CHANGE .00 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address JysS 0000-0001 4/15/96 9$ g be U4 I, as owner of the property, will do the work and the CityI r) Tel. No. '7 y` e892 1 PM 5n41 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 ► above information is correct. I agree to comply with all County ordinances and State laws re ulating Plumbing, and hereby authoriz r�epresenta ivyes of his County to enter upon the abov edit' o inspectio purposes/. ��✓L SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date