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HomeMy Public PortalAbout10154 DAINES DR_Plumbing__ DBS-1710-55 APPLICATION FOR PLUMBING PERMIT DBS-17(DIVISION OF BUILDING.AND SAFETY ` Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 101E (v G1 'e-44'e, CASSATT D GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT'TO FILL IN NEAREST CROSS ST OWNER DISTRICT NO. GROUP ONE I READY FOR INSPECTION MAIL - /� ADDRESS Ia�f d CITY (XC.�.(i' DUSTRIAL TEL NO ��� 3 WASTE APPROVAL PLUMBER f� INSPECTION R CORD ADDRESS / [A ���� CITY TEL. NO LICENSE NO. ! � NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ I BATH TUB @ $1.00 j SHOWER @ $1 00 LAVATORY (WASH BASIN) @ $1 00 1 KITCHEN SINK @ $1 00 DISHWASHER @ $1 00 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $100 WATER HEATER @ $100 I GAS SYSTEM @ $1 00 . 8-D APPROVALS DATE INSPECTOR'S S NATURE UNDER SLAB WORK ,Q PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE !d-lao GAS VENT 9� ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER ®`7 AND STATE THAT THE ABOVE IS-CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED )`10 DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE A,�7/�- p OF PERMITTEE �"""r FINAL '® JOHN A. LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A WOOD, CHIEF PLG. INSPECTOR m 0. CASH I I �Y 9 3 9 4-. JUN( 1 R 3 1 2.0 0 P 4 COMPENSATION DECLARATION APPLICATION F®R PLUMBING' PERMIT 'T herebyt�RKERS' airm that I have a certificate of consent to self 20-0026 DPW 6/87 ry insure, or a certificate of-Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy Nc,/,o Compan:c'??— Certified copy hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS Certified copy is filed with the county building inspec- tion department / NUMBER FIXTURE,OR ITEM @ FEE LOCALITY Lu/i / -7- S WATER CLOSET Date Applicant NEAREST _ CERTIF CATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS 57 COMPENSATION INSURANCE SHOWER ' OWNER ltLx� (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars (:100)or less.) LAVATORY DDRESS�'�'3� 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 8�9� TEL so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR��lL Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS//,0_J Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation-provisions of the Labor Code, you must forth- - LAWN SPRINKLER SYSTEM CIT���� � �— TEL NO���t with comply with such provisions or this permit„shall be STATE LIC deemed revoked WATER HEATER LICENSE NO &-_ c 3 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 3 OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my'license is in full force and effect 5 PER SYSTEM i f��p FINAL 7 // / VALIDATIONDATE 0 License Number Lic Class_ U � FINA � i f, � ZI Date a BY Contractor O ❑ H. I am exempt under Sec W B 8P C for this reason d' Plan check fee ® Z Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name _r I hereby affirm that I am exempt from the Contractor's License Addressr`� Law for the following reason (Section 7031 5, Business and _ __ Professions Code) City Tel No = ��l� 2�- a*�i . T� i` _ IDI, as owner of,the property, will do the work and the �. 1 r"�'� structure is not intended or offered for sale (Section _ 7044, Business and"Professions Code) ® t`"ITAL 20 - 50 CONSTRUCTION LENDING AGENCY r, t 20.511 I hereby affirm that there is a construction lending agency for i_} the performance of the work for which this permit is issued :. t1t1� °tie (Sec 3097, Civ C ) Lender's Name I_j�i(�f i^I�001 5I­V?! Lender's Address Hil€`_le i 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 jaws 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 Date WORKERS',COMPENSATION DECLARATION` -20-0026DPW-4/87 ' '—APPLICATION FOR PLUMBING PERMIT,." , I affirm that I,hove a certificate,of conserit to self in- 76A667A sur ' r certificate of Workers'Compens_ahon Insurance,ora- CE 817(REV 8%86) cert copy thereof:(Sec,+3800, Lab-,•C ) ._, ;'., 4 ~ COUNTY'OF LOS,ANGELES DEPT. OF:PUBLIC WORKS _ 'Policy,No�/1Loe, Companys" ; 0 ~ .. Certified copy is hereby.furnished 1•'- FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING „ fYl.'Cer'tified copy is filed with the county building'tnspection - ADDRESS ©f.� 'r �l d6pa - NUMBER 'FIXTURE OR ITEM -Ca FEE: + ,.� p r / LOCALITY Date �.� r Applicant •`NATER CLOSET(TOILET) J NEAREST CERTIF ATE OF.EXEMPTION FROM WORKERS BATH TUB H CROSS Sr fIN/y: COMPENSATION INSURANCEy 'i` t OWNER�/L/�i�� SHOWER :(This section-need not be,colirr ted if-the work5involved 6y MAIL` the permit.is for,one hundred dollars,(Si'00)or less.)t, LAVATORY° 'ADDRESS-1l� I certify that in the performdnce,of the`work for which this.per mit is issued, I`shall not employ any"person in any manner so SINK as to become'sublect to'the•Workers' Compensafiori Laws DISHWASHER ,d • = f ' ._,'', . '•c CONTRACTOR• ,, Date•. *" Apphcanf' , - � !", � ,� �" CLOTHES'WASHER ;' ' ~ ADDRES� NOTICE TO APPLICANT'If, after•making this'Cectlfica'te'of Ez- i 'I ' emption,you should become•sub�ect to the,Workers'Compen-' SWIMMING POOL RECEPTOR /j ,,- .. CI$.Y4��L/, L� TEL'NO :y sation'provisions�of'the Labor Code,•you'must.'fo�thwith'comp; LAWN SPRINKLER SYSTEM ly' th such"pprovisons or-this permit shall be,;deemed revok- t �' -r' STATE•, ,uCs ed° °' " - WATER HEATER ' LICENSE'NO yD 3 J3 CLASS u . ,`u ­1L ICENSED,CONTRACTORS'DECLARATION DISTRICT NO" PROCESSED BY GAS SYSTEM :'OUTLETS I hereby affirm that I am licensed under provisions•of,Chapter, ,, :_ O�'°, " 9(commencing with Section 7000)of Drvisron 3 of'the Business _ OUTLETS OVER - u and Profess ions.Code, an&my license is in full force'ancl ef=r " 5'PER SYSTEM FINAL / / VALIDATION fect DATE`7- / �! G. 0' License Number ���u.S� Lic Class_ , Q y r a� 4 -FINAL' Co�tractorr ,�.Sb�vEj �r Date �� ju i ti�,u: ' .�. BY iry ry 0 F_ ,�am`exen pt under Sec W &P C for this reason ° - � •� ^ ' �� •- - - • ''" � N.° Plan check feew•.'. z Date f ® .. 3 �• �, PLUMBING PERMIT ISSUING FEE $ hi Signature rr 7 "r TOTAL FEE SINGLE FAMILY". c - �• _ "' '{ Plan check a Iicarit HOMEOWNER-BUILDER_DECLARATION•�` PP -- " , - u •° - - : - I hereby'affirm that I ari,exempt from the Contractor's License Name _r Law for the°`following,reason-(Section'7031 5,"Business'and _` s` y` ' p Professions Code) SAddiess` r L_�aas = 1-,-,as owner of�the:property, will ,do,'the work and he Tel No u„” 'structure is not'mtended or offered for,sale(Seciion 7044,- i; „ , rt, `"• .�a { a } ('Business_and Professions Code) " CONSTRUCTION LENDING AGENCY' e I Fiereby.dffirm that there'is, lendmgiagency,for n - E � � -Ju the performance of the work for which this permrt,is.is"sued, � ;a• - " � � � � � r �•, `- (Sec 3097, Gv C ) - C•Filtfi , "a (Sec Lender's Name Lende'r's Address I certify'thai I Have-read this appli'cation;and's{ate,that th'e t ` ?' • " - aliove information is correct I agree to comply with{all County, ordinances and State laws reg`uloting;Plumbing; and hereby,_ • '' " outhonie-representatives of this County-to„enter upon.the aboveamentioned properly for inspection purposes "-SEE-REVERSE FOR'EXPLANATORY LANGUAGE Sig 2 !u'e_of Per Date. ? 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