HomeMy Public PortalAbout10202 DAINES DR_Plumbing__ 8-49 ® APPLICATION FOR PERMIT
�GA667
n DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING I
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICAN�T�TAO�FII'LL IN DISTRI��NO. GROUP ZONE PERMIT NO.
:dam ��d�79 C.Pi rs�t� - '� IS v
PLUMBER
RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION '-'7
ADDRESS CL_ ZZ� / —
BUILDING " L d
CITY TEL. NO. ADDRESS
COUNTY LOCALITY t
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST. \ I f
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) @ O 50 s ADDRESS
BATH TUB @ O 50 CITY TEL. NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY WASH BASIN) @ O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
- I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O 50 ANGELES COUNTY ENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENT ROPER,TY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50 ssffTURE u [[��////
SIGNPERMITTE -�
WATER HEATER @ 0.50
SLOPSINK @ O 50 INSPECTION RECORD
FLOOR SINK @ 0 50
FLOOR DRAIN @ O 50
DISHWASHER @ O 50
DRINKING FOUNTAIN @ O 50
URINAL @ O 50 ..1
HOUSE SEWER @ O 50 Q
Z
MISCELLANEOUS
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1 00 CESSPOOL
SEPTIC TANK. SEPTIC TANK
DRAIN ( ) PIT ( ) @ ,1.00 SEWER
PERMIT . . I 1.00 GAS TEST
UTILITY'CO NOTIFIED
1
TOTAL FEE
• FINAL
o
76Ae67 17 9-49 ® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY m In 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
fim %y
FOR APPLICANT TOO�yFILL
/IIN� DISTRICT NO. GROUP ZONE ,,PERMIT NO.
PLUMBER EA/'f�WV�- '/Vt�brCJC� RECEIVED BY READY FOR DATC D T I �5.�
E ISSUED
FIRST INSPECTION
ADDRESS
BUILDING
CITY TEL NO.?& ADDRESS
/
L ICE
COUN Y'
/
E NO VO N1 EXPIRES Cf 130'--S LOCALITY V
NEAREST
_ PERMIT FEES CROSSST
NUMBER I � TYPE OF FIXTURE OR ITEM FEE
OWNER IYi/`W1�1/M/j�
MAIL
I WATER CLOSET (TOILET) Q 0.501$
ADDRESS ��`�e Ir'7.J 6►I
�I BATH TUB @ O 501 I CITY Ay^ TEL. NO. At,p 3 O
SHOWER @ O 50lv
I 1 HEREBY ACKNOWL DGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q O 50 I 1 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q O Sol STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O 501 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS SYSTEM OUTLETS @ O 501 I OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
SIGNATURE OF
. 1 WATER HEATER Q O 501 PERMITTEE _ A
SLOPSINK @ o 501 INSPECTION RECORD
FLOOR SINK Q 0,50
_ FLOOR DRAIN Q O Sol
DISHWASHER @ O 50 /r.✓G�i�6f Sn L�...✓r .FrJ,fJ
1 DRINKING FOUNTAIN Q O Sol
URINAL O 501�
Q
HOUSE SEWER Q O 501 i
MISCELLANEOUS
1 w
APPROVALS
IDATE INSPECTOR'S NAME
ROUGH PLUMBING
II GAS PIPING
T GAS VENT
I CESSPOOL Q _1 00 I CESSPOOL
SEPTIC TANK I SEPTIC TANK l
DRAIN ( ) PIT ( @ 1 001 I SEWER
PERMIT I 1 00 GAS TEST s'I�
UTILITY CO NOTIFIED
TOTAL FEE $fj/e ��
`"�" F 1 N AL
;Y11OR14ERS' COMPENSATION DECLARATION
I he�eki 'affirm that I'have a certificate of consent to self in-
y, '
`20-0026'DPW 4/87:• APPLICATION- FOR- PLUMBING PERMIT-.-, .
,76A667A•
sure;orb•certificote,of.Workers'Compensation:lnsurance,oi.a "CE 817(REV••8/86)' °
'c;rtified,^copy thereof•(Sec,3800, Lab:C ); s ✓° = - L,
U COUNTY OF^LOS ANGELES DEPT.'OF PUBL'IG.WORKS,°
Pollicy,No?Company Y
1 L'Certifl d copy is'herel y4urnisher_ ` � �
y ,f,c BUILDING
}
FOR. TO FILL IN (PRINT OR TYPE) p
Certified copy;is filed wiih the county,buildmg inspection _ ADDRESS ' d /�/ j D,
department''` NUMBER_ n FIXTURE OR ITEM @ FEE
.LOCALITY ,r r'
/' Q WATER CLOSET(TOILET) .�
Date Applicanti,A. 4/0t / - i 'NEAREST'
CERTIFICATE OF EXEMPTION'FROM'WOR'KERS'' BATHTUB; } ` CROSS ST OQ
s 'COMPENSATION,INSURANCE r• SHOWER _ OWNER a e
This section;need"not,ge completed,if the.wo�k involved by y ~
the permit,is for one hundred dollars $100 or less LAVATORY" MAIL t
s ( ) �' O -ADDRESS
i,•c rtify ihat,iri'the performance of the wo'rk,forwhich th'is•per- ; -
mit ississued;,I shall not employ an erson m'ah manner so SINK.., _. _ CITY TEL NO',
P Y Y-.P Y
as'to become"subject to the Workers Compensation:Laws DISHWA +
t SHER+,•.•' CONTRACTOR
Date "`T t' Applicant ». -
-.CLOTHES WASHER,
NOTICE TO'APPLICANT" If, after-mokmg,this Ce�tificate'of•Ex- SWIMMING',PCGOL'RECEPTOR ' ADDRESS
emption,`you should become s'ub'lect to the Wo�kers;.Compen- • CITY TEL NO o -
sat'
on provisions,of the Labor Code,you must forthwith-comp-' LAWN SPRINKLER SYSTEM � �_ '
ly_with such°pr'ovisions.or,this permit,shall,be-deemed;evok- STATE /[ �/' LIC' Q
ed } '`w e•'' c WATER HEATER LICENSE NO /�� ��4}S' - CLASS cQ '
LICENSED CONTRACTORS"DECLARATION; = DISTRICT NO PROCESSED BY
GAS SYSTEM -OUTLETS
I^hereby`raffirm'thdt I'am'lice'nsed under pravisions.df°Chapter _
9(commenting with Section 7000)of Division 3-of the.Business O,UTLETS•OVER .
and Professions Code, and my lice'nse-is in full'force and ef- 5 PER SYSTEM,_ FINAL / VALIDATION
fect = r
DATE �D`I O
License'Number Lic',Class' U
a .«.. q FINAL.
Contract6r0/ _Date'
- I
BY ` O
I am exempt under'Sec�' ; W
B -fee
8P:C for this reason ' Ficin CFl@CIC �� �
ate '� �( / PLUMBING PERMIT ISSUING FEE$ ► r
`Signature J ;
TOTAL FEE
SI E FAMILY, t
HOME OWNER,-BUILDERbECLARATION3 " .Plan check ojSplicant,Y •, A tY ;
I hereby affir'm'that I a'm exempt from the Cor tractor's License Name
Law for,ihe followin ''r ason (Section:7031 5, Business and _t `
Professioris.Code) - Address e
a I,-aswowner of-the property:, Ai -do.the work•dnd the 'City , _ Tel No
stiucture,is rot intended,or offered for sales(!%ction'7044; �' r
Busiriess andrProfessions Code)_ f, a _ ' �r` • .. t
+ 50
'CONSTRUCTION LENDING,AGENCY e ': '' 3 ► ` TOD ;
i hereby-6ffirrri that there is d construction fending ogehcy'for
the perforrimance•of'the.work for vihich'thi`s permit is issued?' 1`1 :r , ' ' t _•�it1.6•' ^' f.q-`.' 1'
(Sec 3097;'ECi"v .0CHANGE-
), ; _ :.` J _ • ..
Lender's Name r' o
-L`ende,'4 Address �' " ;• i It it JA
I certify that I have'read this application and state'that the
abovejnformatior'is correct'I agree to'corhply with all County %_ ► �' -'�n�L ,, ' I •�)� '
ordinances°and.State lows,regulating Plumbing, and•hereby r ^
autho'cize'representatives of'thi County,to enter upon the ;e "
above, entione prop rty for echon purp es
= SEE REVERSE'FOR-EXPLANATORY LANGUAGE
Signature, eimittee Ddte�