HomeMy Public PortalAbout10414 DAINES DR_Plumbing__ 76A6APPLICATION FOR PLUMBING PERMIT
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DBS 177 12 ON OF BUILDING. AND SAFETY
1
Depar ent of County Engineer
County of Los Angeles BUILDING -
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN, SUP T OF BUILDING �a
LOCALITY
FOR APPLICANT TO FILL IN NEAREST if
CROSS ST &&" - :-]
OWNER j' DISTRICT NO I GROUP I ZONE READY FOR INSPECTION
MAIL �'Y �
ADDRESS •Y�
INDUSTRIAL
/ CITY TEL NO WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
CITY `
LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $ `
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
e^
1
TOTAL NO @ 080 APPROVALS
DATE INSPECTOR'S SIGNATURE
GAS SYSTEM—' OUTLETS Q 100
UNDER SLAB WORK
WATER HEATER @ 100
ROUGH PLUMBING
PERMIT $ 1 00 GAS PIPING
TOTAL FEE Alac GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGWLATING PLUMBING FIXTURES
PLUMBING
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY c
TY j` _
SIGNATURE =% / J 'I � `
OF PERMITTEP� FINAL
WILLIAM J. FOX, C01iNTY ENGINEER VALIDATION-
ACO 4 6 3Sul
��J—,JUN 8" 3 2.0 0
BY 7
A,-�.EPUTY
•t Z Y ;WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89
_ �J
1 hereby affirm that I have a certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PERMIT/
or a certifrcate r1f Worker's Compensation Insurance, or a certified
copy thereof(Sec 3800 Lab C)
COUNTY OF LOS ANGELES„'. DEPT OF PUBLIC WORKS' DEPT OF PUBLIC WORKS DIV.
Policy No Company - ,
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS t o4 k4 a� c-
❑ Certified copy is filed with the county building inspection 71
department NUMBER FIXTURE OR ITEM @ FEE LOCALITY ei,(�" ` I,�v
Date Applicant WATER CLOSET NEAREST 1� ,�
BATH TUB
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST i
,
COMPENSATION INSURANCE Z ASSESSOR
(This section need not be completed it the work involved by the
SHOWER MAP BOOK PAGE PARC L
permit is for one hundred dollars($100)or less) NER
I certify that in the performance of the work for which this permit LAVATORY
is issued, I shall not employ any person in any manner so as to SINK MAIL
become subject to the Workers' Compensation Laws ADDRESS 1
DISWASHER _ CITY= —3 —- TEL-NO-
Date Applicant - CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the,,Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY�e \ TEL N�
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER d
(commencing with Section 7000) of Division 3 of the Business and STATE i LIC
Professions Code,and my license is in full force and effect GAS SYSTEM OUTLETS LICENSE NO CLASS (�
OUTLETS OVER DISTRICT NO
t PROCESSED BY O
5 PER SYSTEM `[ _
License Number Lic Class ~
FINAL a
W
DATE �p / /� VALIDATION
Contractor Date ` I( (n
❑ 1 am exempt under Sec BY AL Z
B&P C for this reason
Date Plan check fee '
PLUMBING PERMIT ISSUING FEE$
Signature
r
❑ TOTAL FEE
Plan check applicant
SINGLE FAMILY f_T.z
HOME OWNER-BUILDER DECLARATION Name Ir
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031 5, Business and Professions Address --"-
Co ) } 1aMR
City Tel No
I,as owner of the property,will do the work and the structure ,_;T AL 134 - 55
is not intended or offered for sale (Section 7044, Business 1 _
and Professions Code) / ' , _kE E j-,4
,}'
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the r
performance of the work for which this permit is issued (Sec 3097,
Civ C) r r
i fit{t�r_',t i .'i:i,E 1
Lender's Name _ y:�j 3{ i
/
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 - en upon t eabove-mentioned
Operty fQ nsp osa ` �� SEE REVERSE FOR EXPLANATORY LANGUAGE .
/J�l Signature d Date
'•' ~NF COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
,.
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J FOX, County Engineer
DISTRICT O. GROUP ZONE ERMIT NO.
FOR APPLICANT TO FILL IN 4 _ 7q l s11 1 'IV 11
PLUMBER v� ,tel iy ,�J�pA�.. RECEIVED BY READY FOR DATE 1 ISSUED
FIRST INSPECTION �_2
—v
ADDRESS
C �� TE/L.. NO BUILDING
ADDRESS
ITY e.G
r�
COUNTY i LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES _❑Ross ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER Ba"
MAIL
WATER CLOSET(TOILET) @ 050 $
ADDRESS J QAZAP
BATH TUB @ 050 � CITYTEL. No.
SHOWER @ 1350
I HEREBYPeACKNOWL/EDGE THAT I HAVE READ THIS
O LAVATORY (WASH BASIN) O 50 ® APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 � AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 �� ANGELES COUNTY ENSE, OR I AM THE LEGAL OWNER
E NT PROPE Y5RIB ABOVE.
GAS SYSTEM OUTLETS Q 050 0 V OF THREBID.
SIGNATURE OF
WATER HEATER @ ❑ 50 8 PERMITTEE
Ale-
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK 1& 050
FLOOR DRAIN @ O 50
DISHWASHER @ 050
DRINKING FOUNTAIN @ 0.50 tJ U~ 4
URINAL @ O.SO � �' S 7- c /ne S ® /�E Q
HOUSE SEWER 0.50
MISCELLANEOUSAdF
1 Q dS' ivied' /d r 7-O O
/ ®N C i ti Pone
711
q..0 i rI 4PWKXV'ALS
DAT'X INSPECTOR'S NAME
RLIUGH PLUMBING �I/ �'
GAS PIPING
GAS VENT
7 ' /
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT • 1,00 GAS TEST
�yUTILITY CO.NOTIFIED _ A
TOTAL FEE Is l (Do / ✓ '
FINAL
76A66: DBS#t 17 6-52
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