HomeMy Public PortalAbout10526 DAINES DR_Plumbing__ • z — 494 -
78A-17 10.99
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D8 1 ' APPLICATION FOR PLUMBING PERMIT 1
DMSION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING 10526 E, Daily s
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 2
CASSATT D GRIFFIN,SUP T OF BUILDING LOCALITY Temple C It
FOR APPLICANT TO FILL IN NEAREST
CROSS ST El Monte Ave Dr
:1
OWNER Depese DISTRICT NO GROUP p�ZO �EADY
FOR INSPECTION
MAIL � Ift�
1 ADDRESS V
1
INDUSTRIAL
CITY TEL NO WASTE APPROVAL _
PLUMBER EARL (PAT ) ;STANDI,EY, INC . INSPECTION RECORD �,��?�
ADDRESS 2019 N.Ho t P.00 408 �f
CITY El Monte TEL NO G I 1+15 114 �11+�,1 %
1 923
LICENSE NO )01
NUMBER TYPE OF FIXTURE OR ITEM FEE
2 WATER CLOSET (TOILET) @ $1 00 5
BATH TUB @ $1 00
SHOWER @ $1 00
2- LAVATORY (WASHBASIN) @ $1 00 (-
KITCHEN SINK @ $1 00
DISHWASHER @ $1 00
LAUNDRY TUB OR TRAY @ $100
CLOTHES WASHER @ $1 00 v ��
06
v � l
WATER HEATER @ $1 00
GAS SYSTEM @ $1 00
APPROVALS
DATE INSP CTOR'S SIGN TURE
UNDER SLAB WORK p' �_ ✓
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE 11 00 GAS VENT �J y
I D HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ 9
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST 7'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWWR OF THE ABOVE UTILITY CO NOTIFIED `fes
DESCRIBED RESIDE L PROP RTY
J 19
SIGNATURE
OF PERM ITTE FINAL
JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK EL 0 CASH
7 9 7 —Ln it AY ,3 3 11 -00 In
r
WORKERS' COMPENSATION DECLARATION` APPLICATION FOR PLUMBING PERMIT .
I hereby,affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 8/86)
PyN.
teal copy thereof (Sec 3800, Lab C )� �,` ,n COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
X, ia�r Company�"r�'�4!/ ?62r -+ y
❑ Certified copy is hereby furnished
, FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING `
Certified copy is filed with the county building mspec- ADDRESS
to cl partment` NUMBER FIXTURE OR ITEM ® FEE LOCALITY_
Date j �+ �� Applt4ant WATER CLOSET - - NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCE SHOWER OWNER J
(This section need not beicompleted if the work involved by MAIL
the permit is for one hundred dollars($100)or lees.) LAVATORY ADDRESS
I certify that to the performance of the work for which this
permit is issued, I shall not employ any person to any manner SINK CITY11 (21
TEL NO
so as to become subject to the Workers'Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If, after' making'this Certificate of t
SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- CITY '� TEL NO
I"AWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC
deemed revoked - I IWATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT N ,PRMESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 l GAS SYSTEM ( OUTLETS
(commencing with Section 7000) of Dt'vtston 3 of the Business OUTLETS OVER per,
and Professions Code,and my Itcens �ts to full f rce n effectX643 5 PER'SYSTEM
FINAL VALIDATION v
DATE
License Number Ltc lass tY
FINAL d
Contractor MBY V
❑ W
I am exempt under Sec U)
B 8P C for this reason Plan check fee , Z
Date PLUMBING PERMIT ISSUING FEE$ I
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY -
HOME OWNER-BUILDER DECLARATION Name _
I hereby affirm that I am exempt from the Contractor's License Address ` I °s
Law for the following reason (Section 7031 5, Business and - ��0 ��J�`t
Professions Code) City Tel No
❑ I, as owner,of the property, will do the work and the - i iTEll
structure is not intended or offered for sale (Section
7044, Business and Professions Code) , LITHE 0 o 0
CONSTRUCTION LENDING AGENCY t HE" .'410.13
j hereby affirm that there is a construction lending agency for CHANGE
IS t
the performance of the work,for which this permit is issued
(Sec 3097, Civ C )
Lender's Name ►Jl If -(II I(]� 10/2,4/91-1
Lender's Address 3tt43 h-m 11°C4
j certify that I have read this application and state that the
above information is correct I agree to comply with all County y
w ordinances and State laws regulating Plumbing, and hereby
authorize representat s of this County to enter upon the m
a ve-mentt ed p rty for inspection pur o NO SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee a