HomeMy Public PortalAbout10608 DAINES DR_Plumbing__ DEPARTMENT OF COUNTY ENGINEER
{DIVISION OF BUILDING AND SAFETY /��� y� PERMIT APPLICATION _
COUNTY OF LOS ANGELES BUILD Nc ,l I
WILLIAM J. FOX. COUNTY ENGINEER ADDRESS O �
FOR APPLICANT T LOCALITY
BUILDING
(a(� FILL IN NEAREST
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ADDRESS
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LOCALITY �.� O
NEAREST
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., CROSS ST. C-��•nyG' ✓L� A-� L RECEIVED BY Ready for Inspection mD%T�SUE�
OWNER .,!/
MAIL J INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY i vko TEL.NO. INSPECTION RECORD
PLUM�B%ENE )A T TT.1STT T.ATT(1N (Yl
ADDRESS 311 E_ S th STREET L. A. 3
CITY g�PPLaesarVt a- X41
'i LICENSE NO. / L�( ❑COUNTY
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PERMIT FEES a
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NUMBER TYPE BF FIXTURE BR ITEM FEE uI
WATER CLOSET(TOILET) 0 0.80 11 IE
O
BATH TUB 0.80
SHOWER @ 0.80 _
LAVATORY (WASH BASIN) @ 0.80 _
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80 _
> FLOOR SINK @ 0.80
FLOOR DRAIN @ 0.80 _
DISHWASHER
DRINKING FOUNTAIN 0 0.80 _
URINAL @ 0.80 _
GAS SYSTEM.............OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
_ APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ I OD ROUGH PLUMBING
TOTAL FEE o" arj GAS PIPING
HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLI-- GASVENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
UTILITY CO.NOTIFIED
SIGNATURE - //P:._. ✓ /�,,/
OF PERMITTEE..._......__._......_.._. FINAL
76A087 DBS 1T 1/58
78A687A IC4•BIJAPPLICATION FOR-PLUMBING PERMIT
BUILDING AND SAF ETYON
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
LOCALITY n
WATER CLOSET i
BATH TUB NEAREST
CROSS ST. S
SHOWER OWNER
/ LAVATORY MAIL
ADDRESSAt
SINK CITY �.y lL=, �- TEL.NO. Z
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS -2 ,
SWIMMING POOL RECEPTOR 12,43
pJ p
CITYIt
TEL.N07�/f&iln
LAWN SPRINKLER SYSTEM
STATE
NO. S yB '> LIC,
WATER HEATER •
GAS SYSTEM OUTLETS DISTRICT NO. GROUP ONE PROCESS BY
OUTLETS OVER `--�' 09 � .t ,
5 PER SYSTEM INDUSTRIAL O}.
WASTE APPROVAL 0
INSPECTION RECORD V
at
0
d
N
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTALFEE `
Plan check applicant
APPROVALS DATE INSPECTORS SIGNATURE
Name
UNDER SLAB WORK G
Address ROUGH PLUMBING
City T.I.No. GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTENDJO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE Y /
OF PEFMITTEE_Se;� FINAL
Y
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK: M.O. CASH
1 ? 2 `PtAY 9 5 D 35p6_b
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WORKm that MPave arcONDECLARATION CE
APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self cr: etr (e-eo) L.I
insure. or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab. C.)
COUNTY OF LOS ANGELES ' �v BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING //'' V�r
A1,rLR-
Certified copy.R filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE ADDRESS /v
LOCALITY / •
d '�epartment. WATER CLOSET ✓�' /, C
Date Applicant NEAREST BATHTUB. CROSS ST. �A BVI YaL'1' DO,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER LI SeL` �(, Wti
(This section need not be completed if the work involved LAVATORY MAILADDRESS }
by the permit is for one hundred dollars ($100) or less.) -
SINK CITY TE jNO. O
1 certify that in the performance of the work for which this DISHWASHER /✓� U
CONTRACTOR
permit is issued. 1 shall not emplo any erso In a�y enner ,1..
sLLLLa ase3��subject tlicant o [h rker Co en CLOTHES WASHER ADDRESS 0
ate S APIer SWIMMING POOL RECEPTOR U
OTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. W
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. N
Compensation provisions of the Labor Code. you must forth- LICENSE NO. CLASS Z
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PRO ESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE ,j—� ��
effect.
FINAL (
License Number Lie.Class BY - es
Contractor Date
I am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE D
Lie.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's
Address �,5 Z O A
License Law for the following reason (Section 7031.5, Busi- City Tel.No. 0 0 0 0 0 5
ness and Professions Code):
❑ I, as owner of the property, am exclusively contracting - 2 0 - 1000
with licensed contractors to construct the project0,005
(Section 7044, Business and Professions Code). e o e
CONSTRUCTION LENDING AGENCY 0605-81
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances.and State laws regulating Plumbing, and hereby
authorize representativ s of is County to enter upon the _
above-mentione pro rty inspection purposes. /
�{ Signature of flermittee Date
1