HomeMy Public PortalAbout10628 DAINES DR_Plumbing__ 7WA 7,-CE917 12/59
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s APPLICATION FO`I LUMBIN PRMIT'' '
COUNTY OF LOS ANGELES 1[ /d o2 9s
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY AEIVISION
Q 'JOHN A. LAMBIE, COUNTY NGINEER ADDRESS
WILLIAM A. JENSEN, SUFI OF BUILDING LOCALITY
�I TI�FOR APPLICANT TO FILA. IN,?!� - NEAREST
CROSS ST.
UMBER „ "�+>t',5{' FIXTURE ORITEM OWNEA J Z� ��
I�jWATEA CLOSET MAIL
••fBATH TUB - n ADDRESS
CITY ' TEL. NO,
_ SHOWER
�^ LAVATORY CONTRACTOR
s _
SIVA ADDAESSCj��GfL! 7�A •Rq
DISHWASHER C [% G TEL, NO&,,-3-�
CONTRACTOR'S J/ D �' STATE
LAUNDRY TUB REGISTRATIO " O. ,i 6 j 7 s�v>-- "i.COUNTY ❑
CLOTHES WASdb DIST ,GROU ZONE RO BY
WATER'HE_ATEH a I` ,I /
GAS S. INDUST -'J
WASTE APP OVgI..,
'• INSPECTION RECORD a
OU
0
D, eh l D
n 0 OEM
OR
FIXTURE $ / �' 5 /
APPROVALS E INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK P/L✓ ��:�'�d��P�A•I'/
TOTAL FEE ROUGH PLUMBING
HEREBY ACKNOWLEDGEGAS PIPING l / J1e•
AND STATE THAT HETHAT
L
ABOVE IS CORRECT AND AGREE TOCOMPLY GAS VENT /��p
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. ' .HOT WATER HEATER � / O1� wevl-N
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR I PLUMBING FIXTURES
LCENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.. UTILITY CO.•NOTIFIED /I ' I I ,. I v F I r
SIGNATURE e
OF PERMITTE FINAL -
®. jdVALIDATION - ~OBERTA. WOOD,
E" Cc
N.0. CASH I' UPERVISING MECHANICAL ENG R
y.
WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9189
6A667A APPLICATION FOR PLUMBING PERMIT _
eby affirm that have a certificate of consent to,elf Insure. k
certificate of Worker's Compensation Insurance, or a certified I�l 7 (.�, /i° U�x h�,f[
thereof(Sec.3800 Lab.C.) a (�J
NofUIO�T 133 j ! p y /N-- COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
man _
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR BUILDING J li
Certified copy is filed with th county building inspection ADDRESS / r
oep mens. ,r_ /'I NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Applic /Gl/ WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE ASSESSOR
section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL
It is for one hundred dollars($100)or leas.) OWNER n
Ify that in the performance of the work for which this permit LAVATORY
u ad, I shall not employ any person in any manner so as to MAIL ,�.
SINK ADDRESS
j�e subject tc the Workers'Compensation Laws. -
1 DISWASHER CITY TEL.NO.
Applicant CLOTHES WASHER CONTRACTOR j!
CE TO APPLICANT:If, after making this Certificate of _
)tion,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
ions of the Labor Code, you must forthwith comply with such ADDRESS
or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY j OVY17 TEL.NO,
�boos
yaffirm that I am licensed under provisions of Chapter 9 WATER HEATER encing with Section 7000)of Division 3 of the Business and STATE �1 O LIC. O
GAS SYSTEM OUTLETS LICENSE NO. CLASS
isiohs Code,and my license is in full force and effect. �� V
OUTLETS OVER DISTRICT NO.O PROCESSED BY CC
5 PER SYSTEM G O
P Number _Lic.Class l a I.-
FINAL VALIDATION d
ctor to W
I am exempt under Sec. _ 9Y FINAL ?
I
BAP.C.for this reason Plan check fee rt_f.I{ a
ACCT a
/ �
Date: D jl f.
Signature
PLUMBING PERMIT ISSUING FEES �`
-
I'- 42.611
TOTAL FEE do, Q r'-`.
Plan check applicant 1,11.9- 42- 60
HOME OWNER-BUILDER
DECLARATION Name
SINGLY IHEN 'Q.&D
1y affirm that I am exempt from the Contractor's License Law t`f' rr--
following reason (Section 7031.5, Business and Professions Address _•Rd�i'-�F ,f�I S
` City Tel. No. ,
I, as owner of the property,will do the work and the structure I`hI_[•h 1;11 -,7_ rrr_.
is not intended or offered for sale(Section 7044, Business ` '
and Professions Code). D r `
iCr Q 1 ril 12:
CONSTRUCTION LENDING AGENCY -
ly affirm that there is a construction lending agency for the
�ance of the work for which this permit is issued (Sec. 3097,
Name
{I�Address
Y that I have read this application and state that the above D
(tion is correct. I agree to comply with all County ordinances
late laws regulating Plumbing, and hereby authorize ,
tntq4ves of this County to enter upon the above-men ioned
r nspection purpo .se / SEE REVERSE FOR EXPLANATORY LANGUAGE '
azure of Permittee Date