HomeMy Public PortalAbout10632 DAINES DR_Plumbing__ 76A667-CE817 22/59
APPLICATION FOR PLUMBING P MIT �]
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER /)
OBUIIHDING AMDFET BUILDING
ADDRESS Y ENGINEER �(� •� �.
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY ✓I[�C/t � e,
FOA APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSESDRESS J
SHOWER /
ADJ,•
IL
HATH TUB 3 � a
CI TEL. NO.hl J
LAVATORY CONTRACTOR �/
SINE ADDRESS .o
DISHWASHER CITY O , 460�4�TEL- NO. ;.yp
CONTRACTOR'S STATE 4.
LAUNDRY TUB REGISTRATION NO. _ '070Z LL OUNTY ❑
�- CLOTHES WASHERDISTRICTN GRO Z NE P` C EDB
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
/i-G/-/. D INSPECTION RECORD EC/c.�.rn4�r...✓L N
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/I/rn�Ll�fJ '4' /albinrl I! Ze- O
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Z
m_Q ods$1.00 PER J
OR FIXTURE $ 7 QL/�Or�yyll$P �
/ APPROVALS
DATE IN ECT ECTOR'S SIGNATURE
PERMIT $ 100 UNDER SLAB WORK
TOTAL FEE 1 ROUGH PLUMBING IL9/?t
I GAS PIPING Y°
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER / A
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES r 14 yr.
/ --J
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST FIED 2 r 15.
CALIFORNIA OR THAT 1 AM TH LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT L ROPE UTILITY CO.NOTI12
SIGNATURE '9
OF PERMIT TE _ FINAL
®. VALIDATION ROBERT A. WOOD,
cK.
B.0. cnsH SUPERVISING MECHANICAL ENG'R
�j+11 9 5 0 2 0 VEC 6 5 0 9.0 0
p
4 WORKERS'COMPENSATION DECLARATION APPLICATION
PPLI . A TION FOR PLUMBING
n UMBI�n,�a PERMIT
here8yr affirm that hove a certificate-of consent to self in- 20-0026 DPW 4/90 P'i Jr rb/'9 0�1 IL 41'OV9 ICl'k9 9V9
sure,oria certificate of Workers'Compensation Insurance,ora 76AC67A
certifie-8 copy thereof•(Sec. 3800, Lab. C.) [II,LJII
P¢Iicy No.(�LIdMSCompany STA; COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
❑ Certified copy is hereby furnished. ,
/
Iv1 Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN (PRINT OR TYPE) ADDRESS BUILDING 63 - Drj)/y�'j jj/Q
�` department. NUMBER FIXTURE OR ITEM @ FEE
.-/'tor
i LOCALITY
Date Applicant l_/'HZ's/ r 'y- WATER CLOSET(TOILET) /Q. 'NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' Z BATH TUB CROSS ST. ELM OI\rr - AACC
COMPENSATION INSURANCE SHOWER OWNER " (r(poLl CHIpi Lc..-E
(This section need not be completed if the work involved by Mail
the permit is for one hundred dollars ($100)or less.) �l LAVATORY ADDRESS AAA11&
I certify that in the performance of the work for which this per- .SINK
mit is issued, I shall not employ any person in any manner so CITY TEL. NO.
as to become subject to the Workers'Compensation Laws. DISHWASHER '
CONTRACTOR C+AIZ pCN�f'I L^+s.f "yc-
Date. Applicant CLOTHES WASHER ADDRESS �CL-L ✓�
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY U�- 1� � TEL. NO
sation provisions of the Labor Code, youmust forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit,shall be deemed revok- STATE - LIC. tr)
ed. WATER HEATER LICENSE NO. (J 3�� CLASS C>
. LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS p /
9(commencing with Section 7000)of Division.3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fec. f�j HOSE BIB DATE Z 44
License Nuri 03 2 Lic. Class O
r-� q/ 'FINAL - U
Contractor4t (,OY �5t4 f7�/b BY S
T
I am exempt under Sec. rJ p ACCT.4 OF
B.BP.C. for this reason Plan.check fee 'JJ44"G D 3303 15h.10 a
r
Date:— PLUMBING PERMIT ISSUING FEE$ -� 1 ITEMS Z
Signaturekr? TOTAL 1.--56 .. is
t (,
SINGLE FAMILY TOTAL FEE- CHECK 156.10
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Nome CHARGE .�Q
Law for the fallowing reason (Section 7031.5, Business and
Professions Code): Address
El I, as owner of the property, will do the work and the City Tel. No. 0000-0001 1/17/96
structure is not intended or offered for sale(Section 7044, 4297 1 AM10-31
Business and Professions Code). D
CONSTRUCTION LENDING AGENCY
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.). -
• t
Lender's Name
Lender's Address -
I certify that I have read this application and state that the D
above information is correct. I agree to comply with all County
ordinances and State lows regulating Plumbing, and hereby
authorize reprprsentatives of this County to enter upon the -
above-metitdried property for inspection purposes.
�� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signay Permit, a Date -