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HomeMy Public PortalAbout10633 DAINES DR_Plumbing__ 76AG67A �E OE 817(REV.6/78) ^ yy�� IICIII o APPLIC6TI N FO PLUMB G PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS T OCALITV WATER CLOSET - NEAREST BATH TUB CROSS ST. SHOWER OWNER / LAVATORY ,'� MAIL . nR ADDRESS SINK ey, CITY N O. DISHWASHER 4 CONTRACTOR CLOTHES WASHER ADDR _ SWIMMING POOL RECEPTORe - CITY TEL.NO. LAWN SPRINKLER SYSTEM QS STATEJ UC. WATER HEATER Cp-`O LICENSE NO. CLASS GAS SYSTEM n OUTLETS U APPROVALS D INSPECTOR'5 SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING 9 6 GAS PIPING GAS VENT // V HOT WATER HEATER "ZS _ +..A W PLUMBING FIXTURES GAS TEST N PIOn check fee UTILITY CO.NOTIFIED z PLUMBING PERMIT ISSUING FEE$ TOTAL FEE /t TY FINAL �Z�j•-� Plan check applicantVV PLAN CHECK VALIDATION V A/O Nome � �/� . / • Vr Address 1#0099 68 City Tel No. 2 B o 1 0,0 Q I HEREBY AL OWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE O O O ,.a O O U THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 6428-80 1HEREBY CERTIFY,THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COU iE OF CALIFORNIA OR THAT I AM THE LE NEP OF.AND INT TO RESIDE IN OVE DESCRIBED flESIDENTIA PROPERTY. SIGNA OFPERMITTEE �1s5181Ci N R CESSED BY I INDUSTRIAL WASTE APPROVAL 76A667-CE817 12/59 TEMPLE IEcu CHTY APPLICATION FOR. PLUMBING PERMIT: COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY RIVISION BVILDmG /o G 3 3 Q�N fl �/ Jc JOHN A. LAMBIE. COUNTY NGmEER ADDRESS WILLIAM A. JENSEN. SUP'T OF BUILDING _ LOCALITY FOR APPLICANT TO FITS IN - NEAREST ' ,y CROSS NUMBER FIXTURE OR ITEM �/ / OWNER /{ woo O WATER CLOSET ADDRESS /G6 '7 01 P BATH TUB SHOWER CITY 7e~ /e C'i E TEL. NO. coxrxxcrox LAVATORY SINK ADDRESS 0707/6 //✓, /1/fq L.P/ DISHWASHER CITY ���.jqM 6`2 TEL. NO.,-;I-e9 -f-e.ZC' CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. /.SCf-rll O COUNTY ❑ < CLOTHES WASHER DISTRICT NO. GRO I ZONE �� ESS BY WATER HEATER Cjl C K Lel n/✓ �✓ INDUSTRIA. GAR SYSTEM I WASTE APPROVAL (/✓4.�dr 'Gr v/Ce INSPECTION RECORD w — O U C O w U 41 w N Z $1.00 PER ITEM OR PIXTURE $ APPROVALS DATE INSPECTORS SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING V✓ GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. _ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST q CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED .e �_ S .I(atJ/�A.cifYli SIGNATURE L OF PE RMITTE FINAL / VALIDATION ROBERT A. WOOD, CK. B.Q. DASH SUPERVISING MECHANICAL E �G'R LP.'u0 8 7 8 2 FELB 19 5 D 5.00- •f WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hecel4y affirm that I have a certificate of consent to self 76A667A ins 'e, or o certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) %d41 5 1,d c�o�py9�the�reof (Sec. 3800, Lob. �) COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑ofic N4 _/�LCompany_� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING D /^J �^ Certified copy is filed with the county building 0spec- ADDRESS (p :J J tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY ��'� WATER CLOSET Date' —y? � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER 2 (This section need not be complefad If the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS 7 T Q y G I certify that in the performance of the work for which this - permit is issued, I shall not employ any person in any manner SINK CITY7AWpTEL. so as to become subject to the Workers Compensation Laws. DISHWASHER •��t - CONTRACTOR V�tir7l1 to Date Applicant CLOTHES WASHER ADDRESS �+ ` NOTICE TO APPLICANT: If, after making this Certificate of !" / Cf/�/I/- Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR P P Y LAWN SPRINKLER SYSTEM CITY M TEL. NO. Compensation provisions of the Labor Code, you must forth- 12 e/ with comply with such provisions or this permit shall be STATEpq, LIC. r'CZU deemed revoked. WATER HEATER LICENSE NO. V3 7J77S CLASS J C 3 LICENSED CONTRACTORS DECLARATION DIST�T CESSED Y 1 hereby offirmthat I am licensed under provisions of Chapter 9 ' GAS SYSTEM I OUTLETS IVIUY (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER /9 r and Professions Code,and my license is in full force and effect. 5 PER SYSTEM Ll FINAL VALI ATION License Number r d�2VI Lia Closs���0 DATE at O �J r2Z FINAL r%© U. Contractor �yd�— //�2 Date BY 0 ❑ h- i am exempt under Sec E-. U B.BP.C. for this reason Ed Plan check fee Date: ti PLUMBING PERMIT ISSUING FEE$ D �7 9 7'8 A z Signature #"e e e e,e 5 TOTAL FEE Plan check applicant :I'e.e 1 65.0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name - e o e1 6 5.05 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address - .0 9.2.3 8 7 Professions Code): City Tel'. No. ❑ I, as owner of the property, will do The work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ' 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.). Lender's Name Lender's Address I certify that I have read this application and stole 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 to enter upon the abo menti ed property for inspection purposes, � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date