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Home My Public Portal About10634 DAINES DR_Plumbing__ 7BA667-0E4817 4-67 6� APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES '. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING [� JOHN A. LAMBIE. COUNTY ENGINEER 11 ADDRESS y COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY , a FOR APPLICANT TO FILL IN NEAREST - 47 CROSS 57. NUMBER FIXTURE OR ITEM EACH FEE D DROSS WN WATER CLOSET 41 S1.25 MAIL DRESS f: BATH TUB 1.251 1 SHOWER I 1.25CITY TEL. NO. LAVATORY1.25 CONTRA C7 R SINK I 1.25 'ADDRESS DISHWASHER 1.25 CITY TEL. NO. LAUNDRY TUB 1.25 STATE LIC LICENSE NO. CLASS CLOTHES WASHER I 1.25 DISTRICT NO. GR ZONE P E BY ONP WATER HE 1.50 O / i LACAS SYSTEMOUTLETS 1.50 I INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .70 1 INSPECTION RECORD 1 I I o IW I Z I - I I I APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 21 00 UNDER SLAB ORK D ROUGH PLUM, ING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLt GAS VENT WITH ALL COUNTY ORDINANCES AND STAre LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES ��c[ LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED d SIGNATURE /1 OF PERMITTEE FINAL Xll VALIDATION JACK R. ALLEN _C K, M.o. cnsH SUPERVISING MECHANICAL ENG'R. LACO 2 4 9 9 AN. 8 5 0 3.50- 76A667-CE817 12159 TI N FOR PLUGJPRIMITAPPLICA O O � COUNTY OF LOS ANGELES DEPARTMENT q�OF COUNTY ENGINEER BUILDING A B SAFETY IVISION JOHN A. L MBIE. COUNTY NGINEER - ADDRESS WILLIAM A. JENSEN. SUPT OF BUILDING C Ci<k LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM C� OWNER WATER CLOSET ADDRESS J BATH NB CRY TEL NO. '&,j SHOWER / LAVATORY CONNTRACT A , SINK - ADDERS Sa?0O, O L• DISHWASHER CITY TEL NO. ',?.-/ CONTRACTOR'S /0STATE CL LAUNDRY TUB REGISTRATION NO.C.J ,,-t Sc>/ COUNTY ❑ CLOTHES WASHER DISTRICT Ngo l GRO ZONE E D B / WATER HEATER yIJ� (J(� GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 0. !I V:7 O 7r N _ YO /t-1/-/.Ut /�� / • u asp o h6,✓7` ® $1.00 PER ITEM OR FIXTURE $ 'APPROVALS ( DA E IN PECTOR'SSI G NATURE PERMIT $ 2100 UNDER SLAB WORK ♦Q/7 D... Ak,-i / TOTALFEE � /'6 ROUGH PLUMBING / SLI - O GAS PIPING TO LO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS TION GASVENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER / PLUMBING. i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 714Y LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST /hs / nw . JCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEDESCRIBED RESIDEN ROP UTILITY CO.NOTIFIED _fY�.SIGNATUROF PERMI FINAL ®. VALIDATION ROBERT A. WOOD, Cc. U.o. CASH SUPERVISING MECHANICAL ENG'R �(`j 9 5 0 3 DEC 6 5 D 9.0 0 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I:hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 C, 1 insure,,or a certificate of Workers' Compensation Insurance, 76A667A IILIII or a certirried copy thereof (Sec. 3800,'Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. - Company Certified copy is hereby furnished. ^ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING u Certified copy is filed with the county building inspec- ADDRESS ! tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Dale / A cant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB /f CROSS ST. EL COMPENSATION INSURANCE OWNER (This section need not be completed It the work Involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( ) ) LAVATORY ,7j� ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY % /F__ 7� TEL. NO. so as to became subject to the Workers'Compensation Laws. DISHWASHER [� JJ CONTRACTOR Date �I t Applicant CLOTHES WASHER ADDRESS NOTICE TO APP [CANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, .you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. �..+ PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ,(� s r+ !" �t —�—cam-• (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �/ and Professions Code,and my license is in full farce and effect. 5 PER SYSTEM FINAL , J VALIDATION O DATE C/ License Number Lic. Class !� U FINAL - �� Contractor Dote BY 0 I-1 I am exempt under Sec (� B.BP.C. for this reason Plan check fee a� !, Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Gj Plan check applicant _ SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address y Law for the following reason (Section 7031.5, Business and Profe cions Code): City Tel. No. _ 1, as owner of the property, will do the work and the �- LIT! structure is not intended or offered for sale (Section 'i G11 Al - � 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for -.t r-.• the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address - L-2 ! j'10 I certify that I have read this application and state 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 above-mentioned"proper y for inspection purposes. �j SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dote