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Home My Public Portal About10709 DAINES DR_Plumbing__ 76A66?(CE-817)"-8-71 ` APPLICATION FOR PLUMB NG PERNOT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ' ADDRESS LOCALITY FOR APPLICANT TO.FILL IN (PRINT OR TYPE) NEAREST " CROSS ST. NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 7.75 _ MAIL v/' BATH TUB 1 75 ADDflE$ O C 5P !/� SHOWER 1 ,75 CITY v TEL. NO. Pd �6 LAVATORY 175 CONTRACT R zi SINK 1 75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.75 ICT GROUP PR BY LAWN SPRINKLER SYSTEM 1.75 DISTRvJ) r/ WATER HEATER 1.75 INDUSTRIAL 6 WASTE APPROVAL GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD O V OUTLETS OVER q 5 PER SYSTEM '30 / W d N Z Plan check fee See reverse. PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Ndnle ROUGH PLUMBING Address / Jly]Z� GAS PIPING GAS VENT City44 S— .Z ,HOT WATER HEATER HEREBY CKNOWLE T T HAVE eREAD THIS Ap TIOX AND STATE THAT THE ABOVE IS cO RN ECT AND AGREE TO COM PLUMBING FIXTURES P WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 1 HEREBY CERTIFY THAT I AMPROPERLY REGISTERED AND/OR UTILITY CO, NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 5T ATE OF CALIFORNIA OR THP AM THE LEGAL OWNER OF: AND INTEND TO RESIDE IN THE DESCRIBED RESIDENTIAL PPO RTY. / FINIAL 5 ��— SIGN4TLIRE �j, al ��._^ 4/ L/ OF PERMIT E�E�� ✓"K.V„{{{�� PERMIT VALIDATION CK. M.O. CASH PLAN.CHECK VALIDATION En. M:o. CASH 6.5 50.. . a WORKERS' COMPENSATION hove cerlifc8te fco APPLICATION- FOR PLUMBING PERMIT ^ I hereby affirm that I have a cer+if icate.of consent to self 20-0026 DPW 6/87 Cjul insure, oro certificate of Workers' Compensation Insurance, 76A667A or o certified 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) .r' BUILDING )rt �' � s Certified copy is filed with the county building inspec- ADDRESS /L/ tion deportment. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by MAR the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRE i I certify that in the performance.of the work for which this permit isl.issued, Pshall not employ any person in any manner 'SINK CRYO )6 TEL. NO.-17 7 so as to become subject to the Workers Compensation Laws. DISHWASHER .. CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, offer making this Certificate of ' SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' - CITY TEL, NO. Compensation provisions of the Labor Code, you must forth- .'LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shalt be STATE LIC. deemed revoked. WATER HEATER 501 LICENSE NO, SS LICENSED CONTRACTORS DECLARATION DISIgICT,tip.,/ D BY I hereby off irim that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER - and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL ALI ATION O}.' DATE O License Number Lic. Class FINAL Contractor Dote BY 0 O, ❑ I am exempt under Sec. �/ W B.BP.C. for this reason Plan check fee IV, Z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant .- - HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and ",017 76,I!il _ Professions Code): City Tel. No. I, as owner of the property, will do the work and the _.... . 1 1TE tin structure is not intended or offered for sale (Section 1 , TIITAL �9-3J' e.0Q 7044, Business and Professions Code). V' � ' CONSTRUCTION LENDING AGENCY CHECK 43.CC I hereby affirm that there is a construction lending agency for _ CHANGE the performance of the work for which this permit is issued "' (Sec. 3097, Civ. C.). Lender's Name 01II]11-fifi!!1 ;_`1j 7s_I Lender's Address 9610 1 AN 17 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 laws regulating Plumbing, and hereby authorize represenblives o this County to enter upon the bove menti nedpr perry o inspection urpo es. SEE REVERSE.FOR EXPLANATORY LANGUAGE , Sign gi of Per itree r ale WORKERS'COMPENSATION DECLARATIOE� I hereby affirm that .havecertificate of consent to self 76A667A - APPLICATION FOR PLUMBING PERMIT` . insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a cer ified copyTherno (Sec. 3800, Lab. C,) COUNTY OF LOS ANGELES BUILDING AND SAFETY a.OJ . 051 '1 WA 4LA— Policy o..Company ' ❑ Certified copy is hereby furnished. 1'lo-Bf/ Certified copy is filed with the o nt buildiqq c- FOR APPLICANT TO;FILL'IN(PRINT OR TYPE) BUILDING +r NUMBER FIXTURE OR ITEM ADDRESS NVQ lion department,CSA WJ fjt' !ot @ FEE LOCALITY L Dote ' a�"dJ App)i4ont WATER CLOSET I NEAREST - CERTIFICATE OF EXEMPTIO ROM WORKERS' BATH TUB CROSS ST. COMPENSATION I URANCE SHOWER OWNER /. (This section need not be comple d if the work involved by L the ermit is for one hundred dollars $100 or less. �� ADDRESS 0 r P ( ) ) LAVATORY I certify that in the performance of the work for which this , permit is issued, Ishall not employ any person in any manner SINK CITY /'i�IfC.1 TEL. NO. so as to become subject to the Workers'Compensation Laws. 4 r7 DISHWASHER 'b CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of _ CD Exemption, you should become subject to the-Workers' SWIMMING POOL RECEPTOR Compensation".provisions of the Labor Code, you must forth- CITY &0c TEL. NO. with comply with such provisions or this ermit shall be LAWN SPRINKLER SYSTEM P STATE r' LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED.CONTRACTORS DECLARATION ------ DISTRICT NO, PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER - _ d and Professions Code, and my license is in full farce and effect. 5 PER SYSTEM FINAL q C DATE VALIDATION O License Number�Llc. Class� C A FINAL f Q Contractor f.ClN@/N//6 Dote _ BY `Q'�i- _ U am exempt under Sec _ d El B.&P.C. for this reason D 0 z Plan check fee - Date:- PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant ' HOME OWNER-BUILDER DECLARATION Name - I hereby affirm that I am exempt from the Contractor's License Address s{ode): Low for the following reason (Section 7031.5, Business and ProfessionCity Tel. No. -mac'9 v Q,Q A. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sole (Section 7044, Business and Professions Code). D - 21e -'5a50 CONSTRUCTION LENDING AGENCY I hereby offirm'thot there is a construcliondending agency for - - - - - - - oto a 5 D 506 , the performance of the work for which this permit is issued - ' (Sec. 3097, Civ. C.). Lender's Nome tender'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 laws regulating Plumbing, and hereby authorizerepresentatives of this County to enter upon the ' above- boned prop f inspection purposes. pit SEE REVERSE FOR EXPLANATORY LANGUAGE _ Si o ure of Perm,tee Date