HomeMy Public PortalAbout10836 DAINES DR_Plumbing__ 7SA667 17 a=Av ® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY Olzil
COUNTY OF LOS ANGELES PLUMBOWN
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRfCT NO. GROUP ZONE PERM NO.
PLUMBEFONTANA PLUMBING CONTRACTORS RECEIVED BY READYFOR (/¢Dt/AOTEEf ISSUED
Q FIRST INSPECTION /O^`N^' �
ADDRESY44 W. farvey - Monterey Park, Calif, i
BUILDING
ATlantic 2.4654 - CUmberland 3.1040 ADDRESS a- Ci • 1
CITY
MTEL. NO.
COUNTY ` yLICENSE NO. 13'99 , - ^ ,. �I•_ J
LOCALITY
I NEAREST ,I
PERMIT FEES CROSSST�/��
NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER
rX WATER CLOSET (TOILET) Q 0.50 ISII O�t.�_
ADDRESS
�J BATH TUB Q 0.501 15 CITY TEL. NO.
I SHOWER Q 0.501 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.501 SlgpAPPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q 0.501 ssz STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
f LAUNDRY TUB OR TRAY Q 0.501 J 0 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
tt OF THE RE OF NTIAL P d�P/E/RTY-DE, SCRIBED ABOVE.
�I GAS SYSTEM3L�OUTLETS Q 0.601 T SIGNATURE OF ^'V,'I,iW/T'/-IIQT�..•�'t-7/�f
1 WATER HEATER Q O.S01 .6_n PERMITTEE /V�Y
SLOP SINK Q 0.50I INSPECTION RECORD
FLOOR SINK Q 0.50 1
FLOOR DRAIN Q 0.501
DISHWASHER Q 0.501
1 DRINKING FOUNTAIN Q 0.501
URINAL Q 0.501 . „J
I HOUSESEWER Q 0.501 Q
Z
MISC LLANEO S
Grt2aX,e / '.fin o
I�
APPROVALS
DATE INSPECTOR S.NAME
ROUGH PLUMBING A W-a
�— GASPIPING
GAS VENT _
CESSPOOTNK:L Q 1.00 � CESSPOOL
SEPTIC ASEPTIC TANK
DRAIN ( PIT ( Q 1.001 SEWER
PERMIT . I 1.00 GAS TEST ?? -O�
UTILITY CO. NOTI F•SD• Z w{ �/I/f"'r�9
TOTAL FEE $ If
� 15o FINAL L�-
veAe" 17 a•ao APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER
(f' FOR APPLICANT TO FILL IN DISTRACT NO. GROUP ZONE PERMIT NO.
PLUMBER (/H7 �/' / J / �9 �O
(� ! �J RECEIVED BY READY FOR DATEISSUEb
,� FIRST INSPECTION 12 / �
ADDRESS ..J�UK / -✓Y./ORD/1.:1N./.^_%!_:!�!t+ 6 /
5p p BUILDING
.'.TEL. NO✓4Y Y �/' ADDRESS
COUNTY ( LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES . DRO..ST.
NUM6Eft TYPE OF FIXTURE OR ITEM FEE OWNER' Y
MAIL. ( L
WATER CLOSET (TOILET) @ 0.50 5 ADDRESS
BATHTUB @ 0.501_11I CITY ( ` ( TEL. NO.
SHOWER @ 0.$0 .IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCESAND
KITCHEN SINK @ 0.501 STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRYTUSORTRAY @ 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIALPROPERTYPRO,/P/ERTTY4.DESCRIBED ASO
E.
GAS SYSTEM OUTLETS @ 0.501 SIGNATURE OF N ✓/Y
WATER HEATER @ 0.50 PERMITTEE fr�'J I K YC�i
SLOP SINK @ 0.501INSPECTION RECORD
FLOOR SINK @ 0.501
IFLOOR DRAIN @ 0.501
I DISHWASHER @ 0.501
II DRIN KING FOUNTAIN @ 0.501
/1 URINAL @ O.SOI_ J
_ V1 HOUSE SEW ER @ 0.501 1 QZ
MISCELLANEOUS
0
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.001 CESSPOOL
SEPTIC TANK: SEPTIC TANK !tel
DRAIN ( ) PIT ( ) Q 1.00 I SEWER V
PERMIT . 1.00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE ,
FINAL
V
WORKERS' COMPENSATION DECLARAPiOIV` R
I hereby affirm that I have a certificate of consent to self 76AM7A APPLICATION FOR
PLUMBING D2RMIF
insure, or a certificate of Workers Compensation Insurance, CE 817(REV. 10/BI)" . a
or a certified copy thereof (Sec 3800, Lab. C) COUNTY OF LOS ANGELES 'BUILDING AND SAFETY
Policy gp AktAb c1Xny IIIIIRN921CK111)
Certified copyis hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ertified copy is filed with the ounty building inspe<, 'ADDRESS 36 DR
NUMBER FIXTURE OR ITEM LOCALITY �M �'
lip deportment @ FEE
WATER CLOSET
Date Applicant NEAREST -
ERTIFICATE OF'EXEMPTION FROM WORKER, BATH TUB CROSS ST. .. 5
COMPENSATION INSURANCE OWNER'
(This section'need not be:completed if the work involved by SHOWER f 5 ✓! I -
the ermiPis for one hundred dollars $100 o?less. MAIL _
P ( J J LAVATORY ADDRESS Q s
I certify that in the performance of the work for which this -
permit ts'issued,I shall not employ any person.in-any manner SINK' CITY l TEL NO.gJ1q.._ykJ1.
so as to become,subjecl to the Workers'Compensation.Laws. DISHWASHER CO2 d33
CONTRACTOR
Date Applicant - - CLOTHES WASHER ADDRESS 3 ll
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR -
Compensation provisions of the Labor Code, you must forth- CITY S;Cipw •1 TEL NO'.�355—l
with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM - STATE l',.., r` UC
deemed revoked. WATER HEATER LICENSE NO. �3 `� CLASS "�l.•'V
LICENSED CONTRACTORS DECLARATION DI9kCT NO. PROCESSED BY
I hereby affirm that I am licensed under,provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business! OUTLETS OVER t
and.Professions Code,and my license is in full force and effect. 5 PER SYSTEM - .r
(�� p 4 DATE FINA
_�� VALIDATION V
License.Number bf)e l� tic Class "1 s'
C� M FINAL r
Contractef5diy 1�+-1L1 Date '_ 3 BY —P-"-4 0
❑ I am exempt under Sec. 0.
.B.BP.C. for this reason N
_ D Z
Plan check fee
Date: „PLUMBING PERMIT ISSUING FEE$
Signature
- TOTAL FEE
Plan check applicant ,
SINGLE FAMILY -
HOME OWNER-BUILDER DECLARATION Nome
I hereby affirm that I am exempt from the Contractor's License - A.41 3.5 A
Law.for the following reason (Section 7031.5, Business End Address ,
Professions Code): City Tel.'No. #re o s e oj.
❑ ,
I, as owner of the property, will do the work and the 2♦e ^ 30,50
structure is not .intended or offered for sale (Section
7044, Business and Professions Code). D - o o.e 3 0.5 0
CONSTRUCTION LENDING AGENCY - 0 78 0•Z,-8 3
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 appTcohon and store that the D
above information is correct. I agree to comply with all County '
• ionces and State laws regulating Plumbing, and hereby
raurh r.e.represe tatives of this County to enter.upon the,'a e io a prop rty f inspection purposes. '
SEE REVERSE FOR EXPLANATORY LANGUAGE _
fr-/-
?3
Signal re at Permittee Date