The URL can be used to link to this page

Home My Public Portal About10851,10850 DAINES DR_Plumbing__ PLUBUNG DEPARTMENT OF COUNTY ENGINEER - " _ DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING �) WILLIAM J. FOX, COUNTY ENGINEER ADDRESS FOR APPLICANT TO FILL IN NEARETY ✓ Ci BUILDING NEAREST ADDRESS CROSS ST. Z' DISTRICT N GROUP AZONE for PERMIT NO. LOCALITY % /!/T� - �I S38 NEAREST CROSS ST. _4,9",p",p REC IVED BY Ready lnsoectlon DDAATE/ISSSUED OWNER A!. /3' 6Lrzl �Ze//o/— MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY I/ TEL.NO. INSPECTION RECORD PLUMBER ,Ao*/, V1,9 A(T,; T ADDRESS 62j6 /L. AC ga +.E'AN CITY 4VVQ,4e TEL.N0.FQ731,P7P ❑STATE LICENSE NO. 0 5T000NTY �?� PERMIT FEES a z IUMFiEi TYPE OF FIXTURE OR ITEM FEE17 WATER CLOSET(TOILET) @ 0.80 s Q .I BATHTUB - @ 0.80 a O SHOWER @ 0.80 p LAVATORY(WASH BASIN) @ 0.80 O D KITCHEN SINK @ 0.80 �tAITNTMY TUB OR TRAY @ 0.80 SLOP SINK @ 0.80 FLOORSINK @ 0.80 FLOOR BRAIN @ 0.80 DISHWASHER DRINKING FOUNTAIN @ 0.80 _ URINAL g @ 0.80 GAS SYSTEM__J---._OUTLETS @ 1.00 0O WATER HEATER @ 1.00 00 MISCELLANEOUS APPROVALS DATE INSPECy R'S SIGNATURE UNDER SLAB WORK PERMIT $ I OD ROUGH PLUMBING _ TOTAL FEE QZf GAS PIPING - I IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. GAS VENT ! CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATERHEATER F TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED R IDENTIAL PROPERTY. UTILITY CO.NOTIFIED i SIGNATURE OF PERMITTEE...... .. .. ..a_.- __----- ----------- .............................. . - _ FINAL 569864 DBS 14 1/53 ' WORKER'S COMPENSATION DECLARATION 20.0026 DPW 9/89 76A667A APPLICATION FOR PLUMBING PERMIT I hereby aftirm.ihat I have a certificate of consent to self insure, , or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) — COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county buildin inspection - ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY i DateApplicant rL WATER CLOSET •� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.�( �j' .COMPENSATION INSURANCE - - - - ASSESSOR (-/,{�/q PAGE�r� PARCEL / (This section need not be completed if the work involved by the SHOWER MAP BOOK Oma+ /.J permit is for one hundred dollars($100)or less.) LAVATORY OWNER 1 certify that in the performance of the work for which this permit 7 is issued, I shall not employ any person in any manner so as to MAIL become subjectto the Workers'Compensation Laws. ADDRESS DISWASHER CITY TEL.NO. Date - Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS �1�0 provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM ( /! LICENSED CONTRACTORS DECLARATION CITY - �� TEL.NO.7/"W_?�. a I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and / STATE // LIC. Professions Code, and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. R 7�g CLASS (� OUTLETS OVER DISTRICT NO. PROCESSED BY i'I fel S.PER SYSTEM Q License Number (!/ F J Lie Class h / /� FINAL VALIDATION LU o— CL tel!/ f� LA(— DATE •� Contractor ,._Date fn ❑ I am exempt under Sec. FINAL y AL /✓ Z B.BP.C.for this reason r PI �t.e�4 fob D Date: Signature If PLUMBING PERMIT ISSUING FEE$ 7 :; ❑ TOTAL FEE Q SINGLE FAMILY Plan check applicant - c HOME OWNER-BUILDER DECLARATION Name �=. I hereby affirm that I am exempt from the Contractorn Contractor's Licese Law j ,. _ - ivc for the following reason (Section 7031.5, Business and Professions Address — Hwa �* ❑ City T C ! Tel. No. -'�� 97.50:I,as owner of the property,will do the work'and t-f�tn the structure y i I Gl iS is not intended or offered for sale (Section 7044, Business - I and Professions Code). - _ D TOTAL - 97 .50 .7 m(150 . CONSTRUCTION LENDING AGENCY x CHECK97.5-1 I hereby affirm that there is a construction lendingagency for the tw,,1 performance of the work for which this permit is issued (Sec. 3097, - CHAME U Civ. C.) � -i Lenders Name - I]I I`I(,1-0001 9/ 9/?n Lender's Address 540_ 1 AM11:04 I certify that I have read this application and state that the above D - information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize represent rves of th's County to enter u n the above-mentioned - prope insp ion putp es.� SEE REVERSE FOR EXPLANATORY LANGUAGE tgnature of Fr6rinnittee Date