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Home My Public Portal About9406 DAINES DR_Plumbing__ - DBS-17' APPLICATION FOR � PERMIT DIVISION p OF BUILDING AND SAFETY ILI Department of County Engineer _ r - i h..-.:,rte, o. ::::� .off.Avg N•.'. . County of Los Angeles BUILDING _ JOHN A. LAMBIE, COUNTY ENGINEER - ADDRESS ! t CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST - CROSS ST. - OWNER DISTRICT NO. GROUP �,,Wj.ADY FOR INSPECTION MAIL - i ADDRESS INDUSTRIAL - CITY TEL. NO. WASTE APPROVAL PLUMBER ./ INSPECTION RECORD ADDRESS d _ y ?= CITY TEL'. N0. - LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM " FEE WATER CLOSET (TOILET) @ .$1.00 BATH TUB @ $1.00 ®4 SHOWER @ $1.00 !: LAVATORY (WASH BASIN) @ $1.00 O 4� KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 WATER HEATER .@ $1.00 00 a GAS SYSTEM - @ $1.00 D APPROVALS DATE INSgECTOR'S SIGNATURE UNDER SLAB WORK Ge• 1 PERMIT $ 1 00 ROUGH PLUMBING / �' 1• `� ., �. _�. _ ,� GAS PIPING TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER I1 n WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES In PLUMBING. -a IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST ,7 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE_LEGAL OWNER OF THE ABOVE ' UTILITY CO. NOTIFIED p DESCRIBED RESIDENTIAL P SIGNATURE pp rrA OF PERM ITT FINAL JOHN A. LAMBIE. COUN Y ENGINEER r VALIDATION RQBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.0. CASH - I Aro 9 1 8 0 t JUM 12 3 1 2.0 0 In 76A667 (CE-817) - 5/73 APPLICATIO FOR�PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILD,INc. ' MAKE CHECKS PAYABLE TO: ADDRESS ' HARVEY T. BRANDT, COUNTY ENGINEER LOCAL'ITv' '' FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST - NUMBER FIXTURE OR ITEM @ FEE CROSS•ST... ' OWNER WATER CLOSET 1.75' MAIL BATH TUB 1,75 ADDRESS" ' SHOWER 1.75 CITY tEL. NO. LAVATORY 1,75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY �enLD -[9 EL. NO � 0 CLOTHES WASHER 1,75 STATE LICENSE NO LIC SWIMMING POOL RECEPTOR 1.75 � - - - ' DISTRICT NO. UP ONE CESSEDY LAWN SPRINKLER SYSTEM 1,75 WATER HEATER 1.75 INDUSTRIAL, WASTE APPROVAL p} GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD OUTLETS OVER' ";"• 5 PER SYSTEM .30 -k:;--7e-1 Jh f'7- .-:—,,7,4 P�O a/a o O d R� + o Vp Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE S 3 00 TOTAL FEE APPROVALS DATE_ INSPECTOR'S SIGNATURE Plan Check applicant UNDER SLAB WORK Nam ROUGH PLUMBING _ Address �Q GAS PIPING Y City 15 el. NO. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I -HAVEREAD THIS APPLICATION , AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES f ? WITH ALL COUNTY ORDINANCES AND STATE�LAWS REGULATING PLUMBING. -FASTEST ILIA.a 0 - I.HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSEDAS UIRED BY LOS ANGELES COUNTY AND STATE OF CAL FO RNIA OR T I AM THE LEGAL OWNER OF, AND INTEND TO " •zRESI DE IN THE ABO ESIDENTIAL PROPERTY. FINAL ;Y..7L�/ .il/�'�l/7�-•CS)-�'1 SIGNATUR L OF PER XTTE PERMIT VALID ION 6c�� M•0. CASH PLAN CHECK VALIDATION CK. M.0. CASH 673 _.jUN 2,. . 5 D 65 0 ,&98 WORKERS'COMPENSATION DECLARATION �PO PO 0 C n U O N FOR fob 11 fl fl 11 11 o �N G f71�fb�11 U I hereby affirm that I have a certificate of consent to self 76A667A /^1 L� !�1 ll 11V IJP lT L�IJIIVII IlV ll-LSII�tIVp insure, or a certificate of Workers' Compensation Insurance, ' CE 817(REV. 10/811 or a certified copy thereof (Sec. 3800, Lab. C� � COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company �Jr/`" Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy copy is filed with the county building inspec- ADDRESS NUMBER FIXTURE OR ITEM LOCALITYG� h7on d paGriment. @ FEE Date J 2)O Applicant `'°` flaw I WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB r CROSS ST. 'COMPENSATION INSURANCE J OWNER (This section need not be completed if the work involved by ! SHOWER s the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL 0 �� ADDRESS! I certify that in the performance of the work for which thisT permit is issued,I shall not employ any person in any manner SINK CITY Y TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR��. Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS'ly� Sp�/i✓ G.i/�J Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY 6 TEL. NO�$'7�7�G with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM P Y P P STATE LIC. r deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED 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 670/ > and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL — ' VALIDATION 0 License Number'7�v_P91/14Lic. ClassDATE ! Ilm �� f � � FINAL O ��/ Controcto6` 4'4, � Date 2BY ` V ❑ I am exempt under Sec. 9L N B.&P.C,,for this reason Plan check fee D Z ate: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE G�767A SINGLE FAMILY Plan check applicant ttF 0'0'0 o'o`5 HOME OWNER-BUILDER DECLARATION NameKP'4.5 I hereby affirm that I am exempt from the Contractor's License Address �/ �,o o 4.0,5 0 Law for the following reason (Section 7031.5, Business and �l� -5- Professions Code): Cit — o 010 4 0,. z El 1, �G/'� 6 Tel. No.,,��, � q O I, as owner of the property, will do the work and the 028-83 structure is not intended or offered for sale (Section D 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 hove 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 representatives of this County to enter upon the above- boned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE AV Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPUC a MN FOR .PLUM, a NG PERMT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND'SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING (/ Certified copy is filed with the cou, ty buil nspec- ADDRESS J tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY / WATER CLOSET 69 Date Applica��n.t�� / NEAREST CERTIFICATE OF EXE/d(T(ON FROM WORKERS' BATH TUB CROSS T. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY /. ADDRMAIL ESS (gyp yi_i ��' �'• I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Pate Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT:pf, after making this Certificate of �U� Exemption, you should become subject To the Workers' SWIMMING POOL RECEPTOR' CITY TEL. NO. q Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM +-�`aa'+ (with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS r, LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER l and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL DATE VALIDATION � �I�icense Number Lic. Class @r; 1 DATE FINAL �ontractorr Date Z BY l9 Im exempt under Sec. o B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant8 3 R SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name _ * o 0 0 0 0 !hereby affirm that I am exempt from the Contractor's License Address law for the following reason (Section 7031.5, Business and 2'- o 2 8 5 O rofessions Code): City Tel. No. I, as.owner of the property, will do the work and the o,o o 2�5 r35structure is not intended or offered for sale (Section 1 -82 7044, Business and Professions Code). A2G. CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for e performance of the work for which this permit is issued Sec. 3097, Civ. C.). ender's Name ender's Address certify that I have read this application and state that the Noinformation is correct. I agree to comply with all County inances and State laws regulating Plumbing, and hereby uthorize representatives of this County to enter upon the ve-me"ntione p perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE jib ature of Permittee Date