HomeMy Public PortalAbout9455 DAINES DR_Plumbing__ 5o APPLICATION FOR PERMIT
EATT OF BUILDING AND SAFETY '
OU11TTY OF LOS ANGEIXS
WILLIAM J. FOX. CHIEF ENGINEER f
GR UP I ZONE N El.
FOR APPLICANT TO FILL IN N.D.
PLUMBER '� �L✓",y�y. REcgggLVED BY READY FOR ATE ISSUED
y��3 3 � FIRST INSPECTION / „r,• Osr/
r ADDRESS. C) /✓L d �°,�.'o`� /
/J BUILDING e
_..9� s2,�G{. TEL. No•,� ADDRESS
j CITY a /./�; ,pv
COUNTY v \/z'"4�, �f LOCALITY 111� ._� - \ •
I LICENSE NO. 9`7 40 irk EXPIRES. -- ✓ -
NEAREST
PERMIT FEES CROSS ST. A
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER/•/•-je-6C-V
MAIL
WATER CLOSET(TOILET) �. 0.50 III tt� ADDRESS
BATH TUB @ D.50 JCITY TEL. No.
SHOWER CLD 0.50 p� 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO'COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 ) O - AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50S 0 ANGELES COUNTY�LICENSE. OR I AM THE LEGAL OWNER
Jv OF THE RESIDENT*L PROPERTY DESCRIBED ABOVE.
GAS SYSTEM �DUTLETS @ 0.50
SIGNATURE. OF
J WATER HEATER 0 0.50 ,� PERMITTEE _�+p�
SLOP SINK @ 0.50 INSPECTION RECORD 'd .
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER ® O.SO
DRINKING FOUNTAIN @ 0.50 Z !rte A'2
URINAL Q 0:50 ; �� 1/ ... <<. �,s. T"o
HOUSE SEWER @, 0.50 •. ;-m ��.9'f' _Z
MISCELLANEOUS. C7
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING o�Ss�n.B
GAS VENT
CESSPOOL @ 1.,130 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ) @ 1.00 SEWER
PERMIT • I 1,1313 GAB TEST A. �L
UTILITY CO.NOTIFIED Z
TOTAL FEE $ n
FINAL
76A 667.-G.;. 1111 2-62192-jl�f/)� % ""77�/�1//
:. .-
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 'T
BUILDING AND SAFETY DIVISION BU LD s 1 ~ 4
JOHN A. LAMBIE. COUNTY ENGINEER ADD
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY J'£e��[,� �)
{`
FOR APPLICANT TO FILL 3N
NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25
ADDRESS S -w-
CITY TEL. NO.
SHOWER 1.25
CONTRACTOR
LAVATORY 1.25
ADDRESS —.4;
SINS 1.25 t�L
DISHWASHER 1.25 CITY TEL. N07`
CONTRACTOR'S STATE PH
LAUNDRY TUB 1.25 REGISTRATION NO. L 41 e £/ COUNTY Q
CLOTHES WASHER 1.25 DISTRICT NO'NO. OUP Oa P OCE ED BY
WATER HEATER 1.50 Jam_ �/ (Jv 6
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d
r O
�tiEi t�✓r I'?f�L �. u
V
ua
CL
N
z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
��^ ROUGH PLUMBING Ifi
(
TOTAL FEE / PIPING ) A) dr� V06
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT ( �'
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I +
HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST '
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED.
SIGNATURE � j `�d_.+f� d
OF
PERMITTEE ' "� FINAL AI116YZ%
ALIDATION ROBERT A.IWOOD'�� I
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
WORKERS'COMPENSATION DECLARATION AP UC6=d'tl MN FOR PLUMMIG,IG, PERMT I
I l--areby' affirm that I have a certificate of consent to self 76A667A lul
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 Nou Compan
Certified copy is hereby furnishe
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESSq4% � }��
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
TY
WATER CLOSET 1 �S �_
Date APPIicai5L�N- �pT�,J w NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE OWNER LAM
(This section need not be completed if the work involved by SHOWER
the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL
ADDRESS
I certify that in the performance of the work for which this !—
permit is issued; I shall not employ any person in any manner SINK CITY .) TEL. N
so as to become subject to,the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant_ CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate ofr�
Exemption, you should.become subject to the Workers' SWIMMING POOL RECEPTOR
,Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO8 , `]�/
with-comply with such provisions or this permit shall be STATE LIC. r�
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO', OCE ED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM B OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (�
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VA ATION
"�7Ls� Com/, DATE r a
License Numm'ber,.-n �2`�7�y.� Lic. Ciosss 'vyQ 0
l�n[�E�L. �UCKI.� ate b� y F V.
"N
Contracto ✓ 0
❑ I am exempt under Sec. �'
U
B.&P.C. for this reason Plan check fee a
Date: U)
PLUMBING PERMIT ISSUING FEE$ Z
.Signature ,e
TOTAL.FEE _
Plan check applicant g 9 91 2 A
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License #"o 6,o 0 05
Law for the following reason (Section 7031.5, Business and Address
Professions Code): City Tel. No. A;'o 6 2 2 50
❑ I, as owner of the property, will do the work and the
07044structure is not intended or offered for sale (Section D oto 0 2 2 5 050-
7044,
, Business and Professions Code),
CONSTRUCTION LENDING-AGENCY 6.-a 8 8
1 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 ad this application nd state that the
above information is correct. I agree t mply with all County .
ordinances and State laws regulating Plumbing, and hereby
authorize representatives,of this County to enter upon the
bove-mentioned pro rty for inspection purposes.Zi
6-3-88
SEE REVERSE FOR EXPLANATORY LANGUAGE
gnoture of rmi Date