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HomeMy Public PortalAbout9702 DAINES DR_Plumbing__ 76APPLICATION FOR PLUMBING PERMIT1 DBSS-1-177 10.68 DIMISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST OWNER MAIL DISTRICT Nq GROUP I ZO !E READY FOR INSPECTION I ADDRESS INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY TEL NO LICENSE NO NUMBER TYPE OF FIXTURE O ITEM FEE WATER CLOSET (TOILET) @ $1,00 $ BATH TUB @ $100 SHOWER @ $1 00 LAVATORY (WASH BASIN) @ $1 00 JA KITCHEN SINK @ $100 DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ v-00 CLOTHES WASHER @ $1 00 WATER HEATER @ $1 00 GAS SYSTEM @ $1 00 APPROVALS DATE IA TOR'S/,{GNATURE UNDER AdMWbIRK `9 PERMIT $ 00 ROUGH PLUMBING AS PIPING TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT•I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST 15' , LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED �� �_ DESCRIBED RESIDENTIA SIGNATUREOF PERMITTE AL JOHN A LAMBIE, COUNTY ENGINEER IDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CK EI 0 CASH ACo1-91.6,E SEP 3 3 1 1 .00 0 APPLICATION FOR PLUMBING PERMIT WORKERS'COMPENSATION DECLARATI I hereby affirm that I have a certificate of con td 1f 76A66 A insure, or a certificate of Workers' Compensation hisurance! CE 817(REV 10,-91) or,, certif2Athereof (Sec 3800, Lob �) . i COUNTY OF LOS ANGELES - BUILDING AND SAFETY Policy No ��tV Company IGUV,( Certified copy is hereby furnished ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /r']-1©,7 Certified copy is filed with t e ty buildm spec- ADDRESS ( G�- D`-'� on depar m nt NUMBER FIXTURE OR ITEM @ FEE ' L V LOCALITY"��,/ �L Date Applica WATER CLOSET NEAREST G•-� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST F,_ COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL f 7 P ( � ) LAVATORY ADDRESS ii..L�� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR--k Date-- Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS 1 �� Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO 1 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO _ CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PR ESSED BY . I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ' (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER otd and Professions Code,and my license is in full force and effect 5 PER SYSTEM I FINAL VALIDATIONV License IN c./� Lic Class DATE/f �'�� _S41 ad FINA O CII­ ontra Date BY U U W I am exempt under Sec G //1-2 7 N B 8P C for this reason z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant ' HOME OWNER-BUILDER DECLARATION Name '4 1 8 A I hereby affirm that I am exempt from the Contractor's License Address r o 0 0 0 0'� Law for the following reason (Section 7031 5, Business and - � Professions Code) City Tel No 0 2 8 5 0 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section o o;o 2 R Jc Q z U 7044, Business and Professions Code) � ; CONSTRUCTION LENDING AGENCY ,9,1 2 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 cern that I have read this application and state that the ► abov in ,,tion is correct I agree to comply with all County ordi ces a Stat laws regulating Plumbing, and hereby outkeepr en ti es of this County to enter upon the abtion d r rty for inspection purposesSEE REVERSE FOR EXPLANATORY LANGUAGE Si Permittee Date