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Home My Public Portal About9713 DAINES DR_Plumbing__ � pq_® FOR /► p�y//�g 76A667^ - APPLICATION ■ O ■ PLUMBING PERMIT DBS-170 55 DIVISION 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 pm01LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST OWNER DISTRICT O GROUP ZONE,I READY FOR INSPECTION F� MAIL ADDRESS INDUSTRIAL CITY TEL NO WASTE APPROVAL ECRDAPLUMBER INSP CTION RECORD- ADDRESS DDRESS CITY C/ TEL NO — LICENSE NO NUMBER TYFOE OF FIXTURE611 1TFM FEE WATER CLOSET (TOILET) @ $1 00 BATH TUB @ $1 00 SHOWER @ $100 , LAVATORY (WASH BASIN) @ $1 00 KITCHEN SINK @ $1 00 DISHWASHER @ $1 00 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 WATER HEATER @ $1 00 GAS SYSTEM @ $1 00 APPROVALS DA yTE IW5VQCjOR S SIGNATURE UNDER B WORK PERMIT $ 1 00 61 t ROUGH PLUMBING GAS PIPING NL TOTAL FEE GASVENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES /7 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST _ 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 RESIDENTIAL PRO ERTY SIGNATURE OF PERMITTE NAL JOHN A LAMBIE, COUNTY ENGINEER .101"VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CK tl 0 CASH :'�01 9 2. O'v; SEP 3 3 1 1 .0 0 V) 76A667-CE4817 6-65 APPLICATION FOR LUMBI G PERMIT. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TINEAR7EST JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS SUPT OF BUILDING FOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $125 MAIL BATH TUB 125 ADDRESS CI TEL NO �Ol17- SHOWER 125 LAVATORY 125 CONTRACTOR SINK 125 ADDRESS Q DISHWASHER 1 25 CI STATE �y TEL NO LIC LAUNDRY TUB 1.25 LICENSE NO h�� CLASS CLOTHES WASHER 1.25 DISTRICT NO GROUP Z� E P OCESS D BY WATER HEATER 1 50 f Q � �f } GAS SYSTEM OUTLETS 150 INDUSTRIAL IASTE PPAOVAL a OUTLETS OVER S PER SYSTEM 30 INSPECTION RECORD O Ex O 1- W D" I N Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE D GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER,HEATER PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED -AT PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED,RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE A lll/JIIVVV FINAL CK 0AUDATION M O CASH L 7 2 •4•,7• >3. FEB 2 0 5 D 3.50, - _ . WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 76A667 DPW 4/87 I,,%ieref�i;,+'>7ffirm that I have o certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified capy thereof (Sec. 3800, Lob, C.) COUNTY OF LOS ANGELES 'DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE) 9713 ❑ Certified copy is filed with the county building inspection ADDRESS 7 department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS'• BATHTUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER ��074 (This section need not be completed if the work involved by MAIL ��,,,,,�yy�� the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS lao& -cam I certify that in the performance of the work for which this per- SINK CITY TEL. NO`S V68 mit is issued, I shall not employ any person in any manner so v( v/ as to become subject to the Workers'C ensation Laws. DISHWASHER /J• C?�'/�✓ A'I Date�/�- CONTRACTOR �-7G� Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of-Ex- SWIMMING POOL RECEPTOR emption, you should become subject to the Workers'Compen- sation provisions of the Labor Code, you must forthwith comp- LAWN-SPRINKLER SYSTEM �� ly with such provisions or this permit shall be deemed revok- ATE LIC. ed. / WATER HEATER LICENSE NO. � CLASS (� LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. Q n DATE i License Number ®/ Lic. Class I; �,.�/l� U (/tom IiGG.. ��Orf/ 7c� BIY AL O Contractor Date ❑ U I am exempt under Sec. W B.&P.C. for this reason Plan check fee , Date: PLUMBING PERMIT ISSUING FEE$ a6 (�0 Signature TOTAL FEE 7 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name rft"?' ,a Law for,the following reason (Section 7031.5, Business and 5i , Professions Code): Address. -" Cit ❑ Tel. No. 1 1, as owner of the property, will do the work and the Y _ structure is not intended or offered for sale(Section 7044, Business and Professions Code). oil. E•H 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 Namet _ s H111 _ _ Lender's Address I certify that I have read this application and state that the Poo.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 ablove-mentioneo,pryperty for inspection purposes.. SEE,REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date