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Home My Public Portal About9716 DAINES DR_Plumbing__ r, APPLICATION Ip��! �/L�y PLUMBING pp�py�q p�p�Ipl PERMIT Qp�9pp�I DB5�1�7 10.55 ,DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BU t LD I NG JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN SUPT OF BUILDING LOCALITY FOJI APPLICANT TO FILL IN NEAREST CROSS ST. OWNER DISTRICT GROUP ZONE y READY FOR INSPECTION MAIL T ADDRESS i INDUSTRIAL CITY TEL. NO. '* WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CIT ��++'' EL. NO ` LICENSE NO. Z" NUMBER TYPE OF FIXTUA OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 r DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 J e WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS �^ D ��E jT PECTOR'S S�INATURE UNDER �ORK PERMIT $ 1 00 !. ROUGH PLUMBING v�%O S, -,,/1, ^` .._ GAS PIPING TOTAL FEE GAS VENT 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 FIXTURES PLUMBING. I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFf CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE t UTILITY CO.NOTIFIED W /'„� DESCRIBED RESIDENTIA , R P TY, - - SIGNATUREOF PERM PERMITTE '^ � NAL JOHN A. LAMBIE, COUNTY ENGINEER �lALIDATION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR O. CASH DLJ9 2 J.� SEP 3 3 11 .00 r WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 sure,o certificate of Workers'Compensation Insurance,oro 76A667A certified copy thereof (Sec. 3800, Lab. C.) QUI JOUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ✓I/1_ I��. Certified copy is filed with the county building inspection ADDRESS / , J/ t-V e,-- rr0f department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �� ,p C7 Date Applicant WATER CLOSET(TOILET) NEAREST //L CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS S.T 2GYC(Q COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAILq�1 /141 the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS / ` & j9a!g 1He5 //t. I certify that in the performance of the work for which this per- SINK �/�a! C, al�� (p��8 mit is issued, I shall not employ any person in any manner so CITY /-4�p� /� TEL. NO. as to become subject to the Workers Compensation Laws. DISHWASHER //&(P C CONTRACTOR (/t./4 e-r- Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER � a LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS Q� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE License Number Lic. Class 5 O FINAL y Contractor Date BY ACCTo4 O I am exempt under Sec. 33303 43.40 t' U B.BP.C. for this reason Plan check feepoll1 ITEMS Date: PLUMBING PERMIT ISSUING FEE$ p TOTAL -43-40 � i Signature TOTAL FEE n CHECK 43.40 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant CHANGE o00 I I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code):, Address 0000-0001 12/ 4/95 I, as owner of the property, will do the work and the City Tel. No. 3549 1 AM11:34 structure is not intended or offered for sale(Section 7044, Business and Professions Code). ► CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for I the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). i Lender's Name j Lender's Address I certify that I have read this application and state that the 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-mentioned property_f c inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date