HomeMy Public PortalAbout9833 DAINES DR_Plumbing__ 7IIA967APPLICATION FOR PLUMBING PERMIT .1
DBS-171T�SION OF BUMI)ING AND SAFETY '
1 Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SUPT OF BUILDING ::1
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS STIt,:z
OWNER DISTRICT NO. GROUP I ZONE
I READY FOR INSPECTION
MAILI
ADDRESS I Al F l�
j INDUSTRIAL
CITY f�TEL NO WASTE APPROVAL
PLUMBERlaw C+J" e.s•�'E'd;�9ti� 'J► � ��1�-' INSPECTION RECORD
ADDRESS 1n�^^ C.1 'J • Ca:4(v%ih Av Fele (�rn�4�j
CITY L:1J. �'l'L=s� Tg��('�.WM CaHif l 11
LICENSE NO. o�f Sst
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $100
SHOWER @ $1 00
LAVATORY•(WASH BASIN) @ $1 00
KITCHEN SINK @ $1 00
DISHWASHER @ $100
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ $1 00
WATER HEATER @ $1 00
GAS SYSTEM @ $1 00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING 12 1% SCO , J
GAS PIPING
TOTAL FEE GAS VENT
I D HEREBY ACKNOWLEDGE THAT-I HAVE READ THIS APPLICATION HOT WATER HEATER
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
"
IHEREBY CERTIFY THAT I 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 RESIDENTLAL PROPERTY
SIGNATURE
OF PERMITTEE FINAL Q
JOHN A. L.AMBIE. 11.NTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR"
!1 G. CASH
� Co2.8 2 6� MV23 3 3.00
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I heil6by,.officm that-] have a certificate of consent to self in- 76AA6667A, 4/90
sure,ar a certificate of Workers'Compensation Insurance;or a
certified copy thereof (Sec 3800, Lab 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) A
Certified copy is filed with the county building inspection ADDRESS o
department NUMBER FIXTURE OR ITEM (d FEE LOCALITY
WATER CLOSET(TOILET)
Dote Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCE SHOWER O OWNER
(This section need not be completed IF the work Involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 2033 PAIN8S D2
I certify that in the performance of the work for which this per- SINK CITY y� TEL NO ^7
mit is issued, I shall not employ any person in any manner so CF �[l �?S/
as to become subject to the Workers'Compensation Laws DISHWASHERn
CONTRACTOR UJ AJ c„
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL NO
sation provisions of the Labor Code;you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC
ed WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I-am licensed under provisions of Chapter GAS SYSTEM OUTLETS �
- ..�'��
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- FINAL t VALIDATION
fect - . 5 PER SYSTEM
HOSE BIB DATE
License Number Lic Class 8M
FINAL ACCTee • U
Contractor Dbte BY 3303 43.41
I am exempt under Sec ITEMS F'
B&P C for this reasonV
Plan check fee � ''// _0 � "TOTAL 43 m,
Date PLUMBING PERMIT ISSUING FEE$ D ( 1 -CHECK 43.49
Signature NOTAL FEE o% D CHANGE _ .OD
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License' Name 0000-WO 1 2/,15/96
Law for the following reason (Section 7031 5, Business and
Professions ICode) Address 481°5 1 AMID 11
�1, as owner of the property, will do the work and the City Tel No
structure is not intended or offered for sole•(Section 7044,
Business and Professions Code) i
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 have read this application and state that the
above information is correct I agree to comply with all County'
ordinances and State jaws regulating Plumbing, and hereby
authorize representatives of. this County to enter upon the
above-mentioned property for inspection purposes
a 9ro SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permitt Date