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Home My Public Portal About9909 DAINES DR_Plumbing__ 76JA 667—CE 817 8/68 i APPLICATIO F91 .PLUM INC PE MIT COUNTY OF SOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /; f JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS (/ COLEMAN W JENKINS. SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (PRNT OR TYPE) NEAREST 1 CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE &, OWNER WATER CLOSET 1.50 _ MAIL BATH TUB 1.50 ADDRESS' .(� SHOWER 1.50 TY `� TEL. N LAVATORY 1 50 CONTRACT SINK 1 SO ADDRES3 DISHWASHER 1.50 C TEL. NO CLOTHES WASHER 1.50 STA E ^^�� LIC ' LICENSE CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GR¢UP TE PROCLAWN SPRINKLER SYSTEM 2 00L ' O WATER HEATER 150 INDUSTRIAL U WASTE APPROVAL Z GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD 0� OUTLETS OVER U 5 PER SYSTEM 30 Lu Z Plan check fee 2r)-/. of above See reverse PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE22 APPROVALS 'DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel No HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED REBID NTIAL PROPERTY FINAL SIGNATURE JACK R. ALLEN,.SUPERVISING M CHANICAL ENG'R OF PERM ITTE PERMIT VALIDATION cK M o CASH PLAN CHECK VALIDATION CK M o CASH " /60 ✓ % WGRKERS'COMPEN$ATIC3N DECLARATIrJ@I 76A667A, I hereby af?trm that I hive a, certificate of consent to self ce ev (z-ao) A P P L]C A T I O N FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a tified col2y thereof e . 38 a C.) _ COUNTY OF LOS ANGE ES � BUILDING AND SAFETY 11 ompa Certified copy is hereby furnished. / iu FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS ® Certified copy is filed with e c my buil inspection NUMBER FIXTURE OR ITEM • FEE department. WATER CLOSET LOCALITY Date Applicant NEAREST / - BATH TUB CROSS ST CERTIFICATE OF E PTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAIL - (This section need not be completed if the work involved LAVATORY ADDRESS ,Q / by the permit is for' one hundred dollars ($100) or less.) } SINK CITY ' TEL NO 0 I certify that in the performance of the work for which this DISHWASHER V CONTRACTOR permit is issued, I shall not employ any person in any manner .� . /L ;x so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS /J Date Applicant SWIMMING POOL RECEPTOR CITY ` !J C/ TEL. NO V NOTICE TO APPLICANT- If, after making this Certificate of " ej LL Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC N Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO V� �� CL SS' 3 with comply with such provisions or this,permit shall be deemed revoked GAS SYSTEM OUTLETS DISTRICT NO./� P OCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of'Division 3 of the Busi- FINAL VALID ON ness and Professions Code, and my license is in full force and DATE — effect FINAL License Number "d Ltc Class C 3�- BY �o � Contractor Date / 0 I arri xempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ p acting in my professional capacity (Section 7051, Bus- iness us iness and Professions Code) TOTAL FEE LIE Lic or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address + License Law for the following reason (Section 7031 5, Busr City Tel No 24.7 3'4 A ness and Professions Code) El # ooao I, as owner of the property, am exclusively contracting o5. with licensed contractors to constru0 0ct the project 2 2 5 0 0 (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY o •0 2 O O v I hereby affirm that there is a construction lending agency 0 4, 1 4-8-1 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 1 agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of t ounty to enter upon the y above-me ne r6perty for mspe kion purposes Sig a re 6f Permittee Da e WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consErnt to seif 76A667A ,Tsure, or a certificate of Workers' Compensation Insurance, CE 817,(REV 10/81) ,T ci,cerriffied copy thereof (Sec 3800, Lab CC ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N O. mpany. .�/� vL `'yell�l ❑ Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING '® Certified copy is filed with the county building inspec- ADDRESS' r� ' tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITYC_Date �� b Applicant WATER CLOSET NEAREST 71 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST LCJ/' COMPENSATION INSURANCE SHOWER OWNER' (This section need not be completed If the work Involved by MAIL the permit Is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the.work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to be'come subject to the Workers'Comp Dation Laws DISHWASHER 6 /I / CONTRACTOR Date6APPlicant 56= CLOTHES WASHER ADDRESS NOTICE TO APPLICANT 'If, after ma mg this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM. CITY T� / e, TEL NO g with comply with such provisions or this permit•sholl be STATE LIC GG� deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION O DISTRICT N PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,-and �myy license is in full force and effect PER SYSTEM, FINAL VALIDATION License Number! 1L rLic Class `�— DATE O FINAL Contractor Date c --�F / G U ❑ O I am exempt under Sec - � B &P C for this reason W Plan check fee ® a Dote N PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE C tit Plan check applicant g SINGLE FAMILY ACCTes HOME OWNER-BUILDER DECLARATION Name J3QJ 4aa40 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and 1 ITEMS - Professions Code) City Tel No TOTAL 43 - 40 ❑ 1, as owner of the property, will do the work,and the structure isnot intended or offered for sale (Section ® CK 43.40 7044, Business and Professions Code) , CHANGE .00 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued -0090-0��1• 7/��f{� (Sec 3097, Civ C ) r4J 1 5 1 AM. °0 1151 Lender's Name � • � 9:415 , a Lender's Address i 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 ob e-mentioned pro rty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE S gnature of it ee Date