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Home My Public Portal About9915 DAINES DR_Plumbing__ i,761A667-Ck0817 10-67 APPLICATION FOR PLUMBING_ -PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY C — FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET - 1.50 MAIL BATH TUB 1.50 ADDRESS SHOWER 1.50 / CITY TEL. NO. �J LAVATORY 1.50 CONTRACTOR �v��— SINK 1 50 ADDRESS 1�- DISHWASHER 1.50 CITY TEL. NO �^1 `—&' CLOTHES WASHER 1.50 STATE LIC _LICENSE NO �� CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GROUPJ ZONE PROCESSED CL BY LAWN SPRINKLER SYSTEM 2.00 �(� t O U WATER HEATER 1 50 INDUSTRIAL WASTE APPROVAL 0 GAS SYSTEM OUTLETS 1.50INSPECTION RECOR ~ U OUTLETS OVER '` LJ 5 PER SYSTEM 30 y ••� - _ e L Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE $ 2 00 TOTAL FEE 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 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS Ck D AGREE TO COMPLY PLUM B ING'FIXTURES WITH ALL COUNTY ORDINANCE AE LAWS REGULATING GAS TEST PLUMBING I HEREBY CERTIFY T T I M PREGISTERED AND/OR UTILITY CO NOTIFIED, LICENSED AS REQUIRE BY L S NUNTY AND STATE OFCALIFORNIA OR THAT AM T E GR OF,AND INTEND TORESIDE IN, THE ABOVE ESCRI ED REPROPERTY FINAL --- -- -•• SIGNATURE JACK R. ALLEN,`SUPERVISI M HANICA L' ENG',R- OF PERMITTEE PERMIT VALIDATION k,c K M o CASH PLAN CHECK VALIDATION c1c M o ASH .. �5 5 ,�t1.2. . 5 Q `6:50� a. ��- WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING- PERMIT I hereby affirm that I-have a certificate of consent to self 76A667A- I - insure, or a certificate of Workers' Compe sation Insurance, CE 817(REV 10/81) ,, % I ,I I or a certified copy thereof (Sec 3800, La C ) COUNTY OF LOS ANGELES BUILDI AND SAFET Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING p67 Certified copy is filed with the county building inspec- ADDRESS / tion department NUMBER. FIXTURE OR ITEM @ FEE LOCALITY Date �� 3 Applicant WATER CLOSET - NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB_ CROSS ST COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER' MAIL / the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS f I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO.) so'as�to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR 'Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR 0 _ Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- �-y LAWN SPRINKLER SYSTEM with 'comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO ,,,,,,///�� PROCESSED BY I hereby affirm that I-am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commenting with Section 7000),of Division 3 of the Business OUTLETS OVER 9111.' and Professions Code,and my license is in full force and effect 5 PER SYSTEM AT J VALIDATION License Numb Lic Class y� ��, 99 FINAL O �" . , Contractor Date BY U_ LU 91116 I am exe � " 91116 N B&P C for this reason Z • Plan check fee Date t'R PLUMBING PERMIT ISSUING FEE$ Signature Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the'Contractor's License c'7, Law for the following reason (Section 7031 5, Business and Address o o`off o Professions Code) City Tel No ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 21 '65 D 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY ,.1 6 F O Zi . I hereby affirm that there is a construction lending agency for ( 2,c.7— ✓J 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 Stat regulating Plumbing, and hereby authorize representatives of this County'to enter upon the above-mentioned property for inspection purposes l SEE REVERSE FOR EXPLANATORY LANGUAGE j �AAr ). , Signature of Permittee Date