HomeMy Public PortalAbout9944 DAINES DR_Plumbing__ 76A667-CEt817 6-65
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
ROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY NO.
LAVATORY 1.25 CONTRACT
SINK 1.25 ADDRESS 2
DISHWASHER 1.25 CITY
ATE LIC
LAUNDRY TUB 1.25 LICENSE NO CLASS
CLOTHES WASHER 1.25 DISTRICT NO GROUP ZONE PROCESSED BY
WA 1.50 �
GASSYS OUTLETS 1'50 INDUSTRIAL O
WASTE APPROVAL
OUTLE OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
A ROUGH PLUMBING
TOTAL FEE 4 GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INT TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENT L P PERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMIT T FINAL
AMDATION
CK M O CASH
LAtfc 4 6 3 9 SEP 12 5 D 3.5 0
i" z„WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby,affirm that I have a certificate of consent to self 76A667A
nsure, or acertificate of Workers'Compensation Insurance, CE 817(REV 8/86)
or,'o��cerhfied"copy thereof (Sec 3800, Lab C - J- =
COUNTY OF LOS ANGELES DEPT. OF PUBLIC •WORKS
Policy No Company ^,
Certified copy is hereby furnished '
aFOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec-• ADDRESS
tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date A li ant' WATER CLOSET NEAREST t
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB a CROSS ST lU 1
COMPENSATION'INSURANCE,
OWNS
(This section need not be completed if the work-involved by SHOWER P y `; '
�j'/
the permit-is for one hundred dollars ($100)or less.) 3 LAVATORY DDRESS�`i Y O,V•ejt `
I-certify that in the'performance of the work for which this
permit is•issued, I shall-not employ any person-in any manner SINK CITY TEL NO
so as to beco a sublect to,theWorkers Compensation Laws DISHWASHER 1,
1 xx CONTRACTOR /
Date Applicant � AA l CLOTHES WASHER V ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of
Exemption, you should become subject to tKe Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the•Labor Code, you must forth- CITY TEL NO
LAWN SPRINKLER SYSTEM
with comply'with such -provisions or this;permit shall be STATE LIC
deemed revoked WATER HEATER O V LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION L� DISTRICTNOdf���,/// PR ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 5 // y,
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER U
and Professions Code,and my license is in full force and effect 5 PER SYSTEM DATE a l� �' VAIs TION 0
FINAL
License Number Lic Class It
FINAL - O
Contractor Date BYEJ - _ (•'
I am exempt W under Sec •, C
B 8P C for this reason Plan check fee Z
Date Poo
PLUMBING PERMIT ISSUING FEE$
Signature
i TOTAL FEE S
Plan check applicant'
SINGLE FAMILY . S 2 O'A
HOME OWNER-BUILDER DECLARATION_ Name qq �,-
,
I hereby affirm that I am exempt from the Contractor's licenseess / #$ o ° ° 9, '5
o
Address
Law for the following reason (Section 7031 5, Business and DZ
Professions Code) City I Tel-No ;( s 0 0.6,5 0
® I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section ® 9 ° 1 0 65 0,5
7044, Business and Professions Code),
CONSTRUCTION LENDING AGENCY ;09,2 9.”$7'
1 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 T J
I certify,that I hove 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 prope ty for inspection purp ses.
�A\1Yl SEE,REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee, Dotd,1