HomeMy Public PortalAbout10787 DAINESWOOD DR_Plumbing__ B.I" T,D.BB
G- APPLICATION FOR PLUMBING PERMIT 1
B
Y DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING
ADDRES
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING
.._ . .. _
LOCALITX
It
FOR APPLICANT TO FILL IN I NEAREST
CROSS ST.
OWNER
. - � DISTRIC � GROU /^ZONE IiEAOY F.R INsPFCTION
MAIL
ADDRESS Z rdE 'Dowe S wov
�
�9 / INDUSTRIAL
CITY - [ TEL. NO. WASTE APPROVAL
r
PLUMBER �C_�r ��ir p� INSPECTION RECORD
ADDRESS
CITY TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 5
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER - @ $1,00
✓ LAUNDRY TUB OR TRAY @ $1.00 D
CLOTHES WASHER @ S1.00 Q Q
WATER HEATER @ $1.00 (�
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT
ROUGH PLUMBING
S 7 00
GAS PIPING
TOTAL FEE o
GAS VENT
1 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. PLUMBING FIXTURES-
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
e LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
i DESCRIBED RESIDENTIAL ROP TY.
SIGNATURE
OF
IOF PERM TTEE FINAL I
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATI ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CPSH
1 5 3 114Y 14 y3O 6.00 in
'MPENS;TION DECLARATION APPLICATION FOR (PLUMBING PERMIT L
1 y 71 have,o certificate of consent to self 76A667A
insure, orbS_'wte'of Workers' Compensation Insurance, - CE 817 (REV.,8/86) LJ
or a certified copy thereof (Sec. 3800, Lob. C) -
P❑ollcy NoCompany _
COUNTY OF LOS' ANGELES DEPT. OF 'PUBLIC WORKS,
Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) - BUILDING - D C Oij • i-/
Certified copy is filed with the courily.building inspec- ADDRESS• 6
hon de artment. NUMBER FIXTURE OR ITEM. @ FEE /I
P _ LOCALITY, Cl
WATER CLOSET //'' _ -
Date Appli4anl � 'v NEAREST / ^ - � ^A
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB. CROSS ST. li V DA
- COMPENSATION INSURANCE - - '- OWNER - a.'
This section need not be tomploted SHOWER ov
if the work involved MAIL
she permit Is for one hundred dollars.(SI00)or loss.) LAVATORY - ADDRESS ✓PJ r
I certify that in the performance of,the work for which this - - - - - -
permitis issued, I shall not employ any person in any manner t SINK .00 CITYvy� r^ TEL. NO. /
so as to become subject to the Workers'C mpensal ion Low DISHWASHER - l.�- b
. CONTRACTOR
Date pit, aft CLOTHES WASHER - ADDRESS -
NOTICE TO APPLICANT: If, after making this Certificate�of - - — r
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR // V"
Compensation provisions of the Labor Code, you must forth- .LAWN SPRINKLER SYSTEM CITY TEL. NO.
with comply with such provisions or this permit_shall be _ STATE LIC.,
deemed revoked WATER HEATER LICENSE NO. CUSS
LICENSED CONTRACTORS DECLARATION. -GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
I hereby affirm that.]am licensed under provisions of Chapter 9 1 -
(commenciriq with Section 7000) of Division 3 of the Business .OUTLETS OVER r 7 ��
and Professions Code,and my license is in full force and effect.. 5.PER SYSTEMFINA / ! V/ (DATION O
DAT
License Number Lic. Class - ' O
y
FI A y
U
Contractor -- Date _ - BY 1 ,/- W
y�
❑ I am exempt under Sec. _ - - - - ` ✓ f'71 5.3 A
B.BP.C.for this reason D # e . e e e 5 IA
- -
Plan check fee Z
Dote: PLUMBING PERMIT ISSUING FEE E ,}v '( e e z a 5 O
Signature - - TOTAL FEE ° + • 2 a.S O csi'
SINGLE FAMILY
Pion check applicant O Q O 2 8 7
- -
HOME OWNER-BUILDER DECLARATION Nome -
I hereby affirm that I am exempt from the Contractor's Licensegddress '
Law for.the.following reason (Section 70.31.5, Business and
Prof
ions Code): - City - _ Tel. No.
LJ I, as owner of the property, will do the work and the _ - -
structure is not intended or offered for sole (Section - D:
7044, Business and Professions Code). -
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lending agency for
the performance of the work for whichthis permit Is issued - - - - -
(Sec. 3097, Civ. C.). -
Lender's Nome
Lender's Address - -
I certify that I have read,this application and stale.that the - D
'above information is correct. I agree to comply with all County
ordinances and Stale laws:regulating Plumbing, and hereby - -
authorize representatives of this County to enter upon-the '
db mentioned or perty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE _
,Signature
0
f Perry iflee. Dale - --