HomeMy Public PortalAbout9914 DUFFY ST_Plumbing__ 76A667-CE#817 2-66 �^ ��
APPLICATEON FOR
PERM
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS //
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 7,
i
FOR APPLICANT TO FILL IN, NEAREST
CROSS ST.
RNUBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25
BATH TUB 1.25
ADDRESS Q
CITYTEL. NO.
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
e
SINK 1.25 ADDRESS/7,7 / `
DISHWASHER 1.25 CH
SATEj ssJJ//II
LIC
LAUNDRY TUB 1.25 LICENSE NO./ 7-7 / ,� CLASS C J
0
CLOTHES WASHER 1.25 DISTRICT NO. GRPLU E P O BY
WATER HEATER 1.50 D r
GAS SYSTEM OUTLETS I'S0 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD v
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
�� ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LICATION 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.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST a
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,A D INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RE IDENTIAL PRO PE 1 Y. UTILITY CO. NOTIFIED _
SIGNATURE `
e OF PERMITTEE FINAL �P J
.o
V LIDATIO JACK R. ALLEN
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M.0. CASH SUPERVISING MECHANICAL ENG'R.
Ao.9.6 9 5 Go jUL 19 5 D 7.00-
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APPLICATION FOR PERMIT
DEPARTMENT*OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES L N I
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIC�.N0.
sGROUP ZONE PERMIT
NO.
PLUMBEFON ®N® PLUMBING CONTRACTORS
9
RECEIVED BY READY FOR DATE ISSUED
OO r t� FIRST INSPECTION
3 /
ADDRES44 W. Garvey - MonteIey Park, CaL
y-
A`'antic 2.4654 - CUmberlan 3-100-,' BUILDING
CITY TEL. NO. ADDRESS —
COUNTY ,p ✓j � /'
EXPIRES LOCALITY
. LICENSE . ?
- /
NEAREST /
PERMIT FEES CROSS ST. 'C
-NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) @ 0.501$ I ®
p ADDRESS
M/: I BATH TUB @ 0.50.1. C-ITY TEL. NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.501 _ APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
L` I LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE,,,,OR—I AM THE LEGAL.OWNER
y
OF THE RESIDENTIAL .0 DESCRIBED\ABOVE.
y I GAS SYSTEM � OUTLETS @ 0.501 SIGNATURE OF
•I WATER HEATER @ 0.501 —c PERMITTEE 6
SLOP SINK @ 0.501 F INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.501 d ,I
IDISHWASHER @ 0.501
r
DRINKING FOUNTAIN @ 0.50 I � "
URINAL @ 0.50(
I HOUSE SEWER @ 0.501 I Q
Z
MISCELLANEOUS I I�
I
I I
I�
I
APPROVALS
DATE INSPECTOR'S NAME
I� ROUGH PLUMBING
GAS PIPING ,L'� / I�a
GAS VENTX171"'
1/�v �l
CESSPOOL @ 1.00 I I CESSPOOL �I
SEPTIC TANK: I—� SEPTIC TANK
I
DRAIN__( ) PIT ( ) @ 1.00 I SEWER
PERMIT . • I 1.00 GAS TEST TOTAL FEE $ UTILITY CO. NOTIFIED
—w FINAL
WORKERS'COMPENSATION DECLARATION o 0 0 0 0 0
I hereby affirm that I have a certificate of consent to self 76A667A o ppdOC�Q�O�� �O� pdMn�n1C3�N1C fCQG �
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a.certified copy thereof (Sec. 3800, Lab. C. __ ^^ COUNTY OF LOS ANGELES BUILDING AND SAFETY
olicy No. �" Company S F'u/wo
Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9 ot
Certified copy is filed with the county building inspec- ADDRESS `
tion department. NUMBER FIXTURE OR ITEM n FEE Q
LOCALITY M1��C__. C l'i
Date Applicant .�� WATER CLOSET NEAREST 1 1 `
CERTIFICATE OF EXEMPTION FROM WORKERS' J10— BATHTUB CROSS ST. ►�! LW
COMPENSATION INSURANCE OWNER ' ,CAA—fIi �C)V jr �0
(This section need not be completed if the work involved by SHOWER
the permit is for one hundred dollars ($100)or less.) 4� ) LAVATORY MAIL P
ADDRESS Cr
certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. j DISHWASHER (?/� q
CONTRACTOR y`J► (Jf v+—��.J�
Date Applicant CLOTHES WASHER —ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of'
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY
Compensation provisions of the Labor Code, you must forth- �� � TEL. NO.`� (0(4qLAWN SPRINKLER SYSTEM
with comply with such provisions or this permit 'shall be 1 STATE �y (� LIC.
deemed revoked. WATER HEATER LICENSE NO. y —L CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. CESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM '.OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER q--
and
and ProfeCL
ssi s C e and my license is in full force and effect. 5 PER SYSTEM FINAL
DATE / VALIDATION 0O
License,Nu be �o Lic. Class
p.�� FINAL O
Contractor Date Z D'1 BY 0'
U
❑ �
1 Z.e ptunder Sec. �Bfor this reason
Plan check fee
Date:
'PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name �`L{ 2 9 A
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and o o o 0 o 5
Professions Code): City Tel. No.
I, as owner of the property, will do the work and the ,2rO r° 1 650
structure is not intended or offered for sale (Section o 1 Q 5 0 cx.,,
7044, Business and Professions Code). �• ,
CONSTRUCTION LENDING AGENCY
d9,f,20'-84
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 inform ' is correct. I agree to comply with all County
ordinances nd S ate laws regulating Plumbing, and hereby
out a epres ntatives of this County to enter upon the
a ve-m ne property for inspection purpose
SEE REVERSE FOR EXPLANATORY LANGUAGE
g�ature ermittee Date