HomeMy Public PortalAbout9955 DUFFY ST_Plumbing__ y8A86y 97 ?1-4g APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIC NO. GROUP ZONE PE MIT NO.
PLUMBErs QNTANA P1 11MRING' CONTRACTORS RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION �d
ADDREss344 W. Carvey - Monterey Park, Calif. .
CITY AT antic 2-4654 - TELNgi.berland 3.1040 ADD EISS -
COUNTY (Q/3 p 5 LOCALIT0 - `
LICENSE NO. ggJJ/1 •"1 EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER 1 TYPE OF FIXTURE OR ITEM FEE OWNER / —• /wi�e�t6�'I'VK�
MAIL
�I WATER CLOSET (TOILET) @ 0.501 $ I ADDRESS
BATH TUB @ 0.501 I CITY TEL. NO.
SHOWER @ 0.50 IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
KITCHEN SINK @ 0.50 I CERTIFY THAT I PO SESS TH ABOVE VALID LOS
LAUNDRY TUB o�OR TRAY @ 0.501 Or^I THE RESGELES OIDENY LIC L PMVQft�,GAL
OVE, OWNER
IGAS SYSTEMA--OUTLETS @ 0.501 SIGNATURE OF
WATER HEATER @ 0.50 1 PERMITTEE
I SLOP SINK @ 0.50 111 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.501
DISHWASHER @ 0.501
DRINKING FOUNTAIN @ 0.50
IURINAL @ O.SOI I ,J
IHOUSE SEWER @ 0.501 I Q
MISCELLANEOUS I L7
O
I I
I I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 I I CESSPOOL
SEPTIC TANK: I I SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.001 I SEWER I f�
PERMIT . I 1.00 GAS TEST
UTILITY CO. NOTIFIEDI (O
TOTAL FEE
o7�p I FINAL
7616 B- A 11 tl IIS I C A""71 tl I !1`tl 11 ORPLUMBII�43`?del I1= D f'J li II
CE BI7 B-BUILDING AND SAFETY DIVISION
Department of County Engineer a
a
County of Los Angeles BUILDING
JOHN A. L.AMBIE,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING a
,.,r... - LOCALITY TeMP city
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER J. .V 1rc- DISTRICT NO. GROUP I ZONE f READY FOR INSPECTION
MAIL $
ADDRESS /� `O
CITYre.wI, IrQ 'e �f I f TEL. NO.ryro 1 34 ?4 INDUSTRIAL
WASTE APPROVAL
PLUMBER �� -A! y- INSPECTION RECORD
ADDRESS
CITY TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $ �-
,+ BATH TUB @ $1.00 -
/ SHOWER @ $1.00 C
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
II LAUNDRY TUB OR TRAY @ $1.00 '
9 CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00 Y
GAS SYSTEM @ $1.00
y�
APPR 'VALS
A I SPECTO ' SIG ' TURE
UNDER SLAB WORK ,
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT W4TER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 5
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT IAM PRO RLY REG ERED AND/OR GAS TEST
LICENSED AS REQUIRED Y LOS AN COUN ND STATE OF
CALIFORNIA OR THAT AM THE G JONF THEA VE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA PROPERTY.
SIGNATURE n
OF PERMITTEE FINAL to
r " ROBERT A.WOOD,
JOHN A. LAMB] COUNTY GINEER ALIDATION SUPERVISING MECHANICALENG'R
CK M.O. CASH
WORKER'S COMPENSATION.DECLARATION 76AO667�DPW 9/89 ^ �P��^A���nn ®R PLUn��nAnG PERMT
I hereby affirm that I Vfave a certificpte of consent to self insures �U (� �I u�u u�{
ALF—
or a certificate of-Worker's Compensation Insurance, or a certified
copythereof(Sec.3840 Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS. DEPT. OF PUBLIC WORKS DIV.
Policy No. �Company
❑ .= Certified copy is hereby furnished.
❑
FOR.APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ��Certified copy is filed with the county building inspection ADDRESS
department. NUMBER _. FIXTURE OR ITEM (?n` FEE LOCALITY �`G
Date Applicant \ WATER CLOSET NEAREST
CROSS ST. 46,#ZGt/
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR
COMPENSATION INSURANCE
(This section need not be completed if the work involved by the
SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) LAVATORY OWNER ®s¢y� �L//�� \
-'
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to SINK - MAIL - -
ADDRESS-
become
DDRESSbecome subject to the Workers'Co
soliNLW .
DISWASHER CITY TEL.NO.
� d 7T1
Date V Applican CLOTHES WASHER CONTRACTOR /` r
NOTICE TO APPLICANT: If, aft ing th' Certificate of
Exemption,you should become subject to the Work s' Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS 270
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY �llC�/�4L C4 TEL.NO. �-
.l hereby affirm that I am licensed under provisions of Chapter 9 STATE LIC.WATER HEATER (L
(commencing with Section 7000) of Division 3 of the Business and IGENSE N0. Z CLASS _ ( "� 0
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V
OUTLETS OVER IS RI CE Y
��M ,e—Z� 5 PER SYSTEM Q
(i G r
License Number Lic.Class
FINAL14�S / :j� VALID T10N , W
C/9' V �////%! $ \ DATE G9 V
Contractor Date (0
❑ FINAL Z
I am exempt under Sec. BY
B.&P.C.for this reason'
IN/P X/
Plan check.fee VV
"Da '
Signature - PLUMBING PERMIT ISSUING FEE$
❑ TOTAL FEE
/ Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name 1 .vw i p F
I hereby affirm that I am exempt from the Contractor's License Law _
for the following reason (Section 7031.5, Business and Professions Address
iff
Code): y
❑ V City Tel. No. a °
I, as owner of the property,will do,the work and the structure
is not intended or offered for sale (Section 7044,Business \ TOTAL iT AL -� - 50
and Professions Code). 20.51-i
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the !' HIt�
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 State laws regulating Plumbing, and hereby authorize
DO-
representatives of this County to enter upon the above-mentioned
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE