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HomeMy Public PortalAbout9105 EMPEROR AVE_Plumbing__ 9S 17 7-31 APPLICATION FOR PERMIT RTMENT OF BUILDING AND SAFETY , COUNTY OF LOS ANGELES wrlmL 1 WILLIAM J. FOX, CHIEF ENGINEER Dt GROUP O FOR APPLICANT TO FILL IN Y PLUMBER ^„� � READY FOR RECEIVED BY FIRBT INSPECTION ATE ISSUED ADDRESS BUILDING CITY �.Q (�..r�m.� TEL _ry.`—4�.5�0 , ADDRESS COUNTY 0 Q� 7LOCALITY LICENSE NO (J EXPIRESce NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER J MAIL WATER CLOSET(TOILET) a a 50 s Cl ADDRES�S?9 BATH TUB 0.50 ClO - alTv } TEL S��S SHOWER ! a 5a ;-cv 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ O 50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK O 50d AND STATE LAWS REGULATING PLUMBING. t CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY O 50 (J ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OAS SYSTEM— � OUTLETS 050 SIGNATURE OF OF THE RESIDENTIAL P OPERTY DESCRIBED ABOVE. WATER HEATER 0513 � PERMITTE SLOP SINK 050 INSPr.CTION RECORD" (i FLOOR SINK 49 0.90 FLOOR DRAIN 0 0.50 DISHWASHER @ O 50 — -L.� &9r DRINKING FOUNTAIN � 0.60 URINAL O 50 HOUSE SEWER 0.60 A ,S A4-r W z MIBCELLANEOUH 17 m 21 e If&) G 7' APPROVALS DATE INSPECTOR'S/NAME ROUGH PLUMBING / 4 GAS PIPING GAB VENT _ CESSPOOL @ 1,00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) 1 00 SEWER PERMIT . ° 1.00 GAB TEST / t UTILITY CO NOTIFIED !. TOTAL FEE dy' 4 rR / FINAL V y� WORKERS'CQMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ierebyhaffirm that I have a certificate of consent to self 76A667A sure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) s tiff d co e f S c 3800,��- �� i�r,$�� ) COUNTY OF LOS ANGELES BUILDING AND SAFETY lacy No Company r Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING f Certified copy is filed with the county building inspec- ADDRESS 9�� 7 Ition department NUMBER FIXTURE OR ITEM Q FEE LOCALITY DateApplicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less ) LAVATORY ADDRESS W ^ f �C/� /h'✓� I certify that in the performance of the work for which this �,q permit is issued, I shall not employ any person in any manner SINK CITY /w L TEL N01S�i ©�y so as to become subject to the Workers'Compensation Laws DISHWASHER c-�M� O�� CONTRACT0�,6/ — Date Applicant CLOTHES WASHER ADDRESS ��LL�� j� NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY ,Cox G+/ TEL with comply with such provisions or this permit shall be STATE - LICENSE Nf�7C/rv� deemed revoked WATER HEATER 57 LICENSED CONTRACTORS DECLARATION DISTRICT NO P OCESSEL9 BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and/Pro/Vf�e{ssions Cede, 06 and my lice ���u1;folccad effect 5 PER SYSTEM FINAL -7, VALIDATION O License Number •7L�icY'ClYass� DATEJ ' U f� FINAL 0 Contractor Date BY �" ❑ V i LU am exempt under Sec /0 7`,3 H B &P C for this reason ® Z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ O Signature TOTAL FEE (J Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 0080 I hereby affirm that I am exempt from the Contractor's License Address 11 (�°�- 30.50 Law for the following reason (Section 7031 5, Business and Professions Code) City Tel No 'o 0 0 _Z 0 E 0 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , {� 4 v 0-8a 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 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 re resentatives of this ounty to enter upon the above-me i perty for ection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ZI gnature of Permittee Dates