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HomeMy Public PortalAbout10649 FAIRHALL ST_Plumbing__ 76A667C IC6617 A) 11/76 'APPLICATION FOR,PLUMBIN PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS O WATER CLOSET LOCALITY 4� C/V NEAREST BATH TUB CROSS ST &2_Q)4#— SHOWER ZV)d—SHOWER OWNER �a g LAVATORY MAIL ADDRESS S SINK CITY TEL NO DISHWASHER CONTRACTOR IVIAPf-f eIft L1p4 CLOTHES WASHER ' ADDRESS �� .Z_ � C /3L�o� SWIMMING POOL RECEPTOR CITY �C� TEL NO LAWN SPRINKLER SYSTEM STATE LICy WATER HEATEROr,4w 400 b LIC NSE NO d lf- CLASS DISTRICT NO Gfjp-3 ZQN1 ROCES ED BY GAS SYSTEM OUTLETS 3 ©D ✓`'�,(7� OUTLETS OVER u >. 5 PER SYSTEM I INDUSTRIAL WASTE APPROVAL INSPECTION RECORD u C9 0 V t�C6 N Plan check fee PLUMBING PERMIT ISSUING FEE$ p p TOTAL FEE 3 Plan check applicant APPROVALS DATE INSPECTOR S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND,STATE GAS VENT 17 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST , LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITYCO NOTIFIED SIGNATURE OF PERMITTEE FINAL 1VQRKERSDC0yPENcpA 1aNCASH PERMIT VALIDATION cK Mo CASH 4_© 9''MAY 11 5 U OLICY HOLDER:,d � '� - 3.0 OLICY NUMBERaI L43o I y Y d V, ,, - - ' ©: ' COUNTY OF LOS ANGELES APPLICATION FOR PERMIT i Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. GRD P I ZONE . PLUMBER YALLEY�()II ��DT�pCI DMA �- R CEIVED BY FIRSTRREADYPECTION DATE ISSUED ADDRESS �I 1 S� 8290 EAST VALLEY rnl yin I `T � " BUILDING J ! CITY Ci=�, aA TEL No AT 2 27 19 ADDRESS /! COUNTY _ LOCALITY LICENSE NO EXPIRES G NEAREST PERMIT FEES CROBB ST NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) QI) O SO 6 ADDRESS_ BATH TUB ® 050 CITY TEL. No SHOWER Q O 50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) (@ 050 APPLICATION AND STATE THAT THE ABOVE I3 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK (w O 5O AND STATE LAWS REGULATING PLUMBING I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0 050 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER GAS SYSTEM ❑UTLETB O 50 OF THE RESIDENTIAL ROPERTY DESCRIBED A VE � SIGNATURE OF WATER HEATER O 50 PERMITTEE SLOP BINK D 50 INSPECTION RECORD FLOOR SINK @ O SO FLOOR DRAIN O 50 DISHWASHER O BO DRINKING FOUNTAIN 13513 URINAL Q O 50 Q HOUSE SEWER 6 O SO Z_ MISCELLANEOUS 17 M O APPROVALS DATE INSPECTOR'S�NAIA45,4 ROUGH PLUMBING GAS PIPING GAS VENT 7 e-1 CESSPOOL ® I DOCESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( ) @ I OO rE- SEWER PERMIT I ❑O GAS TEST TOTAL FEE 0, UTILITY CD NOTIFIED FINAL 76A667 DBS#17 6-52 DECLARATI WORKER SCOMPENSATION ate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a certificate of consent to self insure or a certificate of Worker s Compensation Insurance or a certified CITY OF TEMPLE CITY copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV' Policy No 0 Q 4ompany NMI G Certified copy is hereby furnished 1 FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING _ sit Certified copy is Bled with the county building inspection ADDRESS department 1, 1 NUMBER FIXTURE OR ITEM ® FEE LOCALITY Tc-mpl P- Ci ty Date 4.11 .1_?—Appliceel' era l- I n sq t g a l l � WATER CLOSET ' NEAREST I CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE ASSESSOR (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) OWNER I certify that in the performance of the work for which this permit LAVATORY - k is issued I shall not employ any person in any manner so as to SINK MAIL ' become subject to the Workers Compensation Laws - _ ADDRESS DISWASHER CITY T51- O .� Date Applicant � ( CLOTHES WASHER NOTICE,TO APPLICANT If after making this Certificate of CONTRACTOR Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such ' ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM 6558 West "Blyd - LICENSED CONTRACTORS DECLARATION CITY TEL NO >- I-hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER —2 5 41 d (commencing with Section 7000) of Division 3 of the Business and STATE LIC O Professions Code and my license is in full force and effect GAS SYSTEM OUTLETS LICENSE N2, CLASS 0 OUTLETS OVER DIST ICT NO PROCESSED BY a: 5 PER SYSTEM p O License Number 1 51 $ 9 Lic Class C3 6 FINAL W W. O. Provin A/93 DATE VALIDATION a Contractor Date ❑ I am exempt under Sec FINAL C Z BY B&P C for this reason Date Plan check fee Signature / PLUMBING PERMIT ISSUING FEE$ f ^' i ❑ TOTAL FEE SINGLE FAMILY Plan check applicant _ HOME OWNER BUILDER DECLARATION Name Ar- - I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5 Business and Professions Address Code) - - - - ❑ Crty Tel No y T I as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044 Business I t f I r-L -:�10 =dam) and Professions Code) _ � *"i if CONSTRUCTION LENDING AGENCY t -- I hereby affirm that there is a construction lending agency for the 'j-f t{`G- =1t)E performance of the work for which this permit is issued (Sec 3097 - Civ C) Lender s Name ii{1 z I-, IJ 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 representative Fpoes ytoenterupon the above mentionedprop i ec y 0 SEE REVERSE FOR EXPLANATORY LANGUAGE TidLLZ 11 'Sig—natur'e7 o P rmlttee Date . r