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Home My Public Portal About10653 FAIRHALL ST_Plumbing__ 76A667A CE 617(REV 6/76) ' (5S APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE BUILDING II V 5,3 ►Y' NUMBER I FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST SHOWER OWNER LAVATORY MAIL NNN z ADDRESS b� SINK CITY &r V TEL NO DISHWASHER CONTRACTO CLOTHES WASHER ADDRESS n\ SWIMMING POOL RECEPTOR CITY lJ TEL NO y� �� LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO of CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT @3 HOT WATER HEATER PLUMBING FIXTURES GAS TEST @S Plan check fee UTILITY CO NOTIFIED g PLUMBING PERMIT ISSUING FEE$ r+ e TOTAL FEE D FINAL k,' Plan check applicant PLAN CHECK VALIDATION Name Address City Tel No IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE + I THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION �� ' 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE y_ LEGAL OW�OFD INTEND ABOVE DESCRIBED RESIDENTIAL PROPERTY //.�' ,1 O SI TU ! (/ V qqq OF PE DISTRICT NO PR CESSED BY INDUSTRIAL r WASTE APPROVAL COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J FOX, County Engineer I 15TRICT NO. GROUP ZONE PERMIT NO. OR APPLICANT APPLICANT T❑ FILL IN S; ■ Z PLUMBER VALf EY BOULEVARD /RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS $-„`? CASi ALLEY '� � �� IN q�r� _ �n c� BUILDING CITY ROSEIWEAD TEL No AT. 2-2719 ADDRESS _ LICENSE a+l NO _- J/ EXPIRES 6'300 LOCALITY �yc NEAREST PERMIT FEES CROSS ST NUMBER TYPE OF FIXTURE ON ITEM FEE OWNER MAIL WATER CLOSET(TOILET) 0 050 B ADDRESS _ BATHTUB a O 50 CITY TEL No SHOWER @ O 50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) (L 050 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 050 'AND STATE LAWS REGULATING PLUMBING I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY (0 0 50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DSCRIBED BOVE GAS BYSTEM OUTLETS 0 O 50 E :SIGNATURE OF WATER HEATER a O SO PERMITTE SLOP SINK 0513 INSPECTION RECORD FLOOR SINK O SO FLOOR DRAIN (� O 50 DISHWASHER Q O 50 DRINKING FOUNTAIN (a O 50 URINAL @ 050 J Q HOUSE SEWER 050 Z MISCELLANEOUS i E3 Ix O APPROVALS DATE INSPEOTOR'S NAMES ROUGH PLUMBING GAS PIPING GAS VENT / V CESSPOOL @ 1 00 CESSPOOL Q '}y� p+ SEPTIC TANK SEPTIC TANK r1L➢.@ 1 At _fA DRAIN ( ) PIT ( ) CL 1 00 SEWER PERMIT 0 1 OD 1 GAS TEST UTILITY CO NOTIFIED �j r1��F✓„ b TOTAL FEE FINAL / 3 76A667 DBS#17 6-52 WORKER S COMPENSATION DECLARATION 200026 DPW 9/89 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 i copy thereo Sec 3800 Lab C) f �,�� /' y�L COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT'OF PUBLIC WORKS DIV ; Policy N - 33 Company l �� _ Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) -� ADDRESS,Certified copy is filed with the county budding mspectionF department _ NUMBER FIXTURE OR ITEM Q FEE _ {� _/r-��, LOCALITY - Date —i Applicant y4 � ° " '�`� �� WATER CLOSET �Y NEAREST y� ~ 1 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 ti _ MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less) LAVATORY OWNER I certify that in the performance of the work for which this permit _ MAI L is issued I shall not employ any person in any manner so as to SINK / _ ADDRESS become subject to the Workers Compensation`Laws r _ d _ ' DISWASHER CITY 42/7z/ TEL NO Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making*this Certificate of CONTRACTOR- Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such 1 ADDRESS /6 `provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM J . LICENSED CONTRACTORS DECLARATION I CITY TEL NO hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �v '` (commencing with Section 7000) of Division 3 of the Business and STATELIC -7 �p CLASS O GAS SYSTEM OUTLETS LICENSE NO Z J p G- _y 2 _ Professions Code and my license is In full force and effect + - - OUTLETS OVER DISTRICT NO PROCESSED BY I= 5 PER SYSTEMp License Number Z �� Ic Class r �Lg O _ FINAL VALIDATION U1 - �iFi�i DATE "G. % O' Contractor, Date (n FINALZ FIN I am exempt under Sec BY B&P C for this reason l -Plan check fee TT Date I PEIPLUMBING PERMIT ISSUING FEE$ Signature / 's AlISL 4- : 8 m 5 ❑ / y TOTAL FEE - �' +_ JYIe_:' Plan check applicant +_Ht1} SINGLE FAMILY - HOME OWNER BUILDER DECLARATION Name r ' I herebylaffirm that I am exempt from the Contractors License Law for the following'reasonl(Section'7031 5 Business and Professions Addresses , Code) `- City Tel No t f is fs—:IfI ,i' ❑ I as owner of the property will do the work and the structure ii lz is not intended or offered for sale (Section 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 ? - - i r � CIV C) Lender s NameC "- � r Lender s Address ' I certify that I have read this application and state that the above - - pop. t r information is correct I agree✓to comply with all County ordinances ^ and State laws regulating Plumbing and hereby authorize - rep re atives of thi County to enter upon the above mentioned prop rty f Inspectio purposes ✓ SEE REVERSE FOR EXPLANATORY LANGUAGE ) Signature bf Permittee r, Date ,