HomeMy Public PortalAbout9221 FLAHERTY ST_Plumbing__ 7GA667 Des 17 7-s1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICTGROUP ZON P
FOR APPLICANT T❑ FILL IN
PLUMBER / � 4- '� READY FOR D •/
RECEIVED BY ATE ISSUED
ADDRESS
7� � FIRST INSPECTION µ,
� .,I �'� �~N� ,�y J •`'� �'
_ BUILDING
OITY iJ TEL ND. ADDRESS
COUNTY NO. EXPIRES LOCALITY
_E
SE �/ �J
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
r MAIL
WATER CLOSET(TOILET) @ 0.50 $ .!D ADDRESS
BATH TUB @ 0.50 CITY TEL. No.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION T THE ABOVE 19 CORRECT
AND LAGREE TO COMPLY WITH RALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 3"� AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
_ OF THE RESIDENTIAL OPERTY DESCRIBED ABOVE.
OAS SYSTEM - OUTLETS 0.50 -�' Cl SIGNATURE OF
WATER HEATER 0.50 .5-v PERMITTER
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.313
FLOOR DRAIN @ 0.50
DISHWASHER EID 0.513
DRINKING FOUK'TAIN @ 0.50
URINAL 13.50 o F'�bC. •,(• / Q f'� �;n����• /` Q
HOUSE SEWER O.SO
MISCELLANEOUS l M in p wit
y � .I� S'- ie P, P? O
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q"6n�Af 6C PGC O
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APPROVALS
pD�ATE/ INSPECTOR'S NAME
ROUGH PLUMBING 0 "-( /1}Jlit i
GAS PIPING
GAS VENT �/- ;?vL- l i 11s1
Y "
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANKS SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT .
1,130 GAS TEST ✓ `
UTILITY CO.NOTIFIED
TOTAL FEE $ I �c N�-V� NIPS
FINAL {
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WORKER'S COMPENSATION DECLARATION 6 DPW 9/89 APPLICATION FOR PLUMBING PERMIT
76A66
I hereby af(irmthat I have a certificate of consent to self insure, 76A667A
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab. C.)
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
�cy No. Company
Certified copy is hereby furnished. BUILDING f
ID ADDRESS APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
Certified copy is filed with the county build i inspe an
department. f N BER FIXTURE OR ITEM Q FEE LOCALITY 1
Date G Applicant - a WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
001
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($100)or less.) OWNER ����
I certify that in the performance of the work for which this permit LAVATORY MAIL
is issued, I shall not employ any person in any manner so as to SINK ADDRESS
become subject to the Workers'Compensation Laws.
DISWASHER CITY TEL.NO.
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR ��
Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO.
1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000) of Division 3 of the Business and STATE LIC. n
Professions Code,and my license is in full force and effect. GAS SYSTEM /OUTLETS LICENSE NO. CLASS pL�
OUTLETS OVER DISTRICT NO. PROCESSED BY
C f 5 PER SYSTEM (/ 7" L)
License Number Lic.Class—�'�—�-
FINAL
DATE VALIDATION
_
Contractor Date
co
I am exempt under Sec. FINAL 7
B.&P.C.for this reason
Plan check fee ,
Date:
Signature
PLUMBING PERMIT ISSUING FEE$ Lf
❑ .��LO 'Z- tr TOTAL FEE (�
SINGLE FAMILY Plan check applicant _
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
a.
for the following reason (Section 7031.5, Business and Professions Address
Code):
E] 1,
Tel. No. M ,
I, as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business _ (-_E
and Professions Code). _;r,�~
'r
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 Z'.
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
representatives of this County to entup 'the above-mentioned
property for inspection purpo SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of PerriMttee Date