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HomeMy Public PortalAbout9173 FORTSON DR_Plumbing__ 76A467,(CE;!}17) - 5/73 tl ./ APPLICATIO OR PLU BI-NG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER,,, k; LOCALITY � FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST ; CROSS ST. o� , NUMBER FIXTURE OR ITEM @ FEE ' WATER CLOSET 1,75 1 ,OWNER f MAIL �v BATH TUB 1.75 ADDRESS' ' / SHOWER 1.75 CITY 4 fJ TEL. NO. / LAVATORY 1.75 7L5CONTRACTOR ` SINK 1.75 J ADDRESS �0, DISHWASHER 1.75 -1F r'' CITY r TEL. NO. CLOTHES WASHER 1.75 STATE `- J I L CENSE•NO' �jF�� CLASS j SWIMMING POOL RECEPTOR 1.75 DISTRICT N GROUP ONE PR CESSE BY LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75 j INDUSTRIAL WASTE APPROVAL d GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD v OUTLETS OVER 30 5 PER SYSTEM ,. C:) Lu Cn Plan check fee See Reverse PLUMBINGRERMIT ISSUING FEE $ 3 00 TOTAL FEE aS APPROVALS DATE INSPECTOR:5 SIGNATURE Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING L/_ 2.71/S.j ,L.,,,J Address GAS PIPING City Tel. NO. GAS VENT ���',r 7 d!j� 0�4�'7✓ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING p PLUMBING. GAS TEST RA aJ,^'�� �17 -'arJ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR" UTILITY CO. NOTIFIED v LICENSED AS REOU I RED BY LOS ANGELES COUNTY AN TATE OF p CALI FORNIA OR THAT I THE L AL OW ER OF, D I END TO J B71 �� �AA1 4v 2 RESIDE IN THE ABOVE D SC IBED SIDE L PROP RT FINAL -7-/6-744 Nt J1 w,, SIGNATURE G PERMITTEE _ PERMIT VALIDATION CK. M.0. CASH PLAN CHECK VA ATION CK. M.O. CASH I . 1 '7'4�MAR 21 © 1 5.2 5 A98 I • ION DECLARATI WORKER'S I have a certificate 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 , copy thereof(Sec 3800 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 @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST 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($100)or less.) I I LAVATORY k NER I certify that in the performance of the work for which this permit Al L is issued, I shall not employ any person in any,manner so as to SINK ADDRESS CJ become subject to the Workers'Compensation Laws. DISWASHER CIT Y-r� CONTRACOR M �T r C/ L NO Date Applicant CLOTHES WASHER � 0` > NOTICE TO APPLICANT: If, after making this Certificate of _ TOR Exemption,you should become subject to the Workers'Compensation SWIMMING.POOL RECEPTOR r provisions of the Labor Code,,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER O (commencing with Section 7000 of Division 3 of the Business and STATE LIC ( 9 ) LICENSE NO CLASS U Professions Code, and my license is in full force and effect. GAS SYSTEM OUTLETS OUTLETS OVER DISTRICTNO PROCESSED D B _ � 5 PER SYSTEM Qf��•—«�•y License Number Lic Class FINAL VALIDATION d DATE I/ZOContractor Date 7❑ (n FINAL Z I am exempt under Sec. BY B.&P.C.for this reason Date: Plan check fee , •_t r Signature PLUMBING PERMIT ISSUING FEE$ ACCT y ■a ) TOTAL FEE El — O 1J30i 39.lie Plan check applicant SINGLE FAMILY i ITEMS HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law TOTAL ( 39 - 30 for the following reason (Section 7031.5, Business and Professions Address Code). CHECK 4tln:i).l City Tel. No. MEI,as owner of the property,will do the work and the structure CHANGE ,I IU is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY � rl �Jil� t1 Yi i I hereby affirm that there is a construction lending agency for theJc AN jn,t' 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 representatives of this County to enter upon the above-mentioned erty for inspection pur oses. SEE REVERSE FOR EXPLANATORY_LANGUAGE lure of Permittee Date