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HomeMy Public PortalAbout4870 FRATUS DR_Plumbing__ � APPLICATION qp e/�_ ®yy� pQ��p� K��( PLUMBING pN ppp��p Kp�ppy pq� Iy�� ppp�p�g DBS 17 Atl Y LICA Y IOYa FOtlC 11 LUYd9BIY �G tl ERtloEIT DB51`'DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST asxmmmm OWNER DISTRICT NO GROUP ZO,NF, I READY FOR INSPECTION MAIL Z ADDRESS 6 14// INDUSTRIAL CITY TEL NO WASTE APPROVAL PLU M B E t ,-. INSPECTION RECORD i olefkdamm ADDRESS 442 W. Fleetwood Place Glendora, California CITY TE LICENSE NO NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1 00 $ / BATH TUB @ $1 00 SHOWER @ $1 00 LAVATORY (WASHBASIN) @ $100 KITCHEN SINK @ $1 00 DISHWASHER @ $1 00 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 �f WATER HEATER @ $1 00 / GAS SYSTEM @ $1 00 APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE bo GAS VENT A I D HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST _ n ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ' n CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED Y DESCRIBED RESIDENTIAL PROPERT SIGNATURE OF PERMITTEE G� FINAL d S� JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CK11 0 CASH I,'To7625, APR 29 3 1. 000 In WORKERS'COI have a SON DECLARATION 76A667A APPLICATION FOR PLUMBING PERMIT I hereb)'"'affirm that I have a certificate of consent to self ce ai7 (z-so) insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) COUNTY OF LOMNGELES I ING AND SAFETY Policy No Company ( /. Q� Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR PE) BUILDINGp ❑ ADDRESS d 20 044_ S ��L Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE department LOCALITY ©L�' C WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST J /V D6 ,CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAIL ;�^ (This section need not be completed if the work involved LAVATORY ADDRESS 2d �S Ng- O by the permit is for one hundred dollars ($100) or less) SINK CITY �ff� C17- TEL N O '�Lj g� U I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR O((j O so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS U DateLLI Applicant SWIMMING POOL RECEPTOR CL NOTICE TO APPLICANT If, after making this Certificate of CITY TEL NO to Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM z STATE LIC Compensation provisions of the Labor Code, you must forth- LICENSE NO AL4SS with comply with such provisions or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS DISTRICT NO RO ESSEDDBBYY LICENSED CONTRACTORS DECLARATIONOUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL i ness and Professions Code, and my license is in full force and DATE f/�� era VALIDATION effect ( v FINAL �. License Number Lic Class FI Contractor Date I am exempt from the licensing,requirements as I am a Plan check fee licensed architect or a registered,professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code) TOTAL FEE Q Lic or Reg No Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address 7 2A A License Law for the following reason (Section 7031 5, Busi- City Tel No # 0 0 0 0 0 5 ness and Professions Code) 1, as owner of the property, am exclusively contracting 2 0 0 1-0-00 with licensed contractors to construct the project _ (Section 7044, Business and Professions Code) =e o- 0 1 Q,Q U CONSTRUCTION LENDING AGENCY 0 8 14-80 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize re entatIves of this unty to enter upon the above-rn io d prope for ction purposes iLlU Signature o rmittee Date