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HomeMy Public PortalAbout10510 FREER ST_Plumbing__ r 76A667 -CE*817 10-62 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES G� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST ING JOHN A. LAMBIE, COUNTY ENGINEER SS WILLIAM A. JENSEN. SUPT OF BUILDING L[iY > FOR APPLICANT TO FILL IN ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR .t J SINE 1.25 ADDRESS G C DISHWASHER 1.25 CITY TEL. NO�. CONTRACTOR'S STATE ❑ LAUNDRY TUB 1.25 REGISTRATION NO. �i s 1 COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P ESSED BY WATER HEATER 1.50 �Q S tl LZ� GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORDIx V ' O — F. U W a z 'y 1 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S /2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE - GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. - I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE f OF PERMITTEE! _ - FINAL g 0 ALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R WORKERS'COMPENSATION DECLARATION 7GA667A I hereby affirm that I have a certificate of consent to self CE 617 (2-90) A P P L I C A T I O FOR PLUMBING PERMIT insure,.or a certificate of Workers'Compensation Insurance,or ( G� a certified copy.thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGE S BUILDING AND SAFETY Policy,No. Company Certified copy is hereby furnished: FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /0,5—/o 0J/o y �� NUMBER FIXTURE OR ITEM • ADDRESS FEE Certified copy is filed with the county building inspection ' LOCALITY department. *� WATER CLOSET � Date .Applicant NEAREST BATH TUB • CROSS ST. 114 L/ F CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER � �� (This section need not be completed if the, work involved LAVATORY MAIL ADDRESS AE. fe77 ,ADDRESS ��JU l _5 } 'by the permit is for one hundred dollars ($100) or less.) SINK CITY y TEL. NO,. �� 0 I certify that in the performance of the work for which this DISHWASHER ' U ,permit is issued, I shall not employ any,person in any manner CONTRACTOR tr- so as to become subject to the Workers' Compensation Laws. CLOTHES.WASHER 0 ADDRESS Date Applicant SWIMMING POOL RECEPTOR W NOTICE TO APPLICANT: If,.after making this Certificate of CITY TEL. NO. O. j Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM N P � STATE LIC. Compensation provisions of the Labor Code, you,must forth- LICENSE NO. CLASS Z with comply with such provisions' or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR ESSED B LICENSED CONTRACTORS DECLARATION• OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE �© � 17 �� effect. FINAL License Number Lia Class BY Contractor Date I am exempt from the licensing requirements as'I am a Plan check,fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in-my professional capacity (Section 7051, Bus- iness and.Professions Code).' TOTAL FEE D 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 License Law for the following reason (Section 7031.5, Busi- City Tel.No. ness and Professions.Code): ;2.2 7 Q'G A I, as owner of the property, am exclusively contracting with licensed contractors to construct the project o o.0 0 0 5 (Section 7044, Business and Professions Code). 2 1 0,.0 0 CONSTRUCTION LENDING AGENCY o o,.0 1.0. 0 0 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.). • 10,21 -80 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. A2?2� e -Signature of Permittee Date