HomeMy Public PortalAbout10534 FREER ST_Plumbing__ 7GAr?7,, DBS 17 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
_u_lsTRIrNl, GROUP Z N PERMIT 0.
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F-R APPLICANT TO FILL IN In
PLUMB
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Y7�1 [a /L /Ii1 R IVED Y DATE ISSUED
}� ll �pj7 FIR I SPECREADY FOR;IDN /
ADDRESS 7 '
SLI N 13
CITY /L�i(/$ .�.d . TEL No. Tv ( �� ADDRESS /Qy 7 /�_—ci'✓
COUNTY LOCALITY i
I .NSE NO. EXPIRES / n
PERMIT FEES CRROSS T .
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERMAIL
-.f�l/1/�" '�+1iL. ✓��� .
yA, /
WATER CLOSET(TOILET) 0 0.50 $ ADDRESS ,�, .g�.' �'~ � yC/.�af v y�
B TH TUB !� O.SO CITY JV1A G3. � (.[JNl TEL. No. �'Ty !) 93 4J
SHOWER0.50 I HEREBY A'CKNOWLEDGEI THAT I HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AIND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK 0 0.50 AND STAVE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL`yOWNEER,
r
E.
GAB SYSTEM G OUTLETS @ 0.50 Ckr THE RESIDENTIPROPERTY/D 'SCRIB DBOL
SIGNATURE
WATER HEATER 0.50 PERMITTE
BLOP SINK 0.50 INSPECTION RECORDV
FLOOR SINK (Q 0.50 r
FLOOR DRAIN Q 0.50 /7/0 US4� �R /'� V F
IV N� �
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50
URINAL 0.50 ,t .�//�i/5� 1l4� /Ai Tit/ Q
HOUSE SEWER G 0.50
MISCELLANEOUS K [7
i
, t n
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAB VENT
CESSPOOL G 1:00 CESSPOOL
SEPTIC TANKt SEPTIC TANK
DRAIN ) PIT ) a 1.00 SEWER
PERMIT 1.00 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE &
� FINAL
1 APPLICATION FOR PLUMBING PERMIT'
o, 'WORKERS' COMPENSATION DECLARATION
I hereby affirm that I haye,a certJicate'of conseht to self 20-0026 DPW 6/87
;nsure, or a certificate of Workers' Compensation;lnsurance, 76A667A
orpa certified copy thereof (Sec. 3800, lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Pal icy
Company
❑ -
Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESS a_6 _�
tion department NUMBER FIXTURE OR ITEM @ FEE
LOCALITY ,
Date Applicant WATER,CLOSET 00 NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' 62 BATH TUB , CROSS'ST. C7&-
COMPENSATION
COMPENSATION-INSURANCE OWNER Q
(This section need not be completed if the work involved by SHOWER � /✓� �JJ. �Jr
the permit is for one hundred dollars.(5100)or less.) LAVATORY oC1 ADDRESS
I certify that in the-performance of the work for which this r�
permit is issued, I shall not employ any person,in any manner SINK. V O CITY
so,as to become subject to the Workers' m �nLaws j DISHWASHER 0
/ 1� CONTRACTOR
Date ^ • Applic T CLOTHES WASHER U ADDRESS
NOTICE TO APPLICANT: If a r',Mnis
this Certificate of z 6.!q
SWIMMING POOL RECEPTOR
Exemption, you should c et to the Workers' CITY TECompensation provision of a de, you must forth- �AWN'SPRINKLER SYSTEMwith comply with such p cions permit'shall be STATE
deemed revoked. / WATER HEATER / �' LICENSE NO. �QZ f7 CLASSY-•'�
LICENSED CONTRACTORS DECLARATION > f� DISTRICT NO RO ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS
(commencing with Section,7000) of Division 3 of the Business. OUTLETS OVER
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL
DATE VALIDATION,
0.
License Number 3o-574:t7 Lic Class eo_3<o U
FINAL
Contractor �" �(' Date v BY OF—:
❑ I am exempt under Sec. f U
W
B.BP.C. for this reason CL
Plan check fee Cl)
Z
Date: PLUMBING PERMIT ISSUING FEE$
Signa:O/MZEVBUILDER
re -
•TOTAL FEE Q
Plan check applicant
IGLE FAMILY s'
DECLARATION Name
I hereby affirm that I am exempt from the.Contractor's License ACCT a
Law for the following reason (Section 7031 5, Business and. Address •�
Professions Code) City Tel No - M '112.50
❑ I, as owner of the property, will do the work and the } 1 ITEMS
structure is not intended,or offered for sale- (Section TGTAL i
7044, Business and Professions Code) n/�u�=� 1 12 50
CONSTRUCTION LENDING AGENCYc �+f1L1+f1 p 112.50
I hereby affirm that there is a construction lending agency for /���u-�
the performance of the-work for which this permit is issued 7d1R1IE, .00
(Sec 3097, Civ C ). ;
Lender's Name 0000—Omi ,D 9/w
Lender's Address 5006 1 AM11:10
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
abov - en ed pro ert nspection purposes
' SEE REVERSE FOR EXPLANATORY LANGUAGE
�ignature e tee Dated