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HomeMy Public PortalAbout10764 FREER ST_Plumbing__ _ O 76A667-CE#817 4-67 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES I� - DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING r �f JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDINGLOCALITY �- FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM (EACH FEE 4- OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS �7 CITY. TEL.-NO. SHOWER 1.25 LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS J DISHWASHER 1.25 CITY- TEL. NO STATE 0 LIC LAUNDRY TUB 1.25 LICENSE NO. CLASS CLOTHES WASHER 1.25 DISTRICT NO. GBQRfP ZQ E P E pD�BY WATER HEATER 1.50 1:5 1 I,C1 L 7 1.50 INDUSTRIAL GAS SYSTEM —/—OUTLETS WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d O U CD H U W CL C/3 APPROVALS DATE INSPECTOR'S SIGNATURE LPERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING GAS TOTAL FEE d AS PIPING '•` I HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMFLY 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 LICENSEDAS REOU D BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR T T AM THE LE L OWNER GAS TEST OF,AND INTEND TO [.•(/J RESIDE IN, THE A V ESCRIBED RE 1NTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL � Q DATION JACK R. ALLEN CASH SUPERVISING MECHANICAL ENG'R. .3;,5 7. 9.t.. [BAR 14 5 0 3 �.Q cc 76A667-CE#817 4-67 J APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING, JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS{ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY, A::-, TEL. NO. " .; .:;:v_ LAVATORY 1.25 CONTRACTOR SINN 1.25 ADDRESS DISHWASHER 1.25 CITY, SEL. NO. STATELIC ~ _ LAUNDRY TUB 1.25 LICENSE NO. L f' CLASS CLOTHES WASHER 1.25 DI&T ICT Nq� G1UPON PROCESSED BY WATER HEATER 1.50 C•' '{� /" r D_ 1.50 INDUSTRIAL O GAS SYSTEMOUTLETS WASTE APPROVAL U OUTLETS OVER 5 PER SYSTEM .30 W INSPECTION RECORD O d W I-- APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE J GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COURiTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER {, PLUMBING. �1 _ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES, LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE - 1 OF PERMITTEE FINAL VALIDATION JACK R. ALLEN CK I' M.O. CASH SUPERVISING MECHANICAL ENG'R. WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereh>/ affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES T'�• BUILDING AND SAFETY Policy No.-5099Company %f Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING --� Certified copy is filed with the county building inspec- ADDRESS 40) Cwt tiondepartment. NUMBER FIXTURE OR ITEM @ FEE // LOCALITY Date 1Appliganl WATER CLOSET //4 NEAREST CERTI CATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. y aR COMPENSATION INSURANCE OWNER A Jl� (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ;100 or less. MAIL P ( ) ) LAVATORY ADDRESS SL$ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NOS so as to become subject to the Workers'Compensation Laws. DISHWASHER q CONTRACTOR(! Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS l G.�e I6 SWIMMING POOL RECEPTOR as Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- rjj oL "'7�- with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM p Y p p STATE -741 LIC. deemed revoked. WATER HEATER LICENSE NO. - / CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROFESSED BYE I hereby affirm that I am licensed under provisions of Chapter 9 GASSY.STEM OUTLETS (commencing with Section 7000) of Division 3 of the Business 0 Jr 'OUTLETS OVER and Professions Code,and my license is in full force and effect. 15 PER SYSTEM •� � O FINAL VALIDATION � License Number J©s7 Lic. ass [ v W� /fir DATE �' FINAL Contractor to r __J BY � ❑ I am exempt under Sec. % MA v / B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 10S6 Signature TOTAL FEE 3 v Plan check applicant SINGLE FAMILY f,� S 3 J.11 A HOME OWNER-BUILDER DECLARATION Name 5 1 hereby affirm that I am exempt from the Contractor's License Address ojo 0 o`c Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. .o v 3.a' ' 0. ❑ I, as owner of the property, will do the work and the o o Q,J 0 3 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® Q �'� (}-34 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 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 enti zdo7y for 7inspcoon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signature of Permittee og Date