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Home My Public Portal About10791 FREER ST_Plumbing__ 76A 7`-CFS 17-8-57 APPLICATION FOR PLUMBING PERMIT COUNTY OF LGS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �j (y L BUILDING AND SAFETY DIVISION ADDRESS G " ` ,L r L et- JOHN A LAMBIE. COUNTY ENGINEER CASSATT D GRIFFIN. SUPT OF BUILDING ,A LOCALITY n) FOR APPLICANT TO FILL IN NEAREST CROSS ST. rLx-11dC-,17 NUMBER FIXTURE OR ITEM OWNER �.y- ,i f WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL.NO. LAVATORY CONTRACTOR p SINK ADDRESS y� K „ DISHWASHER CITY /e7 1 EL.NO. 61 "�6 Q LAUNDRY TUB CONTRACTO S Y G�7/� STATE REGISTRATION NO. / L� COUNTY El CLOTHES WASHER DIST RI NO. GROUP Z NE READY FOR INSPECTION f WATER HEATER / f GAS SYSTEM INDUSTRIAL WASTE APPROVAL A.G a jl INSPECTION RECORD � o-,? `v .�K -y �o f Gam'f F M APPROVALS @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE - OR FIXTURE $ & UNDER SLAB WORK ,e�-� �� SIO//�yy„� � %��•,� ,� ROUGH PLUMBING PERMIT S 1 00 i L GAS PIPING TOTAL FEEGAS VENT EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTORES G.EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED ED RESIDENNATURE RM TTEE FINAL ROBERT A. WOOD, ©� VALIDATION SUPERVISING MECHANICAL ENG'R CK M 0 CASH 3 7 6 3 , AUG 12 5 A 8.0 0 Arl t� WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby 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 there co�f�Sec 338800, Lab. C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No ✓Co �paTiy� ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING yy _ Certified copy is filed with the county building inspec- ADDRESS 0�79 t re-elr S tion department. NUMBER FIXTURE OR ITEM �n FEE LOCALITY i WATER CLOSET ' Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER S e 0 (This section need not be completed if the work involved by l the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL O\ �� S ADDRESS / 1" I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY ! Ire e� , TEL NO. so as to become subject to the Workers Compensation Laws DISHWASHER at CONTRACTOR S"`+�VG V�+r . S atc"'r S %I 1 e JA Date Applicant CLOTHES WASHER ADDRESS Z O� NOTICE TO APPLICANT- If, after making this Certificate of G OZ / v vy-e_ Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO Tf� wG h �' LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATELf.S LIC CLASS e 3G SCU deemed revoked. WATER HEATER LICENSE NO 0'(0 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby-affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINALO _ VALIDATION License Number Lic Class S 014✓ t,,, ev- -- DATE � 1. U 0 FINAL Contractor Date BY I am exempt under Sec tu! B.BP C for this reason � Z' Date Plan check fee ► / PLUMBING PERMIT ISSUING FEE$ i Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 3 5 0,3 A I hereby affirm that I am exempt from the Contractor's License Address 0 0 0,0 o Law for the following reason (Section 7031 5, Business and Professions Code)- City Tel. No. 2'0 0 3 0 50 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® o 0 0 3 0. %0= 7044, Business and Professions Code). � • �= o CONSTRUCTION LENDING AGENCY 07081-8.3 1 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-rftntioned prop for inspection purposes. ALJ (�4 7` 9— R-'� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date