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HomeMy Public PortalAbout10868 FREER ST_Plumbing__ D.S.S.-17 25M SETS 11.46 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBINGWM. J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE - HEATERCESSPOOL SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY ,� , JOB -I- E NAME / .S �',s �' + ADDRESS ` Z/.• L \.I I W ADDRESS �? 7 \ * �i'K LOCALITY 'J CITY'� /J � . / TELNEAREST 0, t� 'TEL.No. CROSS ST. COUNTY �j,, _ CERT.No. EXPIRES NAME \ LOCATION OF SEPTIC TANK, OR CESSPOOL = MAIL - y� ADDRESS�! jaotVS / V L- NORTH O �- CITY TEL.NO. Y IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER "7 I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK a _z BATH TUB FURNACE SHOWER DISHWASHER p LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I METER_,�_GAS ------SODA FOUNTAIN GAS PIPING OUTL � - ©AS VENT II I CESSPOOL i TOTAL NUMBER OF FIXTURES I I 'i SEPTIC TANK _CESSPOOL SEPTIC TANK - SEWER S UTILITY CO.NOTIFIED I I TOTAL FEE � FINAL L_- T WORKERS'COMPENSATION DECLARATION 7swsa7A I hereby affirm that I have : certifiata or,cons t to relf CK.,7 (=moo) A P P L I G A T 141v FOR p is 11 M� t N E7 F�E R M I T tnsµrb, or a certificate ofi Workers'Compenution(r�ran4 or K a certified copy thereof{SeC.3800,Lab.C.) �J COUNTY OF L03 ANGELES 7r� BUl LDfNa AND SAFETY Policy No. Company❑ Certified copy Is hereby furni-shed. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING y � 6 F-1Certified copy is filed with the county bulldlag tnipectlon NU1v� A4DRE8$ �a ER FIXTURE OR nEM � FEE ` p LOCALITY department, WATER CLOSE � Data Applicant NEAREST BATH TUB GROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER Q/ZU MAI L LAVATORY p (This sdclion need not be completed It the w�otk btrotved ADDR (/D V ��c civJB IL by the permit b for �D hmAred dotim (;100) or. lew) SINk CITY TEL.NO, I certify that In the performance of the work for which this VSHWASHER CONTRACTQR cc poM t is Issued, I shall not employ eny-person in aoy manner O to as✓fq become subject to the W tion V►s CLOTHES WABH£R Date Applicant T ADDRESS SWIMMING POp4RECEP'I'QR lis NOTICE TO APPLICANT: if, after rpiking this Certificate of CITY TEL.NO. 0j Exemption, you should become subject to -the Workers' LAWN SPRINKLER SYSTarM STATE LIC- Z Compensation provislons of the tabor Code, you must forth- LICENSE NO. CLA88. *th comply with such provisions or this -permit (hill be WATER HEATEFI detlmbd revoked (3 AS SYSTEM OUTLETS DIsTRI`Cr /. Cels F LICENSED CONTRACTORS )ECLARATION OUTLETS OVER I hereby affirm that I am licensed under provision=of Chapter [Plancheck ISP R SYSTE 9 (commenc)ng.wltb Section 7000) of NN4don 3 of the Buss- FINAL non and Professions Code, and �Y lJeense b in full foFCe and DATE �— VALIDATION 6tfect. FINAL Licerlsd Number Lte,Class BY ,Contractor Date ❑ I am exempt from the licenttng requirements as i am ■ fee licansed architect or a rb&tered professional engineerMBING PERMIT 188UiNp PEE$ acting in my .profetaiorutl capaclty (Section 7051, Rkw Incas and Profbadons Code). TDTAL FEE (� Lic,or Rfo.Nd. Date Plsn ch}ok applloant nOME-OWNER-BUILDEft DECLARATION N&Ms Addross I hereby affirm that I am exempt from the Contractor's .License Law for the following roasod (Sectlgn,7031.5, Buss- City To[.No. n and Prof(*dons Code)-- LL I, as owner of the property, am exclualvely contracting # 6r o,o 0 5 wifh licensed contraptors to construct the project I ' (Section 7044,Business and Professions Code). 2 0 o 2 Q 5 0 CONSTRUCTION LENDING AGENCY °tO ° a Q 5 0 6 Ihereby afTtrm t1}st there is ik consprNction lending agency i for the perforrosnce of the wor for which this permit Is Q;(a 3 0.—8�2 trued(Sec. 3097,Cly.C.)^� Lbnder"i 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 Plµmbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE authorife representatives of this County tp enter upon the above- entioned p;o arty for ln#pecttoA purpoles. F Siryture of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy ',{ No �'� P .y tr �' Company ❑ Certified copy is hereby furnished. � FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 177 Certified copy is filed with the county building inspec- ADDRESS '4.1 C, tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY + WATER CLOSET Date § i Applicant _: NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. j;3 r _ COMPENSATION INSURANCE 1 OWNER . (This section need not be completed if the work involved by SHOWER MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY `•, ADDRESS' " ti I certify that in the performance of the work for which this f permit is issued, I shall not employ any person in any manner SINK % 1 CITY T TEL. NO so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR 1 ( f t Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of r Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY i- r. ..J TEL NO LAWN SPRINKLER SYSTEM e' with comply with such provisions or this permit shall be `• I STATE LIC. deemed revoked. WATER HEATER LICENSE NO. ` a CLASS ' LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM p OUTLETS } (commencing with Section 7000) of Division 3 of the BusinessOUTLETS OVERIW and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION U DATE License Number Lic. Class t 'r W FINAL Contractor F Date I BY ❑ } I am exempt under Sec. � B.BP.C. for this reason an check fee ► a Date: PLUMBING PERMIT ISSUING FEE$ � SignatureW TOTAL FEE f,� SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the IDE =Ia" structure is not intended or offered for sale (Section 101 7044, Business and Professions Code). . .4 CONSTRUCTION LENDING AGENCY 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 applica}ion and state that the , above information is correc t. f agree to omply with all County ordinances and State laws regulating dumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date