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HomeMy Public PortalAbout10941 FREER ST_Plumbing__ 7eAe47-C[#817 r-el TEMPLE CH Lt 1 APPLICATION FOR PLUMBING PERMIT • '�. COUNTY OF LOS ANGELES �. DEPARTMENT OF COUNTY ENGINM BII II C� �S1 FFTY PLOTON nvaDn�a JO 1 OUNTY NGINKKR ADDnW QLC WILLIAM A. J12MIEN, SLrp-T OF EUI LEI Na m FOR APPLICANT TO FILL IIA caoae ar. NUMBER FIXTUR[OR fT[M EACH F[¢ Ow'm WATER CLOT /1 M, IMAII DATE TUB 1.25 AD 1W SHOWER 1.26 C1rT TEL NO. /r LAVATORY lsi CONTRACTOR fHt G DHQ 1 ADDREffi DEWWAREMM CITT TEL NO. I LAUNDRY TIJD 1.25 � nM NO. Co» e [.ZOTHM WA20M 13E DISTRICT NO. GROUP ZON[ PftOCtMED EY wATEa HEATER R��L�4t4r( i zo 5'7 S d r /�- Lo v K¢ --GAS RtaTEm OVTLarR 'IZG 11MU RIALWASAPPROvAL OVTLEfa OVER 5 PER f3TRTEI[ .30 DI=PEC;TIOIf IECORD - ad W APPROVALS DATE TNSPLGTOIt•■■IGNATURL PERMIT s 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 16-0 GAS PIPING I MKWEY ACKNOMRJ<Da[ THAT 1 NAY[ IM&D THIN APPLIGTIQN f $VENT p.ND TAT[ THAT THI i ADVL 1IS CO RIRC'T AND I.ISRa TO COMPLY WrTH ALL COUNTY ORDINANCLS AND STAT[ LAWS FMOULATINa L HOT WATER HEATER CLRTIPY THAT I AM PRQPKRLY IQOIST'�D AND/OIt PLUMBING FIXTURES It0411® BY LOIS ANSLKA COUNTY AND STAT[ OF G.�.S-�� ON THAT I AM TH[ LKQA1 OWN" OF,AND INTLND TO H[ADOY[ IISLD RLISIDKPMAL PnDPKRTY. UTILITY CO. NOTIFIED .TTEE FINAL VA JDATI� ROBERT A. WOOD mM.o. CAai SUPERVISING MECHANICAL ENG'R Ly1Lo 3 8 7 0 Ca APR 2 6 5 D 3,5 0- WORKMV COMPENSATION MCLARAVOIN APPLICATION FOR PLUMBING PERMIT ti I 4;yra Irm that I have a certificate of consent to self 78A667A Insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.SIM or a caftlfled copy thereof (Sec. 3800, Lab. C-) COUNTY OF LO8 ANGELES DEPT. OP,PUBLIC WORkC8 Policy No. Company Certlfl&d copy Is hereby fumishod. FOR Certlfled copy Is filed with the county building Inspec- ��'�TO FILL W(PRINT OR TYPE) ADDS S nt. NUMBER FIXTURE QR ITEM f Fff L OC'ALITY WATER CLOSET CROS3 ST :qIFICATE Appll4ant NEARPST plf 4 .OF EXEMPTION FROM WORKERS. BATH TUB A&1 ,4 / COMPENSATION INSURANCE OWMER rwt be If"work i the permit Is four one huwd llaars ($190)or Wo.) LAVATORY ADDRESS C/ I certify that In the performance of the work.for which this ' permlt Is Inuad•, I shall not employ arty n rty mer annNIC so as to become subject to the Work D&IWASHER CONTRACTOR Date , ppil CLOTHES WASHES ADDRESS NOTICE TO APPUCANT: tYK.PLbor er king this Certificate of gryiyyyU POOL RfCEI7TOR Exemption, you shouldsubject to the' Workers' CITY TEL NO. Compensation provlslons Code, you must forth- LAWN SPRNKIER 51'ETEM A It with comply with such provislons or this permit shall be STATELLK_ deemed revoked. WATER HEATER UCENSE"a CLASS ' LICENSED CONTRACTORS DECLARATION GASSYSTEM OUTLETS Y I hereby affirm tFKv I am licensed under pprroyWons of Chapter 9 (commemcing with Section 7000) of D10slon-3 of the BLWrmm OUTLETS OVER ` and Professions Coder and rrry IIceroe is In full force and effect. 3 PER SYSTEM FINAL V IDATION C DATE v R License Number Llc. Clgsa FI O Contractor Date - B © I am exempt under Sec I� B.e,P.C. for thlsreason Plan Check fee z Date PLUMBING PERMff ISSUING FEE_ IF Signatures TOTAL FEE Plan check applicant �8 0 5 2 A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name # 0 0 0 0 0 I hereby affrrm that I am exempt from the Contraicto�s Lrcertse Addreu .I ° ° 3A 5 0 Lay for the following reason (Section 7081.3, Busrnees and 910 Code): City T.I. No. o o a 3-4,505. ,I, qs owner oft}t• property,will do the work and the structure Is not Intended or offered for-sale (Section 01111, {I a05-87 41 70 , Busine"and:Professlons Code CONSTRUCTION LtNDING AGENCY I hereby affirm that there b a construction lending agency for the performance of the work for which this permit Is Ipued (Sec. 3097, Cly. C_). Lender's Name Landers Address I Ge .I"hat have read this application and state that the , above Infdrmatlpn is correct. I ogee to comply wlth all County ordinances and State lows regulating Plumbing, and hereby authorize rdWwwntatives of this County to enter 'upon the L,,bov,a, n for Inspectlon SH MUM POR MU"NATORY L/►MA09 jkE� IL A 716 ItteeQlate