HomeMy Public PortalAbout9407 GIDLEY ST_Plumbing__ 761-17 7
DBS-1APPLICATION FOR PLUMBING PERMIT 1
f -55
L ISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING �' `j j
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS V" a[ /e
CASSATT D. GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST
CROSS ST.
OWNER d- / DISTRICT NO.j GROUP ZONEI READY FOR INSPECTION
MAIL
ADDRESS ���� y�(/�li�/✓ ���s 1 <.I� I
INDUSTRIAL
CITY /7SP ti+ TEL. NO. WASTE APPROVAL
PLUMBER wa.rd 11. l erm ley INSPECTION RECORD
_ 7 j 1
ADDRESS 3ISS" alrgetLt A v-e. 4 � .
CITY /3 2k/4Wt off �,7a7%'Yl TEL. NO. � / .7 J7-2--
LICENSE NO. ( 3 VVL
NUMBER TYPE OF FIXTURE OR ITEM FEE `y� ^N g L,. +.-?
WATER CLOSET (TOILET) @ $1.00 $ //
BATH TUB @ $1.00
` SHOWER @ $1.00
/1 LAVATORY (WASH BASIN) @ $1.00 r 00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHESWASHER @ $1.00 ao
WATER HEATER @ $1.00 00
GAS SYSTEM @ $1.00 I 00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING i
GAS PIPING
TOTAL FEE ?lob GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
_
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE L AL OWNER ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL,P OPERTY.
SIGNATURE (/�y r
OF PERMITTEE tl �i FINAL
JOHN A. LAMBIE, COUNTY ENGINEERVALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. H.i. CASH
.,AGO 5 8 0 2 vAR 6 3 8.�.i �_.
WQRKERS'COMPENSATION DATION APPLICATION FOR PLUMBING PERMIT
I hbe.a
reby, Arm that I hav �cer4cate of consent to self In- .40-00DPW 418767
sure,or a c Iflccte o�Workers'Compensation Insurance,or a CE 817 A
� CE 817(REV. 8/86)
tertlfled copy thereof (Sec. 3800, Lab. C-)
Policy No. Company C=OUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified cgpy Is hereby furnished. _
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) 9UILDING +�Certified copy Is filed With the county building Inspection ADDRESS
department. NUMBER FIX OR ITEM FEE LOCuALrrY y Cl
WATEf CLOSET(rOilFr) c
Date Applicant NEAREST ,/C��"2C /
EX
CERTIFICATE OF EMPTION FROM WORKERS' 8°m'�g � CROSS ST. (� L
COMPENSATION INSURANCE OWNER L*•e
(This section need not be completed ff.the work Invohred by
the pwmft Is for one hundred dollars(;100)or less.) ' LAVATORY ADDRESS
25
I certify that In the performance of the work forwhich this per- SINK
mit Is Issued•.I shall not employ any person In any manner so CITY TEL N0.
as to become subject to the Workers`Compensation Lays. DISFMAS �R
CONTRACTOR
-Date �v Applicant � /��N/y�I ' CLOTHES WASHER
1`40TI TO APPLICANT: If, after ma-kind thl}'Certlflcate of Ex- ADDRESS
SWIMMING POOL RC{ iOR
emption,you should become subject to the Worker'4bmpen- CITY TEL, NO.
sailors provisions of 1he.LCode,e, you must forthwith comp- - LAWN SPRINKLER SYSTEM
ly with.such provisions or this permit shall be deemed revok- STATE UC.
ed. WATER HEATER LKINSE NO. (LASS
LICENSED CONTRACTORS DECLAR4T)ON, DSSMtly�
I-hereby affirm that I am licensed under'provlslons of Chapter 07 GAS SYSTEM OUTLETS
9(commencing with Section 7000)of DIvIUon 3 of the Business OUTLETS OVER
and Professlons Code, and my license Is In full force and of- 5 PER SYSTEM FINAL VAL TION >_
fact. DATE Old 7
License Number Llc. Class
A O
Contractor Date B
0 I am exempt under Sec. W
B.BP.C. for this reason Plait check fee
Data: , J 7 9 5;•1 A
PLUMBING PERMIT ISSUING FEE$
$Ignature T #'0 0 0 0 0 5
-- TOTAL FEE
'
S17Z FAMILY Plan check a Ircant I ° ° 5250
HOME OWNER-BUILDER DECLAI ATICNJ
I hereby affirm that I am exempt from the Contractor's License Name ° ° 5 2 5 0
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
I, as owner of the property, will do the work and the Clty Tel. No. 09, 1 8 8 7
structure Is not Intended or offered for sale(Section 7044, .
Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hero)?y affirm that there Is a construolon lending agency for
the pbrformance of the work for which this permit Is Issued
(Sec. 7097, CIV. C.)_
Lender:}Name
Lender's Address
I certify that I have read this appllcatlon and state that the ;
above Information Is correct. I agree to comply with all County ,
ordinances and State laws regulating Plumbing, and hereby
authorize representailves of this County to enter upon the I
above-mention ad party for Inspection.purposes.
SEE REVERIE FOR-EXPLANATORY LANGUAGE
Sign re of PermittDate