HomeMy Public PortalAbout9641 GIDLEY ST_Plumbing__ 76A607-CE817 10-60
APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDDRESS
J
JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN /. �� '1
NUMBER FIXTURE O EM
OWNER aU
WATER CLOS �� vkADrDRESR
IL
BATH TOB - �
CDRESS
Y TEL NO.
SHOWER ��
LAVATOHYwNTRACTOR r' - _
r SINK y
DISHWASHER CITY TEL. NO.
CONTRACT R'S ATE
j LAUNDRY TOB 'y,� REGISTRATION NO. ' COUNTY
CLOTHES WAS DISTRICT NO. GROUP //Z NE P OCE ED Y
WATER HEATER -/ /
GAS SYSTPM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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eb� IISE a' W
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Z
a M10PER ITEM I d'L°
vOd�t FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDERvCLAB'WORK
TOTAL FEEROUGH PLUMBING
GAS PIPING .f
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
LDESCRIBFD
HOT WATER HEATER
I
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF
OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE GAS TEST •
RESIDENTIAL PROPERTY. C UTILITY CO. NOTIFIED
EITTEE FINAL ,
ALIDATION ROBERT A. WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
t.til,o 2 8 2 8 AUG 10 5 D 1 5.0 0- Q
WORPRS'COMPENSATION DECLARATION rswurw
I here arfirviltgat I have 9 certificate of consent to .elf ci atr ("a) 'A P P L I C A T I F O R/�LUMBI PERMIT
Insure, or 4 certificate of Workers'Compensation Insurance,or /
a cartffied copy thereof(Sec.3800,La C.)
COUNTY OF L AN BUI LD1 Q D SAFETY
Policy No. Company
0. Gert y Is Z:6d
by. FOR APPLICANT TO Fl.LL IN (PRINT OA TYPE) BUILDING
with, a ty bull n NUMBER ADDRESS FIXTURE OR ITEM • FEE r
?CER
LOCALITY
WATER CLOSETrIFICATE
pp N ABATH TUB CROSS ST.OFEXEMPTION FROM WORKERS'
`COMPENSATION INSURANCE SHOWER OWNER
(This section need not be ccomppkited if the work hnot�ed LAVATORY MAIL
ADDRESS
by the permit is for one h=led dotlm (3100) or leas.) SINK8
CITY TEL.N
I certify that in the performance of the work for which this DISHWASHER
permit 14 issued, I shall not employ any peon in any manner CONTRACTOR
lr
to as to become subject to the Wgrkers' Compeflaation LaWs. CLOTHES WASHER AQDRI 88
Date Applicant SWIMMING POOL RECEPTOR
NOTICE TO APPLICANT:If, after making this CertlRcate of CITY TEL.NO.y�lg_ W
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- LICENSE NQ. CLASS _
with comply with such provisions or t4is permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. CESSED BY
LICENSED CONTRACTORS DECLARA'T'ION OUTLETS OVER
I hereby affh-m that I am licanW under provts]ons of Chapter 6 PER SYSTEM
9 (commencing with Section 7000) of Dtvlaion 3 of the Bus]- FINAL _
non and Profeadons Code, and my license is,to full force and DATE r
VALID
effect. _
License Num r Lic.Claa F W At
BYLJ I
am axe omenta I am a Plan check fee
Ilceased architect or a registered prrofeasionsl engineer PLUMBING PERMIT ISSUING FEE
acting in my professional capacity (Section 7051, Bus-
loan
urmeas and Professions Cdde). -OTS
Lic.or Ret.No. Date Plan cpaoh applicant `
ROME OWNER-BUILDER DF-CI.ARATION Name
I hereby affhm that I am exempt from the Contractor's AddraM j
License Law for the following reason (Section 7031.5, Buai- City Tal.No. � ••
nese and Professions Code):
I, as ow
owner of the property, am exclusively contracting 4 5:J� 5 A
with licensed contractors to cjec
ongtruct the prot # 0 0 0'0 o 5
(Section 7044,Business and Professions Code).
2 GOO
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lenditl; agency
for the performance of the work for which0 0 0 QQ(�this permit is 0 0 0 1 Q 8
issued(Sec. 3697,Civ.C.).
Lender's Name
Lender's Address
I certify that I have read this applicationto that the
above information is correct.I agree to comply County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and regulating Plumbing, d h y
authorize r6 ntatfvea o his County t enter upon e
menti ed property for e n p
Slgnsture of Permittee Date