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1
EX 617"ff APPLICATION FOR PLUMBING PERMIT 1
BUMDING AND SAFETY DMSION
D+pcmtc .mf of Commtr Enyfnrrr
Cotmtr of Lar Angedrr euILDINo
JOHN A.LAMBIE,COUNTY ENGINmm ADDR.ESB
CASSATT D.GRIFFIN,Bur T of BuILDiKr
LOCALITY i/
FOR APPLICANT TO FILL NEAREST -
ROSS ST CEJ
OWNER DISTRICT NO. GROUP ZO IK ■l D7 rot IRSPICTIOi
MAIL
kDDRESr
CITY T NO f INI5USTRIAL
WASTE APPROVAL
PLUMBER INSPECTION EECOED
ADDRX" r
CITY TSL.N
LIC.KNOE NO.
NUYm[R 7-f"OF FUCTURt OR IYaI F[I
WATER CLOSET (TOILET) (2 si.00 S
BATH TUM a 41.00
SHOWER a Jjl.C-0
LAVATORY (WASHBASIN) 0 41.00
KITCHEN SINK 1.00
DISH-WASHIR $1.00
LAUNDRY TUM OR TRAY @ 1.00
CLOTHES WASHER 1.00
WATER HEATER 1.00
GAB 1.00
APPEOVALS
DATE INSPECTOR'D SIGNATURE
tRA
SLAM WORK
PERMIT ; f 0H PLUMBING
OIPING
TOTAL FEE ENT
I HEREBY ACLIOALEDGE THAT I HAVE READ THIS APPLICATI
AND STATE THAT THT ABOVE Id CORRECT AND AGREE TO COMPTSR HEATER
17ITH ALL COUNTY ORDINANCES AND STATE LAAS REGULATI
PLUMBING. ING FIXTURES
1 HEREBY CERTIFT THAT I AR PROPERLY REEG19MED AND/ ST
LICBNSgD AD REQUIRED BY LOB ANGELES COUNTY AND STATE CALIFO NIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOY CO.NOTIFIED
DESCRIBED RESIDENTIAL PROPERTYSIONATURMOF PERMITTEE
ROB A.WOO ,
JOHN A. LAMBIE: COUNTY ENGIN>!aR ALIDATION 6UPERVISING MECHAMICAL ENG'E
�J
X.o. CA"
2796 W 3 0 3 2.00
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78A11
- APPLICATION FOR PLUMBING PERMIT
DBS-1710-55 11 �
YyIVISION OF BUILDING AND SAFETY 1
Department of County Engineer
County of Los Angeles BUILDING p r�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 10802 Gran.
CASSATT D.GRIFFIN,SUPT OF BUILDINGEl Monte
LOCALITY
FOR APPLICANT TO FILL INbilI NEAREST
CROSS ST. -
arp
OWNER DISTRIICC;� NO. GROUP ZONEREADY FOR INSPECTION
MAIL
ADDRESS I
INDUSTRIAL
CITY ��'-� � F TEL. NO. WASTE APPROVAL r— a
``
PLUMBER Lee' 8 lumbina ,✓ `/ r INSPECTION RECORD
PLUMBER �.
E. K�7 .r7 :, E
ADDRESS 7759 E• sarve� k
So. San c a r e ;,1 03 91
CITY TEL. NO.
LICENSE NO. r1-:51S
T `.
NUMMR TYPE OF FIXTURE OR ITEM FEE �I ,: �,,•
WATER CLOSET (TOILET) @ $1.00
BATH TUB @ $1.00
SHOWER @ $1.00 �a1d
LAVATORY (WASH BASIN) @ $1.00 c
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
G RS RE F,0R RO�N'S,= o
CLOTHES WASHER @ $1.00
7 WATER HEATER @ $1.00
�Il ssll`e� LAS 'r11RE19px RRr 16 v
GAS SYSTEM @ $1.00 1NSADE' 11kR11, RAP7,/ � - \ �S
r-alm 6!-tls TEST' `t/1111Z -eF '.4h
APPROVALS FCR,pQ,
DATE INSPECTOR'S SIGNATURE �-
UNDER SLAB WORK
ROUGH PLUMBING
PERMIT $ 1 00
GAS PIPING -
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER •�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING. -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST ,,.,R,t..,.. .�;,,♦_:-n.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED ..:• � :e"`
DESCRIBED RESIDENTIAL PROP TY.
SIGNATURE
OF PERMITTEE FINAL
JOHN A. LAMDIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CASH
f, ; 293 !?FC 4 3 1 1 .00 p
sfiof;�y°�tW ihaver� consentto .alf C19 817 ("0) APPLICATION FOR PLUMBING PERMIT
insure, or■ certificate pf Workers'Compensation Insurance,or
a Certified copy thereof(Sec. 3800,Lab.C.) �}
COUNTY OF LOS QE AND SAFETY
'. .Policy No. Company-
E]
ompanyE Cetttlled Copy Thereby furnished. FMA
R APPLICANT TO FILL IN (PRINT OR TYPE} BUILDING F
Certified copy-is f116d with the tours building FIXTURt OR F>� ADDRESS !`
County tibia tnspeCtion
I deperiment. WATER CLOSET LOCALITY
wee?--
Date-Applicant NEA T
BATHTUB CROSS ST. V l
CERTIFICATE OF J;XEMPT'ZON FROM WORKERS' i
COMPENSATION INSURAINCI; SHOWER OWNER
('Ills section need, nbt be compkAed if the *ork lnrohed LAVATORY MDAFRE88
by the permit is for one hundred dailm ($100) or ler.)
, SINK ' CITYlde� TEL NO.
I certify that lb the perfo of the work for wtllcb thi•1 DISFt'WASH-ER
Permit is jssued, 1 shall not mel any n In7Lny mapper CONTRALTO
so ast be a }bct'to mpensatlon Laws. CLOTHESWASHERU
Dat a SAL--�Ap 011 ADDRESS,
SWIMMING POOL RECEPTOR
NOTICE TO APPL,IC after nlakln Certiflcate of CITY ��f.0 T
Exemption, you ghoul ecome sub to the Workers' LAWN 8PRIN-KLERSYSTEM
Compensation provislotis of the Labor C e, you must forth- STATE LIC. z
vrltb Comply with, such previ cods or this permit shall be WATER HEATER LCENSE NO C
deemed revoked. r OAS SYSTEM OU-tL,ETS �� D18 T N' ROC EDB
LICFNSED CONTRACTORS DECLARATION OUTLETS OVER
r hereby afnrm that I am llcansed under'provbions of Chapter 6 P R SYSTEM
9 (commencing with Section 7000) of Dtvislon 9 df the Bust- FINAL
nems agd professions Code, and m7 license L lq full force and DATE VA PATIO
effect,
FINAL
v
License Number- Llc.Clara- _ � 8Y
Contractor Data
Cl I ani egempt from the llcensing requirements as I am a P18n check f09
licensed architect or Y r6gistered professional engineer PLUMBINGPFRMITISSUl" FEE$
acting in my profesatonal capacity (Section, 7051, But.
Iness and Professions COde). TOTAL FEE
I1c,or Reg.No. Date. Plan check applicant
HOME OWNER-BIULLDER DECLARATION NNne
I hereby affirm that I am exempt from the Contractor'& Ac;d reas
License Law for the following reason (S6ct1on.7031.5, Bltth Chy Tel.No.
nese and Professions Code):
F1j, as owner of the property, are exclustrety contracting 2.0,0 9,9 A
With 4censed contractors to construct the project
(SecOon 70413,Business and professions Code). # o.0,0 0 o 5
CONSTRUC'T'ION LENDING AGENCY Z o o 1-a00 ,
I hereby affirm that there L a conattuction Iending agency
m
for the performance of the work for which this permit .0 o o.0 1,(�0 0,�
Issued(Sec. 3097,Cir.C.). 0 A 0 9-8,1
Len.der's Name
Lender's Address
I Certify that I have read this application and state that the
above information L correct.I agree to comply with all County
cea and State laws reQulating Plumbing, and hereby SEE REVERSE FDR EXPLANATORY LANGUAgE
&nth a representatives of this County to enter upon the
ab nad property fors inspection purposesPa
.
o tree .Date