HomeMy Public PortalAbout10014 GREEN ST_Plumbing__ 78A667
CE 8,17 8-5f; APPLICATION FOR PLUMBING PERMIT 1
UILDING AND SAFETY DIVISION
Department of County Engineer
County of Los Angeles BUILDING 1 { `
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING �/ —
LOCALITY
FOR APPLICANT.10 FILL IN I
NEAREST
CROSS ST.- �- G�LL
OWNER _ DISTRICT NO. GROUP ZONE I READY FOR INSPECTION
MAIL 5�
ADDRESS
INDUSTRIAL
CITY TE NO. WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
TEL. O �/ J �"" / } In r . tz1J 7 2171
LICENSE NO.
/1 f
NUMBER TYPE OF FIXT16RE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00
BATH TUB @ $1.00
SHOWER @ $1.00 i
t
LAVATORY (WASHBASIN) @ $1.00 /
KITCHEN SINK @ $1.00 " .K 3► «J'"
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 , 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT
I D HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER 'P
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT/I AYTHLEGAL OWNER OF T ABOYE UTILITY CO.NOTIFIED
DESCRIBED RESIDEN PY,
SIGNATURE / C
OF PERMITTEE FINAL -OBJ
Ate ! ROBERT A.WOOD,
JOHN A. LAMBIE,COUNTY ENGINEER VALIDATION SUPERVISING MECHANICAL ENG'R
CK. M.0.
' ,G2 7 5 4 SEP 2'7 3 1 0.0 0 p
"'° rt I have DECLARATIONent APPLICATION FOR -PLUMBING PERMIT
I he}aby, affirm that I hrne a certificate of consent to satf+o-
sore,or a cer
rtificate of Worker'Cbmpersctlon Insurance,or a
certified copy thereof(Sec. 3800, Lob. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WOR"
Policy No. ompany
❑ Certified copy Is hereby fumished. FOR APPUCANT TO FILL IN(PRINT OR TYPE) BUILDING
Certtfled copy Is filed with the county building Inspection ADDRESS
department. NUMBER FARE OR ITEM FEE LOCALITY
VDate G Appllcant WATER CLOSET(To4LM NEAREST
CERTIFICATE OF ECEAhPTION FROM WORKERS'
BATH TUB CVC SST.
COMPENSATION INSURANCE SHOWER OWNER
(This secibn awed not be completed If the cork Imrolred by MAIL
the permit Is for one hundred dollars(;100)or less.) LAVATORY ADDRESS
I certify that In the performance of the work for which this per-
mit Is Issued, I shall not employ any p&-son
on In any manner so CITY TB
rs
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Data Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after moking this Certificate of Ex- Z
SWIMMING
emptlon,you should become sub ect to the Workeri Compen- POOLS
CITY w TEL NO
- satlon provisions of the Labor C •,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIG
ed. I WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROBY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS S-ed,
9(commencing with Section 7000)of Division 3 of the Business oVHt
and Professions Code, and my license is in full force and of- s PER SYSTEM FINAL VALJDATION
few 'Z HOSE BIB DATE
License Number ZrL Llc Clan
�Tx adgzy� FINAL
Confrodor T'/V}lilc{/ a BY 5 p�
I am exempt under Sec. OCT. O
1
T.
B.BP.C. for this reason Plan check fee , 3303 310.3` LU
Dater PLUMBING PERMIT ISSUING FEE$ ` 1 ITEM
Signature a ]rq�
rorA1 FEE /b ��E& 3 10 _ ;
SINGLE 310.
HOME OWNER-BUILDER FAMILY
Finn check applicant �
I hereby affirm that I am exempt from the Contractor's License Name �(](]
Law for the following reason (Section 7031.5, Business and CHANGE
Professions Code): Address
1, as owner of the property, will do the work and the City Tel. No. 0000-OW1 6f26/K;
structure Is not Intended or offered for sale(Section 7041,
Business and Professions Code). ( Poo.. 1030 1 AM10:33
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3097, Ov. C.�
Lender's Name
Lender's Address
I certify that I have read this application and state that th*
above Infcrmatlon Is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mention party for Inspection pu
S SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign Are of Permittee Date