HomeMy Public PortalAbout10645 HALLWOOD DR_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GRO P ZON
PERMIT NO.
PLUMBER VALLEY BOULEVARD PLUMBING CO. Is- '�-) � ' Z�S -141-141D
RECEIVED.BY READY FOR DATE ISSUED
ADDRESS
8300 EAST VALLEY BLVD. H acec:I,e C" FIRST INSPECTION
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CITY =} a�iI�17GgqAD TEL.NO. AT. Z-Z�1� ADDRE99 '/Cir/�8��j ��-f//¢-6�
COUNTY vl C 6-30-
LICENSE NO. V EXPIRES LOCALITY
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER ---
MAIL
WATER CLOSET(TOILET) 0 0.50 $' .ADDRESS
BATH TUB 0.50 O CITY TEL. No.
SHOWER fL -0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK. Q 0.50 AND STATE LAWS REGULATING PLUMBING,
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY .LICENSE, OR I AM THE LEGAL OWNER
GAS SYSTEM OUTLETS a 0.50 ®� Qf THE RESIDENTIAL PROPERTY DEBCRIB,6D ABOV
WATER HEATER 0.50 / 0/ BIGNPERMITTEF
SLOP SINK @ 0.50 INSPECTION RECORD 1
FLOOR SINK 0 O.SO
FLOOR DRAIN .Q 0.50
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50
URINAL Q 0.50 -J
Q
HOUSE SEWER 0.50 Z_
MISCELLANEOUS
O
APPROVALS
DATE INSPECTOR'S NAME �.
ROUGH PLUMBING
GAS PIPING A 7
GAS VENT
+
CESSPOOL @ 1.00 CESSPOOL A A IS
SEPTIC TANK: SEPTIC TANK
pf(tf v
DRAIN ( ) PIT ( ) (L 1.00 SEWER A �fUG
PERMIT .
I 1.00 GAS TEST R �I/) jj� nJ"s p✓
6?J I UTILITY CO.NOTIFIED
TOTAL FEE �Q �jg r
[J FINAL U �
76A667 DBS#17 6-52 o+
WORKERS' COMPENSATION DECLARATION � nI�p /p�5� -
I;hereb 'affirm that shove acertificate`-of consent to self in- 20-0026 DPW,4/87 ln111".l�L��C!/`�1 M,N FOR PLUM p �NG .PERMT
Y- 76A667A
sure,or a certificate of Workers'Compensation Insurance,-or a CE 817(REV. 8/86)
certified copy thereof.(Sec 3800, Lab. C.)',"
COUNTY OF,10S:ANGELES DEPT.:OP P BLLC WORK
Policy"No. Company
Certified copy is hereby furnished
' t FOR'APPLICANT TO FILL IN(PRINT'OR TYPE):' BUILDING p
Certified'copy is filed with the-county building'in"spection _ ADDRESS'
department.
NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant`. WATER CLOSET(TOILET) NEAREST
BATH TUB
CERTIFICATE OF EXEMPTION FROM WORKERS'
'COMPENSATION INSURANCE c SHOWER OWNER
ST
(This.section need not be completed if-the work involved by
MAIL
the permit is.for one hundred dollars.($100)or less.) •• -LAVATORYADDRESS /®&,��., ,
.>-
t certifythat in'the performance of tkEi workfor which this.per- ;SINK
mit is issued I shall not employ any person inany manner so CITY TEL. N
as jo be"come subject to the Workers'Compensation:Laws.
.D� ,]. :;.DISHWASHER TOP
at
CONTRACTOR
ate- Applicant CLOTHES WASHER
NOTICE.`TO APPLICANT'. If, 'after milking this Certificate of'Ex- S ®
WINIMING POOLRECEPTOR ,
ADDRESS Ie(�j��
emption;.you should beco'mei'subject to the Workers"Compen- TEL. NCO9
sation' rovisions of the Labor Code,-you must forthwith comp- LAWN SPRINKLER SYSTEM
I with-such revisions or this errriit shat)-l'be deemed revok STATE` :` /
P. y (®
Y'. P P � LIC.'
ed WATER HEATER. .. LICENSE NO. ' CLASS to
LICENSED CONTRACTORS DECLARATION. DISTRICT NO. PROCESSED BY
GAS SYSTEM OUT ;
T'hereb'y affirm that I am licensed under provisions of Chapter
9'(commencing with Section 7000)of'DiJjsion 3 of-the Business %OUTLETS OVER . O
and Professions Code, and rry.license is in full force.and ef- 5PER-SYSTEM
FINAL VALIDATION
fect.
, .
� DATE
, 0.
• •
License Numb'er'- Lic. Class6a V
FINAL
Contractor Date
_ BY O.
1 am exempt:under Sec >' '• LU
B4&P.C4 for this reason
Plan check fee 1_
D
t
Date:
PLUMBING PERMIT ISSUING FEE:$ '/ y _T
Signatureti "9� 3.s Al� -1 _s '
TOTAL FEE
t- SINGLE FAMILY t ' L' yti is _•
HOME OWNER-BUILDER DECLARATION Plan check applicant p
I hereby affirm`_that I am exempt from the Contractor's License Name '"�f3ih
Law for;the,follovving.recison-(Section 703;1.5; Business and
Professions Code): - Address'
;hid _lii;i B' '4
I;'as owner,oft the-property, will do':the work and°the City. Tel. No: c. _
structure is not intended or offered far sale(Section 704 -64, ,, •_t� J,
Business and Professions Code),.
CONSTRUCTION.LENDING AGENCY.•.
I hereby affirm`'Ihai there is a`canstruction'lendingagency for.
the performance of the work:for which this permit;is issued '
(Sec. 3097; Civ. C.):
Lender:s,Name".
Y
Lender's.Address
I cerhfy:'thot 14haveread this application and state that the -
above information is correct. I agree,.to comply with all.County. D
ordinances°and State:;laws regulating.Plumb.Ing,.and hereby t
authoriie-representatives of this.County to enter uponthe
alobve--nVention5plfroperty for inspection purposes:
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date 7 ;