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HomeMy Public PortalAbout10666 HALLWOOD DR_Plumbing__ 76A667C (Cg-817B) -9/75 APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 'moi©� NUMBER .FIXTURE OR ITEM @ FEE ADDRESS f WATER CLOSET LOCALITY --7,* P467 C 17T NEAREST // BATH TUB CROSS ST. Lz-t SHOWER �? �� OWNER LAVATORY MAIL �/`//�/ ADDRESS ��L� MOO/) 12 SINK CITY le TEL. NO. 114j1 - DISHWASHER TOFt vs e ,rssr�rc ati CLOTHES WASHER ADDRESS 112—112— ,f— SWIMMING POOL RECEPTOR CITY 3'Q',,Ir / TE L. NO. �-0 7 LAWN SPRINKLER SYSTEM �j WATER HEATER LICENSE N0. �O O C ASS � O DISTRICT NO. G P ZONE P CESSED BY v GAS SYSTEM OUTLETS S� OUTLETS OVER 6O~.7 5 PER SYSTEM INDUSTRIAL d WASTE APPROVAL INSPECTION REC D Z Plan check fee PLUMBING PERMIT ISSUING FEE S TOTAL FEE �® Plan check applicant Name APPROVALS DATE 1NSPECTOR'5 SIGNATURE �Y/S T-�UC UNDER SLAB WORK Address J��C�3 >/y ,(JUT (p (/� ROUGH PLUMBING CityTel. No. GAS PIPING V I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES L NSED AS REQUIREDBYLOSANGELES COUNTY AND STATE OF GAS TEST FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DE IN 7HE ABOVE GESCRI D RESID N7fAL PROPERTY. UTILITY CO. NOTIFIED NATURE _ /f/�F PERMITTEE FINAL PLAN CHECK VALIDATION ('/ �/) M.O. CASH PERMIT VALIDATION CK. M.O. CASH COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer ' DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer PLUMBING 1 (STRICT NO. GROUP ONE . FOR APPLICANT TO FILL IN T ^ I 1 5�zss_ 21 PLUMBER VALLEY BOULEVARD PLUMBING RECEIVED BY READY FOR . DATE ISSUED FIRST INSPECTION ADDRESS 8300 EAST" VALLEY BLVD. pT n-79A, ��- INSPECTION CITY ROSEMEAD TEL NO. AT. 2-2 d7 ADDRESS COUNTY LICENSE NO. EXPIRES 6-30" LOCALITY NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER i //[ G MAIL WATER CLOSET(TOILET) 0.50 s /14710 ADDRESS BATH TUB Q 0.50 O CITY TEL. NO. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS Z LAVATORY (WASH BASIN) @ 0.50 Q APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. y� 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 8 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER GAS SYSTEM-21—OUTLETS (111 0.50 tJV OF THE RESIDENTIAL PROPERTY DESCRIBED BOVE. O WATER HEATER (10 0.50 ® SIGNATURE PERMITTEF SLOP SINK @ O.SO INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 —1 Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS C7 O APPROVALS DATE INSPE TOR'S NAME ROUGH PLUMBING GAS PIPING G GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) Q1 1.00 SEWER _ PERMIT . . 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE . D �"- /p_r//, FINAL 76A667 DBS#17 6-52 ION - WORKER'S I have a certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) f� Q Policy No� 97 3� Company !\�/v ' COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. / FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS f `department. oNUMBER FIXTURE OR ITEM Q FEE LOCALITY Date v` -� -9 Applicant �y'�)'""7 VO ��� WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. G- COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY /L© is issued, I shall not employ any person in any manner so as toSINK MAIL become subject to the Workers' Compensation Laws. ADDRESS (p/����iL� � q DISWASHER CITY i� �Gfy TEL.NO.t�-3 Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS �G3GG GOj �V� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM - LICENSED CONTRACTORS DECLARATION CITY 0/✓��U��/ `+ TEL.NO.3-7_5-3f �- I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business andSTATE LIC. /1��7 Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS /O` L LICENSE NO. z��� j CLASSO-2-0— L OUTLETS OVER ~J DISTRICT NO. PROCESSED BY 5 PER SYSTEM ZS CSZClass(-- License Number �- Lic.ClassC � � FINAL��✓ .' VALIDATION �jn l DATE Contractor /f/; ontractor //�;/6 -�'`� ��� Date/ z'- 31-Z'q ❑ I am exempt under Sec. BY AL � � BAP.C.for this reason G . 1 AL 4 ~f Date: Plan check fee , 4—� Signature PLUMBING PERMIT ISSUING FEE$ +_113(3= ❑ TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law n ^' c` for the following reason (Section 7031.5, Business and Professions Address Code): ❑ City Tel. No. I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ' 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, Civ.C.) h , Lender's Name Lender's Address I certify that I have read this application and state that the above ' information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize repres 'ves of this County to enter upon the above-mentioned property for i spe ti p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date -