HomeMy Public PortalAbout10667 HALLWOOD DR_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer am B
DIVISION OF BUILDING & SAFETY L
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN ISTRIOT NO. GROUP I ZONE PERMIT NEI.
15 --r A-
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PLUMBER VaLL 'n I n , R1ECEIVED BY READY FOR DATE ISSUED
rlu Iti I G- er— FIRST INSPECTION L— -7ws
ADDRESS 8300 EAST 14ALLEY
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f�c(++rNnIqEI- nn BUILING 10/0 j
CITY RV JLIb'1 L,f�v TEL No.• �. AD..E.1 (j�
COUNTY 9Z' LOCALITY
LICENSE NO. IVI EXPIRES
NEAREST ,
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
AR MAIL
WATER CLOSET(TOILET) @ O.8 ffi V ADDRESS_
BATH TUB @ O. CITY TEL. No.
SHOWER @ M40 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ O.S ® APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ O.S AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0 O. ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS 9Y8TEM j_OUTLETS @ O. O
OF THE RESIDEN-
TIAL PRO
PERTY DESCRIBEDOVE.
SIGNATURE
WATER HEATER . D PERMITTEEd
SLOP SINK @ D. D INSPECTION RECORD
FLOOR SINK
FLOOR DRAIN
DISHWASHER
DRINKING FOUNTAIN
URINAL 0. 0
_.I
Q
HOUSE SEWER @ O. O Z
MISCELLANEOUS E9
Q.'
O
APPROVALS
DATE INSPECTOR'S NAME
i
ROUGH PLUMBING
GAS PIPING 151
GAS VENT II�
CESSPOOL @ 1.00 CESSPOOL
=��SEPTIC TANK: SEPTIC TANK 4�( ,r �;
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1.Do GAS TEST'
UTILITY CO.NOTIFIED
s
TOTAL FEE Y o I FINAL I :/
76A667 DBS# 17 6-52 a
' WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lobb. C_) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No "'`company 9/ �i
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the cou ui ing inspec- ADDRESS L L
tion department. NU R FIXTURE OR ITEM
@ FEE LOCALITY
Date ` Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTI ROM WORKER BATH TUB CROSS 5T:
COMPENSATION INSURANCE
SHOWER OWNER •�t
(This section need not be completed if the work involved by MAIL r
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this —r..
d !
permit is issued, I shall not employ any person in any manner SINK CITY � TEL. NO_ Of��,Z(�
so as to become subject to the Workers Compensation Laws. DISHWASHER °--1JCCII v
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITYC "Iex TEL. NO. � ���
p p y LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE ' _ LIC. s
deemed revoked. WATER HEATER LICENSE NO. �z b_ CLASS S_?
LICENSED CONTRACTORS DECLARATION DISTRICT NO. P O SSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALVALIDATI N 0
DATE
License Number ic.
FIN
Contracto Date 3 o BY
❑ / L7
I am exempt under S c. �
B.BP.C. for this reason 11011. ;21 4 4, 1 A'
Plan check fee
Date: /`'
PLUMBING PERMIT ISSUING FEE$ l # 0 0 0 0- 0 5
Signature v
TOTAL FEE `jQ s ), o o30,50
Plan check applicant
SINGLE FAMILY o 0 o30,5066
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's LicenseAddress 0 1,3 0-8 5
Law for the following reason (Section 7031.5, Business and
Professions 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.).
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 to laws regulati umbing, and hereby
authoriz epres ntatives f ounty to enter upon the
abo entio d pro or inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Pe ittee Date
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