HomeMy Public PortalAbout9807 HALLWOOD DR_Plumbing__ 76A667-CE#817 2-66
Tler;'�--3N�PLICATION FOR PLUMBN PERMF'fl
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ® �L
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER /
WATER CLOSET $1.25 MAIL D
BATH TUB 1.25 ADDRESS
CITY -C TEL. NO.
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR S Q
SINE 1.25 ADDRESS `77
DISHWASHER 1.25 CITY�� 51 C TEL._NO. -C 2
LAUNDRY TUB 1.25 STATE LIC
LICENSE NO. ���CLASS G-
0
CLOTHES WASHER 1.25 DISTRICT NJO(j_ GROUP ZONE O S B
WATER HEATER LSO BY
GAS SYSTEM -2- OUTLETS 1.50 = INDUSTRIAL
WASTE APPROVAL
CD
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
CD
W
O_
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEES,t. D GAS PIPING
0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST `(
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO l
RESIDE IN,THE ABOVE S IBED RESIDENTIAL PROPERTY. j UTILITY CO. NOTIFIED f
r ,p
SIGNATURE
OF PERMITTE l:` 7 -
NAL 1
AUDATION JACK R. ALLEN
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R.
I tfl: 0 6.2 8� jUii 23 5 D
3: 1
WORKERS'COMPENSATION DECLARATION 76A667A
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I hereby affirm that I have a certificate of sent to.self ce`617 (z-e0) APPLICATION FO R PLUMBING •
P R I
I
insure, or a certificate of Workers'Compensation nsui,urice,or
a certified copy thereof(Sec. 3800,Lab.C.) "fl 11
COUNTY OF. LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN•(PRfNT OR TYPE) BUILDING
ElCertified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE ADDRESS
department. WATER CLOSET LOCALITY ^^
Date Applicant NEAREST
BATH TUB CROSS ST. Q/L ^S T
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER K 777 ._
LAVATORY MAIL
(This section need not be completed if the work involved ADDRESS a
by the,permit is for one hundred dollars ($100) or less.) SINK �b
CITY J. N. TEL.NOa "�E'�r�R U
I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not employ any person in any manner CONTRACTOR A
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS U
Date Applicant SWIMMING POOL RECEPTOR pW,
NOTICE TO APPLICANT:If, after making this Certificate of CITY. TEL.NO. fn
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Z
Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. r ,P'R`OC SSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER =d W lG
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE /'LiG/
effect.
FINAL
License Number Lic.Class, BY '
Contractor Date
ElI am exempt from the licensing requirements as I am a Plan check fee
licensed,architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE 12
Lic,or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section.7031.5, Busi- City Tel.No.
ness and Professions Code):
t
las owner of the property, am exclusively 'contracting
ith licensed contractors to construct the project z 47 3 8 A'
(Section 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY # o'=o 0 0 0j'
I hereby affirm that there is a construction lending agency 2 0 0 2 5 0
for the performance of the work for which this permit is
issued(Sec. 3097,Civ.C.). J
Lender's Name ° ° 1 2.5 0
Lender's Address 7.0 2'-812
I certify that I have read this application and state that the
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter. upon the
above- n ' ned property for ipelp,ection purposes.
Sig ture of Permittee Date '