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Home My Public Portal About8615 HERMOSA DR_Plumbing__ 76A667-CE817 6-60 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING (� JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS C `'/Al m- =•-c` .L`-`+ WILLIAM A. JENSEN. SUF•T of BUILDING LOCALITY FOR APPLICANT TO FILL. IN NEAREST CROSS ST. 24-1 NUMBER FIXTURE OR ITEM I OWNER = � . WATER CLOSET MAIL ADDRESS / BATH TUB CITY TEL NO. �� 6^ .5 YCII / SHOWER CONTRACTOR LAVATORY SINKADDRESS DISHWASHER CITY TEL NO. CONTRACTOR'S 4PROCESSED LAUNDRY TUB REGISTRATION NO.CLOTHES WASHER DISTRICTNO. GROUP 7�O91E WATER HEATER GAS SYSTEM DIDUSTAIN. WASTE APPROVAL INSPECTION RECORD /a 1 A A - 0 U 01 O F V W a N 4 ® OHFIXTURE $ ,r(J(,� APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK /I TOTAL FEE (1 V ROUGH PLUMBING - GAS PIPING 1 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 PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /�ID� I Air1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT/II L PROPERTY. UTILITY CO. NOTIFIED SIGNATURE ..7,�.�, ��,-y 9 ,�J OF PERMITTE otr s�.V.E' FINAL - ®Y OVALIDATION ROBERT A. WOOD, , R-G, T,AyN SUPERVISING MECHANICAL ENG'R V;f�280 9 -� FEIS21 5 A �7.0 0 v �'t7cCERS' COMPENSATION DECLARATION - APPLICATION FOR PLUMBING PERMIT t'I hereby"af trm that I.have a certificole of consent to self 76AM7A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY ' Policy N3�LW1,87)ZH 86mpany Wart Am T+sa (O ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ® Certified copy is filed with the county building inspec ADDRESS 86 5 E. reTr Dr. ti`o'�n d��3par�I eJn�t. NUMBER FIXTURE OR ITEM C� FEE LOCALITY Date_..L4�2L V_IE�Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION F06M WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 8615 E Hermosa Dr. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO. 2,96-5441 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR General Heat & Air Coad. Date Applicant CLOTHES WASHER ADDRESS NOTICE'TO APPLICANT: If, after making this Certificate of Ave, Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITYrCP7iq CA TEL. NO. – LAWN SPRINKLER SYSTEM oon with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS C-20 LICENSED CONTRACTORS DECLARATION DISTRICT NO, PR E ED BV I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �.J a, C� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 0 and Professions Code, and my li–ce`n–se is in full force /^and e+fffec/t.� 5 PER SYSTEM FINAL VALID TION License Number 16,2gz/ Lia Classes DATE 79 d O FIN U. B Contractor ❑ o a� i23t .86� C exerU B.BP.C. for this reason 2497.9A LU Plan check fee ► 11 Date: N PLUMBING PERMIT ISSUING FEE$ O # e o e e e 5 Z Signature 1 B a TOTAL FEE Plan check applicant SINGLE FAMILY t HOME OWNER-BUILDER DECLARATION Name �e AZe- I hereby affirm that I am exempt from the Contractor's License Address ' Cie Low 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 Leader's Address _ I certify that I hove 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signor re of Permittee ///�— Date/ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT {► hergby affirm-;hat I have d certificate of consent to self 76A667A u • triune, dr•o certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. _ ❑ FOR APPLICANT TO FILL IN(PRINT OR TV PE) BUILDING /� Certified copy is filed with the county building inspec- ADDRESS D G E e tion department. NUMBER FIXTURE OR ITEM «?i FEE LOCALITY WATER CLOSET Date Applicant NEAREST (L. T (/� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 2OSS COMPENSATION INSURANCE SHOWER OWNER L . (This section need not be completed if the work Involved by the permit Is for one hundred dollars ($100)or less.) LAVATORY MAIL / �+ ADDRESS 15 L ETM I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner ! SINK 4 OWWA3,11461 6 4,1118 D CITY TEL NO.P.t g so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR DateApplic i t r- 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. LAWN SPRINKLER SYSTEM CITY TEL. NO, with comply with such provisions or this permit shall be STATE LIC, deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION 0 DISTRICT NO. P C ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS OV (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ic and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL DATE $ VALID TION } License Number Lic. Class iL FIN 0. Contractor Date BY y" y 0 ❑ 1 am exempt under Sec. B.BP.C. for this reason U Plan check fee WD•. Date:- PLUMBING PERMIT ISSUING FEE$ �� () R 4 2 7.9 A z Signature ^ TOTAL FEE pea ° ° e5 Plan check applicant SINGLE FAMILY I 2250 HOME OWNER-BUILDER DECLARATION Name L �QA/f} D I hereby affirm that 1 am exempt from the Contractor's License Address ° ° ° 2 2 5 0 5 Law for the following reason (Section 7031.5, Business and �� .tC� O �R Professions Code)' Citjjq y$ c� Tel. Noy g' 0 3 21 =8 6 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 o construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Nome Lendei 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 Slate laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the a ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date