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Home My Public Portal About8723 HERMOSA DR_Plumbing__ 7SA"7 DBB 17 7-51 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING 9 i COUNTY F LOS ANGELES WILLIAM .1.. FOX. CHIEF ENGINEER �NE R GRO P ON . F APP I DIST NT TO FILL IN P` PLUMBER i R BY READY FOR DATE YISSUED FIRST INSPECTION TE ADDRESS. ,� BUILDING �. `� CITY TEL N ADDRESS a COUNTY LOCALITY NSE NO. EXPIRES NEAREST PERMIT FEES cgoas BT. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER ` MAIL 91 WATER CLOSET(TOILET) a 0.50 8 ADDRE6 BATH TUB @ 0.50 CITY EL No. SHOWER G O.SO I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) 0 0.50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE ALIO LOS LAUNDRY TUB OR TRAY ® 0.50 ANGELES COUNTY LICENSE, OR I AM,TFIE L L OWNER OF THE RESIDENTIAL PR ERTY E B OV GAB 9YSTEM_OUTLETS ® 0.50 HIONATUR6 OF WATER HEATER a 0.50 PERMIT I SLOP BINK a 0.50 INSPECTION RECORD FLOOR SINK ® 0.30 FLOOR DRAIN 0.50 DISHWASHER ® 0.50 DRINKING FOUNTAIN O.SO URINAL ® 0.50 -) Q HOUSE SEWER ® 0.50 _Z MISCEL - NEOUS D IC G APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) 1.00 SEWER PERMIT • 1.0o GAS TEST r� UTILITY CO. NOTIFIED TOTAL FEE H J FINAL -/7 WgRKERS'at I have v- ION DECLARATION CE917.0 APPLS.ICATION FOR PLUMBING PERMIT 1 hereby affirm that I have -e certificate of m Insur to self cE en ,eel• insure, or a certificate of Workers'CoMpehsa[j:n Insu.'.ce,or `� + a certified copy thereof(See.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING --77 �± r_1 Certified Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE ADDRESS D7 at,3 E. pj\. department. WATER CLOSET LOCALITY Co Lk.,kif SA-1 6CLL,-1 Date Applicant - NEAREST ,,j.. BATH TUB �� CROSS ST. Ii, (/L-1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY i / MAIL �� } (This section need not be completed if the work involved Z/ ADDRESS Z � /'h0� < 4!/Y- (1. by the permit is for one hundred dollars ($100) or less.) SINK CITY `^ � . /�� r ^ WNOW 1 certify that in the performance of the work for which this DISHWASHER D N� permit is issued, 1 shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESSDate�)4�plicant6k1 ��ialh �• (�( SWIMMING POOL RECEPTOR LU NOTICE TO APPLICANT: If, after making this Certificate of CITY Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE Compensation provisions of the Labor Code, you must forth- LICENSE NO.with comply with such provisions or this permit shall be WATER HEATERdeemed revoked. GAS SYSTEM OUTLETS ST CT NNO..LICENSED CONTRACTORS DECLARATION OUTLETS OVER I.I hereby affirm that 1 am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- nessand Professions Code, and my license is in full force and DATE effect. FINAL License Number Lie. Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE 5 + acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that 1 am exempt from the Contractor's Address, License Law for the following reason (Section 7031.5. Busi- City Tel.No. ness and Professions Code): 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 21 9 8 5 A I hereby affirm that there is a construction lending agency # o o e o 0 55 for the performance of the work for which this permit is issued(See. 3097,Civ.C.). Lender's Name 1 0 - 19.00 Lender's Address o 0 0 1 9. 0 0 I certify that I have read this application and state that the 0 9.04—80 above information is correct.I agree to comply with all County SEE REVERS17 FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. � . fSiLa 7_ I?C Signature of Permittee Date WORKERS' COMPENSATION.DECLARATION APPLICATION FOR PLUMBING PERMIT LhereCfj, affirm that I have a certificote•of consent to self in- �6A666A PW a/87 sure,or o certificate of Workers'Compensation Insurance, ora CE 817(REV. 6/86) 'TIL,II r certified copy thereof (Sec. 3800 Lab.,G) - Policy,No. Company COUNTY OF LOS ANGELES DEPT. OF.PUBLIC WORKS 'Certified copy.is hereby furnished. - - FOR APPLICANT TO FILUIN(PRINT OR TYPE) BUILDING copy is filed the county building inspection ADDRESS department. NUMBER FIXTURE.OR ITEM @ FEE LOCALITY 'Date - Applicant WATER CLOSET(TOILET) NEAREST ✓ CERTIFICATE OF..EXEMPTION FROM WORKERS' BATH TUB ^ CROSS ST. R - csi COMPENSATION INSURANCE SHOWER V OWNER c I 7a (This section need not be completed if the work involved by - MAIL ••�� the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS 7,;j3' I certify that in the performance of the work for which this per- / SINK / mit is issued, I shall not employ any person in any manner so CITY TEL NO.�' �,.Gi7 as to become subject to the Workers'Compensation Laws /{/�� HER- � b//�� g.� �` '.lr t `9!`�+ CLOTH SS WASHER Date-6- Appllca nt(N 1��'r'�• CONTRACTOR Oa"�y� ` NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS - emotion,you should becorne subject to the Workers'Comport- SWIMMING POOL RECEPTOR - y CITY E sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM C� ly with such provisions or this permit shall be deemed.revok' 'STATE WATER HEATER .LICENSE 5,1L LICENSED`CONTRACTORS DECLARATION - ICT NO. PROCESSED BY I hereby affirm that I om licensed under.provisions of Chapter GAS SYSTEM OUTLETS A� 9,(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER a and Professions Code, and my license is in full force and at- 5 PER SYSTEM FINALfeci ®� VALIDATION DATE a O License Number Lic. Class U FIN Contractor Date BYa Or O f— I am exempt,under Sec: W IL B.BP.C. for this reason U) Date:— Plan check fee � Z Date: PLUMBINGPERMIT ISSUING FEE $ Signature - TOTAL FEE 2 0.0 5 0 A - SINGLE FAMILY - # •f,0'• • 5 HOME OWNER-BUILDER DECLARATION Pion check applicant I hereby affirm that I am exempt from the Contractor's License Name t - `(6°): Q 0 5.0. Law for the following reason (Section 7037.5, Business and _ •`s i Q Q 5 050 Professions Lode): Address I, as owner of the property, will do the work and the Ciry - Tel. No. - 3 01-8'8 structure isnotintended or offered for sale(Section 7044, - Business and Professions Code). - - CONSTRUCTION LENDING AGENCY - lop 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 and State lows regulating Plumbing, and hereby ' authorize representatives of this County to enter upon the obove-mentionedgrope or spection purposes. I x —$'.? SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 61 Date WORKERS'COMPNSATIONDECLARATIT APPLICATIAN FOR PLUMBING PERMIT j l hereby affirm that I have a certificate of consent to self 76A667A iflsure; or acertificate of Workers' Compensation Insurance, CE 817(REV. 10/Bl) •.jr.a cerfiThd copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. EJ Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM rr FEE Locnury OK�� Sa..•r OQ rV' /`. . Date Appliqant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' I BATHTUB CROSS ST. y( a$�_R. •,e COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by SHOWER ba the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL l..•y (` ` -� ADDRESS /�C , I certify that in the performance of the work for which this permit is issued, I sholl not employ any person in any manner SINK „ CITY ��.7 TEL. NO.2P6 2-Z so as to become subject to the Workers Compensation Laws. DISHWASHER OO _�/ ' /"/ ) /"�� //qJ, CONTRACTOR •O .;t Date/-APPLICANT: If, aft /m �ci'� /s c•�* CLOTHES WASHER ADDRESS Exemption, TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR !- Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE �/ LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. CESSED BY lfp I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS W/I� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER V and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALI TION C' DATE License Number Lic. Class V FINAL ad Contractor Date BY F1WV I am exempt under Sec. d B.BP.C. for this reason 2 9 A Z Plan check fee , Dote: • . . • 5 PLUMBING PERMIT ISSUING FEE$ Signature TO7ALFEE - 40.50 Plan check applicant SINGLE FAMILY • • • 4 0.5 05 HOME OWNER-BUILDER DECLARATIONName I hereby affirm that I am exempt from the Contractor's License Address 5 4—8 5 Law for the following reason (Section 7031.5, Business and 0 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 pool7044, 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 and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned propert for inspection purposes. j� �J SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date J