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HomeMy Public PortalAbout8756 HERMOSA DR_Plumbing__ 76A6 67 APPLICATION FOR ;PLUMBING PERMIT 1 785-1]3-55 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles WM. J. FOX. COUNTY ENGINEER BUAODILDI ftESSNG -- O�/"V7j (G i'YKif! CASSATT D. GRIFFIN, $uP'T OF'B wL71NG LOCALITY ,TOR4PPLICAN,T TO FILL IN NEAREST �r 7� CROSS ST. OWNER r / 'L DIST RICT�•TNO, GROUP ZONE READY FOR INSPECTION MAIL _ADD � -Z INDUSTRIAL CIT TEL.N 7-17,S-6 WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY TEL.NO. LICENSE NO• NUMBER TYPE OF FIXTURE OR ITEM 'FEE { WATER CLOSET (TOILET) _ f BATHTUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINN DISHWASHER " LAUNDRY TUB OR TRAY _ CLOTHES WASHER TOTAL NO. a 0.e0 APPROVALS DATE INSPECTORS SIGNATURE GAS SYSTEM OUTLETS 1.00 WATER HEATER- (a 1,00 UNDER SLAB WORK g� PERMIT $ 7 00 ROUGH PLUMBING ���/� S �/• GAS PIPING TOTAL FEE GAS VENT I,HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ` ` WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES ��� PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS'A ELES COUNTY AND STATE OF CALIFORNIA OR THAT 2 AM TH GAL CANE OF THE ABOVE UTILITY CO. NOTIFIED . DESCRIBED RESIDENT PE ROPE SIGNATURE OF PERMITTEE ` FINAL IHS-S '/A' //l A4t.LT1d WILLIAM J. F COUNTY ENGINEER VALIDATION R. A. WOOD, CHIEF PLBG. INSPECTOR TO9 3 5 5t2 dCT25 3 2:60 TD^DST ,BS 17 I._55 APPLICATION FOR PLUMBING PERMIT 1 DIVISION OF BUILDING AND SAFETY Depmmtment of County Engineer County of Los Angeles BUILDING M�/ J �y?hn54_ .JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS // tb7 / CASSATT O. GRIFFIN,SUPT OF SUILOIna LOCALITY O APP TO,FILL IN CRO S$$T. e OWNER [i ' ,rLL DISTRICT NO. GROUP I ZONE I READY FOR INSPECTION MAILADDRESm INDUSTRIAL �-, CITY / C4 �✓ C`L /LUNO. Gam/ o -I WASTEAPPROVAL PLUMBER P -�.r�/t✓ IN/S!PECTION RECOOR/DJ ADDRESS ��J ,CLAS imC! a- r l?©o CITY TEL. NO: Fi� LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $I.00 CLOTHES WASHER @ $1.00 _ WATER HEATER @ $1.00 _ GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT 1 00 ROUGH PLUMBING g GAS PIPING TOTAL FEE LTD GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRE BY LOS ELES COUN'pf AND STATE OF CALIFORNIA TH AM T LEG L OWN R OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDE, SIGNATU OF PER TTEE V ` V FINAL JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR CK, M,1, CASfI ��09 2 1 E I? n - 4 3 2 00 j-' WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT �7 1 hereby affirm that I have a certificate of consent to self 200026 DPW 6/87 t, I / t InvJret or u certificate of Workers' Compensolion Insurance, 76A667A lul or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.—s Company Certified copy is hereby furnished. BUILDING ❑ ♦ FOR APPLICANT TO FILL IN(PRINT OR TYPE) -7 Certified ADDRESS IN'copy is filed with the county building inspec- r Tt tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITYF+ G Date Applicant WATER CLOSET NEAREST s CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. u s CATW, COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by the permit is for one hundred dollars ($100)or less.) 2. LAVATORY MALL O //� sA ADDRESS V��l� H5Tt I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner f SINK �� � E CITY y1i01�L TEL. NO. so as to become subject to the Workers Compensation Laws. DISHWASHER ,✓h 1 I 1,ye q Z �O �r CONTRACTOR Date ./1.G_{=iAppiicant CLOTHES WASHER f NOTICE/TO PPLICANT: If, aft r making th' Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM t with comply with such provisions or this permit shall be STATE W LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DI SJ ICT NO. E55 BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION a DATE L O License Number Lic. Class— Contractor /jJ,p( U BYFINZ'I I✓ 1 Contractor Date 0 ❑ 1 am exempt under Sec. (,) LLF B.BP.C. for this reason Plan check fee ► N Date: Z' PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant - SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ..._.._ A� hereby affirm that I exempt from the Contractor's License ____.__-.._. _...sfL,CT,AT Law for the followingg r reason (Section 7031.5, Business and Address Professions City Tel. No. Code); 3307 31.75 I, as owner of the property, will do the work and the ._,-__ .._- __- _..._..___-...1 I1C.I F] structure is not intended or offered for sale (Section TOTAL 7044, Business and Professions Code). - 81 . 75 CONSTRUCTION LENDING AGENCY MCK 31,75 1 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.). ('R� 1e Lender's Name 00 ;I MI 7�18/89 Lender's Address 45 1 AM 8:51 1 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 property for inspection purposes. ( 4 / 7/g SEE REVERSE FOR EXPLANATORY LANGUAGE X11•` Signature of erm,11.e Date