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HomeMy Public PortalAbout8807 HERMOSA DR_Plumbing__ CE 817(REV.6/7e) � JVL 'f )IY 1 �S APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TVPEI BUILDING ADDRESS 'I/WIT,-fin WO / HE2M �DrZ NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET LOCALITY -rmacmj NEARESTrpFJ 1,�ii� l W BATHTUB CROSS ST. 1L ]C7I,I Q 1 I SHOWER OWNER (LI i a LAVATORY MAIL O � _9 _ _ ADDRESS C. SINK CITYJ"em4� CLE TEL.NOa6'b DISHWASHER CONTRACTOR ���C C ^ ACLgzS CLOTHES WASHER ADDRESS (--)I ppW E. GkMb II(L. SWIMMING POOL RECEPTOR - ,y'T CITY '— - TEL.NO.4 2?V(0 LAWN SPRINKLER SYSTEM STATE /n� (� LIC. . WATER HEATER LICENSE NO. Oq �9L{ CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'5 SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING Y GAS PIPING C GASVENT V HOT WATER HEATER 7-L�- 1ti O PLUMBING FIXTURES V GAS TEST N Plan check fee UTILITY CO.NOTIFIED Z PLUMBING PERMIT ISSUING FEE$ oo _ TOTAL FEE FINAL PLAN CHECK VALIDATION Plan check applicant [per �;��.�y �qL py ye rp�',y�`p�;��7r t, ,y {,ue Name a ®99 FH ki AL IJR1 %J tlo�aT 10 IN Address � City Tel.No. HEREBY THAT TIHE ABOVE IA5 CORRECTDGE ANDTHAT I HAVE READ AGH EE TO COMPLY WITH ALL APPLICATION OORDINANCES (�..�9 Y U O A AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION y I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS p C C C u O 5 REQUIRED BY LOS ANGELES C ATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND IN NO TO RESIDE IN ABOVE DESCRIBED RESIDENTIAL 2 J O 1 0.00 PROP RTY. NATURE O V 1C0 �� OF 'LTE cats-so DISTRICT NO. ROCESSED BY INDUSTRIAL WASTE APPROVAL WORKERS'`OMPE"SAT'°" DECLARATI°" APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667 DPW 4/90 ssu re,ora certificate of Workers:Compensation Insurance,or a 76A667A certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS LIILJIII Policy%No. Company . ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING "�, F ❑ Certified copy is filed with the county building inspection ADDRESS J �.•vv 7rK �/E� I .(1.. department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Dtlte Applicant WATER CLOSET(TOILET) ' / �.�J . CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' - BATH TUBNEAREST �p COMPENSATION INSURANCE SHOWER I �� OWNER YiI V� 'L&LA (This section need not be completed If the work involved by MAIL .� I the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS b �. Lp`2'VVvv I certify that in the performance of the work for which this per- TEL NO.'SINK CIT mit is issued, I shall not employ any person in any manner so Y L.l,,,y � i j as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR b'L Dale Appiicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS emption,you should become subject to the Workers'Compem SWIMMING POOL RECEPTOR CITY TEL. NO. lotion provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO, CLASS LICENSED CONTRACTORS DECLARATION - DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �O 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER C and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION feet. HOSE BIB DATE _ a License Number Lic. Class O FINAL U Contractor Date BY - cc O -i�J I v F I am exempt under Sec. 'c Wa B.BP.C. for this reason Plan check fee `�'� 72'�" i T T ENr z Date: PLUMBING PERMIT ISSUING FEE$ © _ Signature ` I O`AL 72-75-? TOTAL FEE J SINGLE FAMILY L_; t.y, , i HOME OWNER-BUILDER DECLARATION Plan check applicant I-hereby affirm that I am exempt from the Contractor's LicenseCHANGE I'( Law for the following reason (Section 7031.5, Business and Name Professions Code): Address 5/ 25.,QI_i_i t—ill illi _ 2 t', =i I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, ;! Business and Professions Code). - r ► 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 representaju'ves of this County to enter upon. the above-mentioned pr erty for inspection purposes. �.•� ,S''7� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D to