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HomeMy Public PortalAbout8909 HERMOSA DR_Plumbing__ 76 A 667 - CE 817 7-69 / APPLICATION FOR PLUMBING PERM COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING D E�PM ©5/r JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS SHOWER 1.50 CITY ETEL. LAVATORY 1.50 CONTRALTO SINK 1.50 ADDRESS DISHWASHER 1.50Cf3'X 7E N Q CLOTHES WASHER 1.50 STATE LIC LICENSE N CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE P S BY LAWN SPRINKLER SYSTEM 2.00 C WATER HEATER 1.50 O INDUSTRIAL CL O WASTE APPROVAL OGAS UTLETT EM OUTLETS 1.50 _ INSPECTION OR V OUTLETS S OVETEM .30 11,4-1; Al �C Q 0 5 PER SYSTEM / V 6. rz Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 5 2 00 TOTAL FEE APPROVALS DATE INSPECTOR SIGNATURE Plan check appllcam UNDER SLAB WORK Name ROUGH PLUMBING _ Address GAS PIPING City Tel. No. GASVENT HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGIST EO AND/OR UTILITY CO. NOTIFIED /I n LICENSED AS REQUIRED BY LOS A LEB COUNTY AN STATE OF CALIFORNIA OR THAT 1 AM THE OWNER I TO BESIDE IN,THE A¢OVE OE¢CR ENTI P ?;PERT FINAL �7 �� �✓K//✓`��� SIGNATURE JACK R. ALLEN, SUPE Hv ISIN HANICAL ENG-R. OF PERMITTEE PERMIT VALIDATION CK. M.0. CASH, PLAN CHECK VALIDATION CK. M.O. CASH � �� 3 3 5 4 JAPI1 4 5 D 3.50- v DEC TION WORKERS't I have a certificate cafe of corse APPLICATION FOR PLUMBING PERMIT 11 hereb)f affirm that I have o certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A667A or o certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy company Republic Indemnity Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDADDRESS SG Certified copy is filed with the county building inspec- ADDRESS H909 East Hermosa Dr. tion department. NUMBER FIXTURE OR ITEM Q FEE Locnu7Y Temp 1 e City Date 6/17/92 Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER owNERMr. & Mrs. David Lan (This section need not be completed If the work Involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 8909 East Hermosa Drive I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Temple City TEL. NO.285 so as to become subject to the Workers Compensation Laws, DISHWASHER CONTRACTOR Bryant Heating & A/C Date Applicant CLOTHES WASHER ADDRESS 1350 East Las Tunas Dr. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY San Gabriel TEL. N0.2H6 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENBE NO. 221 751 CLASSC-20 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 1 GAS SYSTEM 1 OUTLETSD (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 55 and Professions Code,and my license is in full force and off act. 5 PER SYSTEM FINAL } 221751 C-20 DATE ' VALIDATION c License Number Lic. Class UVIV . FINAL ./l7r', It Contractor Bryant Htq. & A&e 6/17/92 BY qq o ❑ I am exempt under Sec. W n' ,71/(` B.BP.C. for this reason a' Plan check fee ► ' Z c cn Date: PLUMBING PERMIT ISSUING FEE$ 24 75 yt.. Signature TOTAL FEE 39, 30 Plan check applicant SINGLE FAMILY T-;,i.- HOME OWNER-BUILDER DECLARATION Name _ I hereby affirm that I am exempt from the Contractors License t 0,A� ,3° a 301 Law for the following reason (Section 7031.5, Business and Address r Professions Code): City Tel. No. 7"'f-' r `'t I, as owner of the property, will do the work and the structure is not intended or offered for sole (Section 10.7044, Business and Professions Code), CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for r_ the performance of the work for which this permit is issued (Sec. 3097, Ci, 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 6/17/92 Signature of Permittee Date