HomeMy Public PortalAbout8915 HERMOSA DR_Plumbing__ ]BAPPLICATION FOR PLUMBING PERMIT
oeS.17.l](DIVISION OF BUILDING AND SAFETY
Depratment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BU ILGINB
LOCALITY
FOR APPLICANT TO FILL IN NEAREST po
CROSS ST. p d
OWN
MAIL DISTRICT NO. GROUP I ZONE I READY FOR INSPECTION
ADDRESS 5l �//-��+
INDUSTRIAL
CITY L. NO. WASTEAPPROVAL
PLUMBER ` u A INSPECTION RECORD
ADDRESS 4 y y LJ/] —R,
I
CITY �J TELP.�NO.
LICENSE NO. -/` y
fff��e
NUMBER TYPE OF FIXTl1eE Oq ITEM FEE
WATER CLOSET (TOILET) @ $1.00 400
BATH TUB @ SI.00
SHOWER @ SI.00
LAVATORY (WASHBASIN) @ S1.00
KITCHEN SINK @ SI.00
DISHWASHER @ SI.00
LAUNDRY TUB OR TRAY @ S1.00 CTO
CLOTHES WASHER @ S100
WATER HEATER @ $1.00 OD
GAS SYSTEM @ 51.00 TSD
APPROVALS
DATE I NSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT S F 00 ROUGH PLUMBING -2
GAS PIPING
TOTALFEES GAS VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER t
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY II Pr p
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES f1 v�M 9L1<-
PLUMBING. _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIJkENTIAL PRO ERTY.
SIGNATUREC� II''
OF PERMIT FINAL I �1 ,) ` J/`[)A .1w....-
JOHN A. LAVE31E, COUNTY ENGINEER A1tVALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
�+/-CK e.0. CASH
L&5.5 5 v FEB 19 3 6.0 0
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
1-hAV,'affirm'that I hove a certificate isf consent 1¢serf in- 767 DPW 4/8]A66
An
sure, or a certificate of Workers'Compensation Insurance,ora CE 817(REV. 8/86) "TILJII
certified copy thereof (Sec. 3800, Lab. C.)
Policy No- Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS, '
certified copy is hereby furnished.
FOR APPLICANT TO FILL IN.(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS I`t -
j ` department. NUMBER FIXTURE OR ITEM @ FEE
�j Locnurv �
Dote ?2_1 Applicant v/! r�i./. v�C(:�� WATER CLOSET(TOILE?) f
�a . t
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'- BATH TUB CROSS 5T
COMPENSATION INSURANCE OWNER
SHOWER
(This section need not be completed if the work involved by MA"
the permit is for one hundred dollars ($100)or less.) t LAVATORY — ADDRESS S r _
I certify that in the performance of the Work for which this per-
mit is issued, I shall not employ any person in any manner so SINK CITY - TEL. NO. '
as to become subject to the Workers' Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ` U
NOTICE TO APPLICANT: If, after making this Certificate of Ex- - ADDRESS I
sorption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR
sotion provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM .CITY TEL. NO%- ' fr
ly with such provisions or this permit shallbedeemed revok- STATE �T HC CO J
ed. • I I - WATER HEATER /� �. LICENSE NO. L_- CLASS -
LICENSED CONTRACTORS DECLARATION LO DISTRICT No. ROCESSED BY
6 _ 05 '
TGAS SYSTEM OUTLETS hereby affirm that I am licensed under provisions of Chapter '
9(commencing with Section.7000)of Division 3 of the Business OUTLETS OVER -(
fend Professions Code, and my license is in full-force and ef- 5 PER SYSTEM FINAL - VALIDATI d
1� DATE i
License Number_I �� 7 tic Class - p
/j /Z_ l �, Z�_�� FINAL Q
Contractor b/FOi��///11A _Date s BY O
❑ I am exempt under Sec.
( W
a
8.8 P:C. for this reason , / 2
Plan check fee
Doi.:_ PLUMBING PERMIT ISSUING FEE$ �lh
Signature
TOTAL FEE
' SINGLE FAMILY
'HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractors License' Name .t
Law for the following reason (Section.701 Business and
Professions Code): Address -..
1, as owner of the property, will do the work and the City Tel. No.
tiE 7� 50
structure is not intended or offered for sale(Section 7044,
Business and Professions Code).
*CONSTRUCTION LENDING AGENCY
- tlllAL 4-6 -_s5 F
i 4_ .,1 'L c i
I hereby affirm that there is a construct ion'lendIng agency for _t'6'e, �tva Jl_
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C).
.i ;-1ryt7t �l_II_
Lender's Name
Lender's Address _).. - C ._
I certify that I have read this application and state that the , - —•'zt., ? Fit : +.i�t
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-m atoned Pro pert or ins p ction purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE c
gnature ofPermittee -Date