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HomeMy Public PortalAbout8925 HERMOSA DR_Plumbing__ 7 8/6B ]R A E67_DE BIAPPLICATION PLUMPING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 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 . �a,LnhL,C�lo WATER CLOSET 1.50 IL BATH TUB 1.50 ADDRESS SHOWER 1.50 CITY ''r, TEL.-NO. ,¢.8;y-jQ .gy LAVATORY 1.50 CONTRACTORSINK 1.50 ADDRESS.AJD"'DISHWASHER 1.50 CITY NCLOTHES WASHER 1.50 TIC LIC TCENSE NO. 240y-/ 9 CLASSL3SWIMMING POOL RECEPTOR 1.50DIBTRIC,.TINoO. GROUP �QNE � LAWN SPRINKLER SYSTEM 2.00 LVQ WATER HEATER 1.50 INDUSTRIAL ZO WASTE APPROVAL GAS SYSTEM OUTLETS j7s �j INSPECTION RECORD w OUTLETS OVER D- 5 PER SYSTEM '30 / -7,r- Bfds/fr. e---ss Y0�-r7' z a-2? 7S Gres lfir- N8Lp!i.�C 0+745 L/Nt 57Vdj;eD /A/rG1 5bo,�WS �2 uNdtrvTcD /K<ht ZS vEw L/ ✓L Plan check fee 25°� of above. See reverse. /tV j'a /c9r�OT'I.6C- PLUMBINGG PERMIT ISSUING FLE S ,� ®b RflDIT/6N 3//7 obapw' sn Bs C*'00" APPROVALS DATE INSPECTORS SIGNATURE Plan cheek applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT CILV Tel. IND, HOT WATER HEATER HEREBY ACKNOWLEDGE THAT 1NAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLV MBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO J+j RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL / SIGNATURE / JACK R. ALLEN, SUPERVISIN ECH ANIC AL ENG'R. OF PERMITTEE PERMIT VALIDATION cK. M.O. CASH PLAN CHECK VALIDATION CK. M.o. CASH 97ii t� z / 5 u 4.75a � r75667 ,.95 APPLICATION FORPLUMBING PERMIT � 1 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles guILDINc / - WMJ. FOX, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OP BUILDING FOR APPLINT TO FILL IN NEAREST CROSS ST OWNER /I //''� . _ / i DISTRICT NO. GROUP ZONE, gEADaCINSPEti ION MAIL .� Kn !// _ADDRESS INDUSTRIAL CITY TEL.NO. WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY Q'CL! TEL. N0.Alto- NUMBER ^' _LICENSE NO. 30 _ TYPE OF FIXTURE OR ITEM FEE WATER CLOSET LET) ' BATH TUB SHOWER ( OLD lj�ig�FG FF.Pf.'D7"'II�j LAVATORY (WASH BASIN) KITCHEN SINK �P(�^U:'l rA (/ 'r/,/ DISHWASHER - _ F/�/.�.�/' !",'./'//'.^f AT MFS' LAUNDRY TUB OR TRAY CLOTHES WASHER .SR LE. J I. TOTAL NO. - (d o.eo e% APPROVALS vIlyd AQy, DATE INSPECTOR S SIGNATURE GAS SYSTEM-OUTLETS 61.00 - WATER HEATER Cu 1.00 UNDER SLAB WORK ROUGH PLUMBING PERMIT S 1 00 GAS PIPING TOTAL FEE / ? C' GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE HEAD 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, 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GASTEST LICENSED AS REQUIRED BY LOS ANGELES Cp.UWfTTAND STATE-OF _ CALIFO P.NIA OR THAT I AM L O NN ER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL , SIGNATURE -/ - pp OF PERMIT FI NALJFI: fi`60yE `)A'.�/'JF'71>ADl.AiL' MOTE OF 3`2.6. WILLIAM J. FOX, CoI6NTY ENGINEER VALIDATION R. A.WOOD. CHIEF PLBG. INSPECTOR �Co 6 50 S AUG 10 . 3 2.6 0 o� WORKEtCOMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT • 'I hereby�affirm that I have a certificate of consent to self ]6Ab67A insure, dr a certificate'of Workers' Compensation Insurance, CE 817(REV. 10/81) ' 'or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY LOS ANGELES BUILDING AND SAFETY t o.co Policy No. Company ❑ Certified copy is hereby furnished. BUILDING F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspec- ADDRESS , _ NUMBER FIXTURE OR ITEM tion deportment. © FEE LOCALITY �7,2,,ca�,�5 Date Appl ic.ont WATER CLOSET Co 36 O NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS Si. v4/ /f/ ry EAl> COMPENSATION INSURANCE OWNER- / SHOWER ..cpT— (This section need not be completed if the work involved by OD SA permit is for one hundred dollars ($100)or less.) LAVATORY MAIL 0 ADDRESS 3 certify that in the performance t emplo a the work for which this �/V permit is issued, shop not employ ony ersfflaL� 3 SINK CITY C ,-L/y nf��/� TEL. NO.� _ y so as to become subject to the Work o CJ/'x,j' DISHWASHER CONTRACTORDate /l-.,?o-SISApplicani CLOTHES WASHER lKJ NOTICE TO APPLICANT: If, after m king this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR lB��� Compensation provisions of the Labor Code, you must forth- CITY TEL. N with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM ✓ STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION ) 00DISTRICT[Jg./ CESSE BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM �Q OUTLETS S (///oV (commencing with Sectionof Division 3 of the Business OUTLETS OVER �• and Professions Code,and myy license is in full force and effect. 5 PER SYSTEM FINAL �/ VA ATION License Number Lic. Class DATE /. DtJ FINAL Contractor Date B 0 ❑ 1 am exempt under Sec. w a B.aP.c. for this reason N Date: Plan check fee Poo PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE z351,4A Plan check applicant �r,.xei NS SINGLE FAMILY #•' e o 0 0 0 5 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address V/L Pro cions Code): City ;fJ Tel. No a ^ L Q,5 t7'-Si Ov L��A7 0 g/ 6' / I, as owner of the property, will do the work and the I �•2 0-8.5 structure is not intended or offered for sale (Section , 7044, 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 a e- tionr7, drty f r inspection purposes. / /// SEE REVERSE FOR EXPLANATORY LANGUAGE CVJ/�/t ignature of Permittee Date