HomeMy Public PortalAbout9102 HERMOSA DR_Plumbing__ 76A667 CE#817 561'
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINES//
BJOHNIIA. LAMB E COUNNTTY ENGINEER A
DDRESS 9102 E. Hermosa Dr.
WILLIAM A. JENSEN, SUPT OF BUILDING CALITY
Tem le Cit C;t c
FOR APPLICANT TO FILL IN OSS dNUMBER FIXTURE OR ITEM NERWilliam J. Leen
wATEa cyosET ADDRESS 9102 E
SHOWEBATH R
CITY Temple Ci - NOAt 6-0862
SHOWER
CONTRACTOR ARCO PLUMBING Co
LAVATORY
SINE ADDRBSS527 West Garvey -
DISHWASHER CITY Monterey ParPP- HO. CU - 0
LAUNDRY TUB REGISTRATION ANO. 113206-C36 CO TUNTY
CLOTHES WASHER DISTRICT/NO. GROUP I ZONE PROCESSED BY
1 WATER HEATER .h- Q i 'Fuel 2 a, d
INDUSTRIAL O
GAS SYSTEM WASTE APPROVAL V
INSPECTION RECORDIm
I�'
n �f/n a-rL.0 L/"8n•s.L�_ Na7L�f.L/ � u
z
Q $1.00 PER ITEM
1 OR FIXTURE $ 1• G APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00UNDER SLAB WORK
TOTAL FEE 1 $3 .92ROUGH PLUMBING
GAS PIPING
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY GAS VENT I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER lII^1I ln'I
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES •I I
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 1
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED,RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE FINAL
VALIDATION ROBERT A.I WOOD
p K! M.G. '/DAR SUPERVISINGIMECHANI/ENG'R
L� 8928 FEB ?8 5 D 3 .00 e
a n WORKERS COMPENSATION DECLARATION 1 C/' /� T
I hereby, off um'jhat 1 have a certificate of,consent to'self"m 20-0026 DPW 4187 APPLICATION FOR PLUMBING PE.R PERMIT
sure, or.a certificate of Workers'{om ensotian Insurance,or a ,76A667A
P - 'CE 817(REV. 8/86) • — - - —fi
certified copy,thereof (Sec 3800
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS,
Policy No.' Company.
O;�Cenifiedcopy is hereby furnished F BUILDING
- 'FOR APPLICANT iOFILL'IN'(PRINT OR TYPE)
L
Certified copy is filed with the courtly building inspection - - ADDRESS / v'' - /yd` p r' t�
.department. NUMBER FIXTURE,OR ITEM ° @ FEE -
LOCALITY 7cMGL
Date "'- Applicant WATER CLOSET
1. (TOILET)
- NEAREST - - -
I - - - ,
,( Tr' CERTIFICATE OF EXEMPTION FROM WORKERS' x . � ,BATH TUB CROSS ST.
COMPENSATION INSURANCE. I OWNER • �s /,���
r - SHOWER w s: / ,. Y� d n/,
(This sectiori'need not be completed icthe.�vork'involved by - MAIL
-,the,permit is for one hundred dollars (5100).or.less;) LAVATORY - ADDRESS7N
I certify that in the performance of the worm for.whlch this per- • -
mit is'issued' (shall not employ any person'in onymo'nner so SINK" CITY �?�, � r TEL. C
asfo'becomesubject rothe Wdrkers Compensation Laws. , O '
'., ' ^ . r � DISHWASHER- - ^• CONTRACTOR. x: .
Dote Applicant - CLOTHES WASHER ADDRESS
,NOTICE NOTICE TO APPLICANT If, after makirg this'Certifcate'of Ex- SWIMMING POOL RECEPTOR
empti m you shoald.become subject to the Workers'Comport- - CITY .. TEL NO,
sotion'p no visions-of the Labor Code _you mustforthwith comp_ n' - i _ LAWN SPRINKLER SYSTEM -
•y,with such provisions or thispermit sholl`be deemed:.revok- STATE UC. •
ed " WATER•HEATER 't• r LICENSE NO r CLASS
-LICENSED,CONTRACTORS DECLARATION 'j - DISTRICT O CESSEIi BY -
L. GAS'.SYSTEM OUTLETS „p
I hereby affirm thot'I am licensed under provisions of Chapter - _
9.(commencing with Section 7000)o$Division 3 of the Business _ OUTLETS OVER 'il r '
. and Professions'Code, and my license is in full force and ef,- 5 PER SYSTEM FINAL r VLIDATION >
feet .-
_ DATE:
License Number ''bc..Class / O
d- U
FINAL
Contractor - ' .. Dated _ - BY O
F
. . U.
•I-am exempt under Sec a
-B 8P C .for this reason- - , N
Plan check fee _ - Z
. Date: '- r . :
_ PLUMBING PERMIT ISSUING FEE$
re
.. ' . - TOTAL FEE t•f
SINGLE FAMILY - . _
` HOME�OWNERL BUILDER DECLARATION Plan check applicant 5._ _
tt
' I Hereby affirm that a am:exempt from theComractor's'License [Address
me , -
Law,for the following reason .(Section 7031.5, Business and �N "r x ( �'�. �' F�{'�'T'T .
P ofessions Code): 0 '� •�. �/�M l ch r` ' M7 ,ibI, as owner of the property will d•me work and the y S c �'V-;� Tel. o' - rr-�6� ITE
structure is not intended or offered for.sale•(Section 7044, _ ' - '
Business and.Professions Code)' _ - - - - 1 - 16 s c
POP.
'rj`f CONSTRUCTION,LENDING,AGENCY rLs('V 6.,
Ihereby,offirrn that there is a construction lending agency.for -
the,performance-of the work for which this''permii is'issued - -
' (Sec 3097• Civ. C.).
,Lender's Name •. .CHANGE
Lender's Address - -
I'certify that I have read ihis".apphcotion and state,that the p41�_I�QQ �'�"�/g9
above.nformation is correc) I agree to comply with all County - Ipool
ordinances cmd`State laws'regvlating Plumbing, and hereby .. ` �s. JS 9:22 r,
_ 1 1�
authorize represent fives of th is"Cou my to enter upon the - - ''- �^ J .. ' 1 AM
ob -me tion ape rty for inspection purposes:
SEE REVERSE FOR EXPLANATORY LANGUAGE
i ' tureo er ittee