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Home My Public Portal About9133 HERMOSA DR_Plumbing__ D.B. n 25M SETS 12-43 -APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OX. LOS ANGELES WM.J. FOX, CHIEF ENGINEER g TURE OF INSTALLATION DISTRIC .NO. GROUP ZO PERMIT NO. FIXTURES COMPLETE s RECEIVED,BY FIRS /{N Y /FC ION ATS'ISSUBD GEBHPOOL SEPTIC TANK "/ VMISCELLANEOU/ A�/PyPPyL�ICANTFILL I-N HEAVILY OUTLINED PORTIONONJOB . /j//iL�[iF"/' e[ _d/l //Y ��1�'`I O,l,0, 4:V ADDRESS ADDRESS 4r LOCALITY, /\ l w - NEAREST y CITY /'\ �11i./b� /Y�a iMi�XTELjNo. CRO80ST. c?. LOCATION COUNTY CERT.No. - - �" EXPIRES S NAME �fl�. lJ • LOCATION OF SEPTIC TANS, OR CESSPOOL z MAIL V 3 ADDRESS NORTH O CITY TEL.NO. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. > 3 N OWNER '1 CORRECTIONS SOUTH J DESCRIPTION OF WORK a z_ BATH TUB FURNACE CD m SHOWER DISHWASHER D LAVATORY REFRIGERATOR KITCHEN BINK WATER SOFTENER FLOOR BINK SANDTRAP GLOP SINK FLOOR DRAIN L-WASHTRAY URINAL APPROVALS ER CLOSET DRINKING FOUNTAINDATE INBP[CTORE M.�M[ ER HEATER DENTALLAVATORY ROUGH PLUMBINGEn GAS SODA FOUNTAIN, GAB PIPINGOUTL GAS VENTCESSPOOLAL NUMBER OP FIXTURES SEPTIC TANKSPOOI REPTICTANK V V SEWER I i/ S / UTILITY CO.NOTIFIED TOTAL FEE FINAL � _l/_(/Lf 78A667-CE617 3-59 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESS JOHN A. LAMBIE. Couuty Engineer CASSATT D. GRIFFIN, Supt of Building YFOR APPLICANT TO FILL IN T. NUMBER FIXTURE OR ITEMWATER CLOSET BATH TUB SHOWER CITY TEL. NO. p LAVATORY CONTRACTOR SINE ADDRESS DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. � Y ✓ COUNTY ❑ CLOTHES WASHER DISTRZ�NO. G,Bqup ZONE PRO ESSED BY WATER HEATER / i5 ' — GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD /_=' 1 0 $1.00 PER ITEM OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTALFEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENTWITH ALL PLUMBING COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE GAL9W OF THE ABOVE DESCRIBED RESIDENTIAL PROPERT J UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL ®F OVAUDATION ROBERT A. WOOD, QK. B.o. cAsx SUPERVISING MECHANICAL ENG'R has-3 1 s r� 2 p s A 3-0 0 WORKER'S COMPENSATION DECLARATION 76A667A DPW 9,89 .APPLICATION FOR PLUMBING PERMIT I hereby affirthat I 20-002,.�that h9ve a certificate of consent to self insure, or a-certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) - COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished, BUILDIN _ F] G Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS department. NUMBER FIXTURE OR ITEM [q FEE LOCAU p OQ Date Applicant ILAVAORY SET V t� NEAREST 1 0 M w CERTIFICATE OF EXEMPTION FROM WORKERS' \ CROSS ST. F-� - COMPENSATION INSURANCE ASSESSOR C¢¢�1 q (This section need not be completed if the work involved by the MAP BOOK 5',-J,g PAGE 0/ PARCEL 037 permit is for one hundred dollars($100)or less.) ` OWNER �� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to MAIL 1^� ^.^ ,e become subject to the Workers'Compensation Laws. - ADDRESS 4 // v� GM-Se CITVTEL.NO.Date Applicant ASHERNOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR _Exemption,you should become subject to the Workers'Compensation OOL RECEPTORADDRESS provisions of the Labor Code, you must forthwith.comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. } I hereby affirm that I'am licensed under provisions of Chapter 9 WATER HEATER 11 (commencing with Section 7000) of Division 3 of the Business and STATE LIC. O Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS U 1 OUTLETS OVER DISTRICT NO, PROCESSED BY Ir 5 PER SYSTEMry Q License Number Lic.Class OC Z�C.c.ti firLG FINAL �— V�/ VAL-1_ D� ATION a DATE IiJJ Contractor Date W ❑ :... !am exempt under Sec. BWAL Z� �'Iw ,i2=�_� IS B.&P.C.for this reasondill 1 't!t` Plan check fee =ice Date: / ►' f 1 Yi _ a a __- Signature PLUMBING PERMIT ISSUING FEE$ ❑ _ TOTAL FEE C:1Hf1(�- SINGLE FAMILY Plan check applicant �a 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 Professions Address Code): City Tel.No. I, as owner of the property, will do the work and the 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. agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize. - representatives of this County to enter upon the above-mentioned property for ��inspection np�purposes..� _ SEE REVERSE FOR EXPLANATORY LANGUAGE ' 1 'Signature of Permittee Dat