HomeMy Public PortalAbout9831 HOWLAND DR_Plumbing__ TEA.17 APPLICATION
10.59 FOR PLUMBING PERMIT 1
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DIVISION OF,BUILDING AND SAFETY
Deportment of County Engineer
�+ County of Los Angeles BUILDING 2/_ �^ / •.,u Li
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J
V� CASSATT D. GRIFFIN, SUPT OF BUILBING
LOCALITY
FOR APPLICANT TO FILL IN NCROSSEAREST. G' {+1•`�
OWNER • •LVyy/ Z / o�fy//}'/J' DISTR_IICCT NO. GROUP /ZONE READY FOR INSPECTION
MAIL
ADDRESS
(' INDUSTRIAL
CITY TEL. NO. WASTEAPPROVAL
PLUMBER .. •oGlil�l Co, INSPECTION RECORD
ADDRESS ')yy')rl///5
CITY 5wcv"v+^''w TEL. NO.
LICENSE NO. 'Al JJ
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 S
BATH TUB .00
SHOWER ' �� L�+�' @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY T US OR TRAY @ $1.00
CLOTHESWASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT S I 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE A
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES 1 I'_"- bC
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST +
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTI PROPERTY. T
SIGNATURE ,
OF PERMITTEE VW FINAL 'llI QTt
V
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR
CK. N.•. 7
H
L&3 3 5 7;° DEC 13 3 2.0 0 In
O affirm that
I have a- ION DECLARATION CE 81a APPLICATION FOR PLUMBING PERMIT
affirm that I have a certificate of consent to self ce eir (z-sol
or a certificate of Workers'Compensation Insurance,or
tified copy thereof(Sec. 3800, Lab. C.) C COUNTY OF LOS ANGELES BUILDING AND SAFETY
U�CilpLI7t3 0M 1 CnI4&
.Policy Nn. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified co NUMBER FIXTURE OR ITEM • FEE ADDRESS —
pyis filed with he county building inspection �7
de art ent. -- // WATER CLOSET LOCALITY PLC
Date �� Applicant ` OVV'� : ld♦:]KL�S NEAREST /
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. L� ,AJ�_
COMPENSATION INSURANCE SHOWER OWNER a
f
(This section need not be completed if the work involved LAVATORY MAILADDRESS ci P
,3 L.f.QJ..I T
by the permit is for one hundred dollars ($100) or less.) SINK CITY _ ,y .�.t�. TEL.NO. 'L C�b'Z
I certify that in the performance of the work for which this DISHWASHER �^ U
CONTRACTOR
permit is.issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS -- \\ 0
Date Applicant SWIMMING POOL RECEPTOR `' Cl U
NOTICE TO APPLICANT: If, after making this Certificate of CITY f_f r—tW Y TEL.NO. C
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE ��tt LIC. CZ r[,f0 to
Compensation provisions of the Labor Code, you must forth- L.n LICENSE NO. S9 9 CLASS C e Z
with comply with such permit shall be WATER HEATER
p y provisions or this
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. �j PROCESSED BV
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL
ness and Professions Code, and my license is in full force and DATE / Z¢—�r VALIDATION
effect. Q � (3,CZCIO rC2p
License Number ✓?(LLLL— Lic.Class C- FINAL
'jQ ��[
Contractor1 6&87 Q10.xx7 Date 1 ;yg
I am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ y G^ r
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code):
1, as owner of the property, am exclusively contracting 223 6 0 A
with licensed contractors to construct the project
(Section 7044, Business and Professions Code).
gooeoo5
CONSTRUCTION LENDING AGENCY Z 250
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is o 0 0 2 S 0
issued (Sec. 3097,Civ.C.).
mu
Lender's Name
1217-81
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
o 'nances and State laws regulating Plumbing, and hereby
oath 'ze representatives lof this County to enter upon the
above- en lured p open or inspection purposes.
Srgnat ore of Permittee Date
1.