HomeMy Public PortalAbout9960 HOWLAND DR_Plumbing__ COUNTY OF LOS ANGELES APPLICATION. FOR PERMIT
Dd'partment of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
:5-7/ v
PLUMBER C• �,� ® o k D ®y READY FOR DATW ISSU D
FIRST INSPECTION G �•_p
ADDRESSf!!GJ .J
6 92A EBUILDING
CITY TEL. No. �YADDRSS i6a
tel-
COUNTY -LOCALITY
LICENSE NO. EXPIRE
NEAREST
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERC. �• G 5g
MAIL
WATER CLOSET(TOILET) @ 0.50 $ ADDRESS pic. �Q./ /� / Y ���99
BATH TUB @ 0.50 CITY 1 TEL. NO1 G. 1�(f/2
SHOWER @ 0.50 1 HEREB ACKNOWLE E THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ O.SO AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 - ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDE IAL PROPERTY DESCRIBED AB VE,
GAS SYSTEM OUTLETS (�_b 0.50 !
SIGNATURE ❑F �t
WATER HEATER @ 0.50
PER MITT 4•
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50 ,
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 'U
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS O
Q
J1�-.
Y"-�
9
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . . 1.00 GAS TEST
TOTAL FEE UTILITY CO.NOTIFIED _
®m FINAL --``
76A667 DBS#17 6-52
WORKER'S COMPENSATION DECLARATION 76A867A V9f89 APPUCAMN FOR PLUMBNG PERNT
I hereby affirm that I have a certificate of consent to self insure, a!
_or a certificate of Worker's Compensation Insurance, or a certified c �°
copy thereof(Sec.3600 ab.C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �•' ��-( �ltT
❑ Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM Q FEE
LOCALITY • y
Date Applicant WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less,.) , OWNER2£�y
/may _r
I certify that in the performance of the work for which this permit �'
LAVATORY ✓L/JR.• ir�fr�
MAIL
is issued, I shall not employ any person in any manner so as to SINK , ADDRESS �� /f� �i
become subject to the Workers'Compensation Laws. p
� DISWASHER _� CITY /�/���� �y �j���TEL.NO.Gf
Date Applicant CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of . 29L t��L/
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION I WATER HEATER CITY TEL.NO. d
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000 of Division 3 of the Business and STATE LIC. O
( g ) LICENSE NO. CLASS
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V
OUTLETS OVER DISTRICT NO. PROCESSED BY / a:5 PER SYSTEM \ �� CUP/L'-L�IZ�C�is� O
License Number Lic.Class V
_ FINAL / VALIDATIONW
DATE ` _�i a
Contractor Date V /1 J ris_(,s _ (/)
El am exempt under Sec. / FBY
INAL ,// -- -=�_
B.&P.C.for this reason p 0/y\� "
Plan check fee
Date:
PLUMBING PERMIT ISSUING FEE$ �/f HL
Signature %;: -:H
TOTAL FEE fir:'
Ott'•
Plan check applicant t l (")N-6EE ,I ii:
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law !.liryrtY�;i�;'s i s = r _ f
it
for the following reason (Section 7031.5, Business and Professions Address. .. .. � • -
Code): " C')i''
City Tel.No. - -
1,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. I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
represent ryes of this County to enter upon the above-mentioned
property pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
S gnature of Permittee Date