HomeMy Public PortalAbout9241 KENNERLY ST_Plumbing__ 76A667 138917 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DIST 14-0. Gpmup ZONE PERMIT NEI.
FOR APPLICANT TO FILL IN
PLUMBER`k. • { ` �� /EIV gY READY FOR a DATE IS ED
yam+ FIRST INSPECTION r�
ADDRESS 1,/4
CITY ''` A TEL. N �dg-41'/ ADDRESS
COUNTY v /IA D �(" LOCALITY '
LICENSE NO. EXPIRES
NEAREST -
PERMIT FEES' CROSS BT
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER rV
MAIL 04
WATER CLOSET(TOILET) @' 0.50 S ADDRESS
BATH TUB @ 0.50 CITY R/ TEL Nu. ` ?
SHOWER 0.50 1 HEREBY ACKNOWLEDGE 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 @ 0.50 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
w� OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAB SYSTEM.?OUTLETS @ 0.50 " AQ I�
SIGNATURE OF (�Ja��ff
WATER HEATER @ 0.50 PERMITTEI
SLOP SINK @ 0.50 - INSPECTION RECORD `
FLOOR SINK @ 0.50 ,
FLOOR DRAIN @ 0.50 -
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50
URINAL @ 0.50
Q
HOUSE SEWER 0.50 _ _Z
MIBCEL NEOUS - •E3
• O
APPROVALS
DATE INSPECTOR'S NAME
o I I
ROUGH PLUMBING
GAS PIPING (N►✓+
OAS VENT 2
CESSPOOL @ 1.00 I CESSPOOL
SEPTIC TANK: SEPTIC TANK-
DRAIN ( )• PIT ( ) @ 1.00 SEWER '
PERMIT . . . 1.00 ^ OAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE
s� r �
FINAL
WORKERS'COMPENSATION DECLARATION 78A687AA P P L I C A►T I O N FOR PLUMBING PERMIT
I hereby affirm that I have a' certificate of consent to,,self, cr. s17 ('i V4
insure, or a certificate of Workers'Compensation Insurance,or 3'
a,certified copy thereof(Sec. 3800,Lab. C.)
COUNTY OF LOS ANGELES , BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUI,LDINGq A
ADDRESS
rtified copy is filed with the county building inspection NUMBER, FIXTURE OR ITEM • FEE
Ce
department. WATER CLOSET LOCALITY^TYlnn
..�—� ��'��•
Date Applicant NEAREST :
. BATH TUB CROSS ST_.
CERTIFICATE OF EXEMPTION-FROM WORKERS'
COMPENSATION INSURANCE SHOWER 'OWNER
MAIL
(This section,need not be completed if the'work involved LAVATORY ADDRESSd
by the permit'is for one hundred dollars ($100) or less.) SINK - O
CITY TEL. NO.•.
I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not emMiny person any manner, CONTRACTOR; L O
so as to become subject to th ' sation'Laws. CLOTHES WASHERDat� pplicantADDRESS L W
SWIMMING POOL RECEPTOR a
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. N
Exemption, you .should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO CLASS '
with comply 'with such provisions or this permit shall be
deeiried revoked. DISTRICT NO. P SSED BY
GAS SYSTEM OUTLETS
LICENSED CONTRACTORS DECLARATION• OUTLETS OVERQ�
I hereby affirm that I am licensed under provisions of Chapter' 5 PER SYSTEM
a�l .
9 (commencing with Section 7000) of Division-3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE —Z
effect:
FINAL
License Nu r Lic.Class ( BY
Contractor Date 5g—J_,q fe
I am exempt from the licensing requirements-as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ,
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 Address the Contractor's � �i t�ti� - •
License Law for the following reason (Section 703 1.5, Busi- City Tel.No. — 5 9 Q 4 A
ness and Professions Code): �'
aI, as owner of_the property, am,exclusively contracting -W0 0 0 0 0 5
with licensed contractors to construct the project- •
(Section 7044, Business and Professions Code). 2"o 0 3 25 0
CONSTRUCTION LENDING AGENCY o,o o ,32 5 0 v
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 0 a•2-7'-8 2 :
issued(Sec. 3097,'-Civ.C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the
Ninformation is correct.I*agree to comply with all CountySEE REVERSE FOR EXPLANATORY LANGUAGE
d State laws regulating Plumbing, and herebyesentat* of this County to enter upon•,the
e r e for inspection purposes.
Signature of,Permittee Date