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Home My Public Portal About9229 KEY WEST ST_Plumbing__ 78A667-C Ei1SI7 5/63 I APPLICATION FOR',PLUMIBIN PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION fN7EAREST JOHN A LAMBIE. COUNTY ENGINEER WILLIAM A JENSEN, SUP T OF BUILDING FOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM EACH FEEWNER , WATER CLOSET $125 () BATH TUB 125 ADDRESS 2 / / NO SHOWER 125 CITY TE LAVATORY 125 aCONTRAC70H ` SINK 1.25 ADDRESS DISHWASHER 1 25 CITY TEL NO/v-/-, STATE LAUNDRY TUB 125 R GINS�TRAi ON NO. /-1-S® 15CTOR'S — COUNTY ❑ CLOTHES WASHER 1.25 DIST RI NO GROUP � � PR CES D Y WATER HEATER 150 GAS SYSTEM OUTLETS 1.50 INDUSTHL4,L a WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD U O HU til a h Z '�f ? APPROVAL V / DATE, f' INS E_CTOR- SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING �`7`•�fl3 � � TOTAL FEEGAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGFLU HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES ' ! LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DW9-CjABED RESIDENTIAL P PERT UTILITY CO NOTIFIED ...y SIGNATURE A i OF PERMITTE �� FINAL ! . LIDATION ROBERT A WOOD cK M O CASH SUPERVISING MECHANICAL ENG R LiTo 4 ,6 5 81-0 JP,P>f 2 0 5 0 13.75, 76A667 08917 11-50 APPLICATION FOR PERMIT ,_DEPARTMENT OF BUILDING AND SAFETY ' COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DISTRICT O. OU ZONE FOR APPLICANT TO FILL IN � 17�'y� 6 PLUMBER 1, �'I fes' �-e?�-� L RECE VED BY READY FOR DATE ISSUED FIRST INSPECTION / s/ ADDRESSBUILDING CITY ed `l"`��r"" TEL. NO.,A p b47 ADDRESS LICENAf_ NO. ® EXPIRES LOCALITY NEAREST / a PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER �p 1 MAIL ^ ' WATER CLOSET(TOILET) @ 0.50 $ ADDRESS BATH TUB @ 0.50 4159�CITY TEL. NO. r / �°6� SHOWER @ O.SO 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 1 AM THE LEGAL OWNER OF THE RESIDENTIAL P�RO7PER'',�1f]j DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 -l SIGNATURE OF ( {�!-`-%"'`" �� )j��t,(, ��'"'t%(✓o.'p=j WATER HEATER @ 0.50 PERMITTEE ' SLOP BINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ O.SO DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J Q HOUSE SEWER @ 0.50 _Z MISCELLANEOUS O Q. O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING i GAS VENT CESSPOOL @ 1;00 CESSPOOL ' SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT I 1.00 GAS TEST UTILITY CO.NOTIFIED n�^� TOTAL FEE �� FI NAL ,.,, ;• AGVORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A Ar insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) ,� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Sr� a5ZAZZ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Dates •� ��Ap�PTIFROM e _ WATER CLOSET NEAREST CERTIFICATE OF WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER Z (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS i F I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.�g 7 so as to become subject to the Workers'Compensation Laws. DISHWASHER oma' /�� CONTRACTOR l!J Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of ��✓��/ Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY� TEL. NO. G Compensation provisions of the Labor Code, you must forth- SiG LAWN SPRINKLER SYSTEM with comply with such provisions or this permit 'shall be STATE y�v� C� LIC. deemed revoked. WATER HEATER LICENSE NO. vC�1s� / CLASS LICENSED CONTRACTORS.DECLARATION DISTRICT NOROCESSE 'BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL VA&ATION @6 DATE License Number Lic. Class FINAL Contractor Date BY �D ° t y3�7/ I am exempt under Sec. B.&P.C. for this reason Plan check fee � Date: �20a3A PLUMBING PERMIT ISSUING FEE$ Signature # o o o o o 5 TOTAL FEE Plan check applicant ( o o 1 6 5 0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o o'o 1 650Q7: I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and O ca 2 1 —85 Professions 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. I 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0.,S nfTuure of Permittee Date 'WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMING PERMIT •I hereby affirm thp,t I have`a certificate of consent to self 76A667A insure, or a certificatc,of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. El Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 922.9. Key West Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY Temple C I t y Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. s ' COMPENSATION INSURANCE SHOWER OWNER Pa.U 1 Gonzalez (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAILSame ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'ComM;w DISHWASHER 1 - 4- 14-8 6 CONTRACTOR Con t r.01 Ener E n g r . Date Applicant CLOTHES WASHER ADDRESS 1 3.3 2 A . Miller NOTICE TO APPLICANT: If, after ming this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become s bject to the Workers' CITYAn a he i m TEL.949.3—0 3.0 3 Compensation provisions of the Labo Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. 463595 CLASS 4 4 LICENSED CONTRACTORS DECLARATION DISTRICT NO. CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS , ok (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER t and Professions Code,and m license is in full force and effect. 5 PER SYSTEM y FINAL VAL ATION I Solar Pool Hea er DATE '- License Number_ 4 F+Gr5_Lic. Class C 4 4 U FI Contractor C o n trol E n e rpg, 4- 14-86 a I am exempt under Sec. � @s B.&P.C: for this reason � Plan check fee 00 ;2 4 4 6,0 A Date: PLUMBING PERMIT ISSUING FEE$ Signature # o 0 0 0 0 5 TOTAL FEE ) - 3050 Plan check applicant SINGLE FAMILY 0 0030,50:05 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Q 1 -86 Law for the following reason (Section 7031.5, Business and Professions 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. I agree to comply with all County or inances and State laws regulating Plumbing, and hereby a hor:ize ��t of this County to enter upon the a ve-me for in ose3. SEE REVERSE FOR EXPLANATORY LANGUAGE �2 Si nature of Permittee Date