HomeMy Public PortalAbout9252 KEY WEST ST_Plumbing__ 76A667 Des 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENOINEER PLUMBING 1
DISTRICT O. GROUP ZONE PERMIT No.
,BFOR APPLICANT TO FILL IN
PLUMBER L �. "--' -" ` . RECEIVED BY READY FOR DATE ISSUED
Q FIRST INSPECTION /
ADDRESS
BUILDING
CITY TEL. N00% r-amv It y y y
ADDRESS
COUNTY TY
LICENSE NO. C Y EXPIRES 0 f� LOCAL[
NEAREST
PERMIT FEES CROSS BT.
��''IIIIll
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER
MAIL
WATER CLOSET(TOILET) 0.50 # ADDRESS
I BATH TUB 0.50 CITY 1(TfiL�ie.��bb TEL. No. ea-93
SHOWER 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK (5) 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY (� 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OAS SYSTEM—J--OUTLETS 0.50 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
SIGNATURE OF �/ ✓9'6 �1.r ("'y"f'�y'G .
WATER HEATER 0.50 PERMITTEE
SLOP SINK 0.50 _ _ - - INSPECTION RECORD -
FLOOR SINK 0.50
FLOOR DRAIN 0.50
DISHWASHER ® 0.90
DRINKING FOUNTAIN 0.50
URINAL Q 0.50 J
Q
HOUSE SEWER 0.50 Z
MISCELLANEqO�U/S��y3
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
OAS PIPING I j S/
'v I
GAS VENT ,L ti
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.0131 1 SEWER
PERMIT . . I 1.00 GAS TEST
UTILITY CO.NOTIFIED B
TOTAL FEE
a /
FINAL
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90
76A667A
sure,or a certificate of Workers'Compensation Insurance,or a
certified copy thereof (Sec 3800, Lab C )
Policy No Company
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Fj Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
F]
Certified copy is filed with the county building inspection ADDRESS
department NUMBER FIXTURE OR ITEM (al FEE LOCALITY
DoteApplicant WATER CLOSET(TOILET) NEAREST
!� d fi
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST t..)_
COMPENSATION INSURANCE SHOWER OWNER �,L (_� ��R �• L- L
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less ) LAVATORY- ADDRESS
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so SINK CIT �� �� �_ TEL NO_2eS—�
as to become subject to the Workers'Compensation Laws DISHWASHER If -
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL NO
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC
ed WATER HEATER r - LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO roe,,,
/ PRROCCESSIED BY
'
I hereby affirm that I am licensed under provisions of Chapter- GAS SYSTEM OUTLETS L`s
9(commencing with Section 7000)of Division 3 of the Business - OUTLETS OVER _ _ ;
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL N�4,�DATION
tett HOSE BIB DATE
License Number Lit Class FINALNE - 0
Contractor Date BY '
!_-T
kL
E_a 0
1 am exempt under Sec ( ECI, sit
U
B&P C for this reason W
Plan check fee '_Iirtt�' = a =1_) H
Date PLUMBING PERMIT ISSUING FEE$
Signature +-
TOTAL FEE
SINGLE FAMILY �
HOME OWNER-BUILDER DECLARATION Plan check applicant -t_!!;,-
1 AM11'.4'_
1 hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031 5, Business and
Professions Code) Address
1, as owner of the property, will do the work and the City Tel No
structure is not intended or offered for sale(Section 7044,
Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construcnon 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
abo e-mentioned property for inspection purposes
g- g SEE REVERSE FOR-EXPLANATORY LANGUAGE
S rga-ture Permittee D to