HomeMy Public PortalAbout9253 KEY WEST ST_Plumbing__ 76AS67-DBS 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY �� amm Es'���
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. •
FOR APPLICANT TO FILL IN R
OUP I ZO-NE PERMIT IND
PLUMBER �' a l ICA" RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS �� � � �+ 4. �f//Y_\/"' � �S
BUILDING dy y •/, �f.� ,
CITY TEL. NO. G O o ADDRESS
COUNTY 4p3 LOCALITY
LICENSE NO. 4
d Y EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER'~ '
MAIL Lam.
WATER CLOSET(TOILET) Q 0.50 m ADDRESS 6 �j
BATH TUB 0.50 CITY if. TEL ND. + ,/
SHOWER O 50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Cry 0.50 APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I
CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS SYSTEM--3—OUTLETS 0 0.50
OF THE RESIDENTIAL OPE TY D SCRIBED ABOVE.
�a `?•..'{�p,L� ,�'�'"fL� _I+
SIGNATURE OF G� L I
WATER HEATER 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR BINK Q 0.50
FLOOR DRAIN 0.50
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50
URINAL 0.50 J
a
HOUSE SEWER @ 0.50 Z_
MISCEL,LANEOUS t7
(Y
O
APPROVALS
/BATE INSPECTOR'S NAME
ROUGH PLUMBING
OAS PIPING
GAS VENT
CESSPOOL a 1,00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ) PIT ) @ 1.00 SEWER
PERMIT . . 1.00 GAS TEST
UTILITY CO.NOTIFIED /
TOTAL FEE
r FINAL
WQRKERS' COMPENSATION DECLARATION 'APPLICATION FOR PLUMING PERMIT
r 20-0026 DPW 4/87'
I,her �iffirm that.l-hove a certificate of consent to sel'or a
ire,or 6-certificate of Workers'Compensation Insurance,ora 'CE 817(REV 8/86)
'certified copy thereof (Sec 3800, Lob`C )? ;
Folic y oN COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
, Company „F '�. > .-
' c_
❑_ Certified'copy is'hereby furnished BUILDING
FOR APPLICANT TO FILL IN (PRINT OR TYPE) r+
Certified copy is filed with the county building inspection ADDRESS �3 . �
department NUMBER FIXTURE OR ITEM tl.� Ca^ s FEE 4 { '
� a ^ r LOCALITY z
Date- Applicant / WATER CLOSET(TOILET,)
y NEAREST J „� �SA t. �, H&JO0
CROSS ST G,J'► L
CERTIFICATE OF EXEMPTION FROM WORKERS" BATH TUB _
COMPENSATION'INSURANCE t =`- s OWNERS/ 'J; �'
SHOWER fr
(This section need not be completed if the work involved by MAIL _ N s,
the`permit is for-one hundred dollars ($100)or less ) LAVATORY ADDRESSg59f A -q4, l LJ�y
I certify that-irithe performance of'the work for'which this per-
mit is,issued,I shall not employ any person in any manner so SINK CITY T �� TEL-NO �
as to become subject to the Workers'Compensation Laws
DISHWASHER 7b , ,� f^AE n�
CONTRACTOR J�/ mr
Date Applicant �� CLOTHES WASHER ADDRESS
NOTICE O APPLICANT If,after`making this e'tificate'of 76 SWIMMING POOL RECEPTOR
emption,you should become subject to the rkers'Compen- - - CITY �g3_ 3?J
-,satian proLisions of'the Labor Code;you must forthwith comp- LAWN SPRINKLER SYSTEM
ly wrth such provisions''or this pe�mrt shall be deemed revok- STATE LIC
ed WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS'DECLARATION ;r DISTRICT NO PR -CUSSED BY
• GAS SYSTEM- OUTLETS
I-hereby affirm that I am licensed�under_'provisions,of Chapter G .f
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER '
and-Professions Code, and'my^license is in full force and ef- -5 PER SYSTEM FINAL VALI TION a .
fect?jC o- ti b DATE
<, O
License Number Lic Class U
FINA
Contractor Date BY a O
r� w 0'5 7.9 A �.
*I`am exempt under'Sec J W
# e o o a 0-5 d
B &P C,for this reasonV1
Plan-,check fee �. 2'a 5 0
' Date PLUMBING PERMIT ISSUING FEE$ _
i^ ' Signature c' o o 0,2&5,0 0
_ TOTAL FEE q,
t w� SINGLE FAMILY
HOME,OWNER'BUILDER DECLARATION Plan check applicant �� ffJ
0901 t88
I hereby affirm that I am exempt from the Contractor's License -Name
Law for the.followin9 reason=(Section 7031 5;,Business and
' Professions Code) Address
1, as owner of the property, will do the work and`the City JTM,0� C! Tel'No 6,- L 174-
st�,cture is not intended or offered'for sble,(SectionJ044, r F _ ,
B'usmess and Professions Code)
CONSTRUCTION LENDING AGENCY
_ hereby affirm that there is a cmnstructiori lending agency for
the-performcince of the work for which this permit is issued ;
(Sec -3097, Civ C )' t
? I - v _ 5 ` �1;>` � •� }�- - , _ - .. . - . L <,.
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 r
ordinances and State laws regulating Plumbing, and hereby -
authorize erepresentatives,of this County to enter upon the " -
obov'e-mentioned property forspe n purposes r
r � SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature Permittee ate a V