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Home My Public Portal About9855 KEY WEST ST_Plumbing__ 1 76A667 CE#B17 2-82 TEMPLE C I] 17 Y APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING p � Q JOHN A LAMBIE. COUNTY ENGINEER ADDRESS C Jul WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE I Ip WATER CLOSET $125 OWNER MAIL n p 1 BATH TUB 125 ADDRESS SHOWER 125 CITY �� TEL NO ' LAVATORY 125 CONTRACTORC � Q6 S1.,VeZ SINS 125 ADDRESS ' S -rU6LA- DISHWASHER 125 CITYCTOR'Sl� TEL NO 7'&.266 ATP LAUNDRY TUB 125 REGISTRATION ION NO [ COUNTY ❑ CLOTHES WASHER 125 DISTRICT NO G UP 7R25E5np BY WATER HEATER 1 50 J GAS SYSTEM OUTLETS 150 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD �- d V \ C w H W Q Vf z APPROVALSDATE INSPECTOR S SIGN4AT RE PERMIT $ 2 QO UNDER SLAB WORK . v ROUGH PLUMBING TOTAL FEE V``✓ GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER NG REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST RNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO IN, THE ABOVE ESCRIBED RESIDENTIAL PROPERT UTILITY CO NOTIFIED TURE ERMITTEE FINAL VALIDATIONROBERT A OOD CK M O CASH SUPERVISING MECHANICAL ENG R 6' 5 2 5 0 3.2 5N 7GA867 -CE9817 9/63 TC / APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING r ) JOHN A LAM IE, COUNTY ENGINEER ADDRESS J (/ WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 125 ADDRESS SHOWER 1 25 CITY TEL. NO. �� f LAVATORY 1.25 CONTRACTOR SINS 125 ADDRESS DISHWASHER 1 25 CITY TEL. NO.&may REGISTRATION ON NO. �03�S'"3 STA LAUNDRY TUB 125 COUNTY ❑ CLOTHES WASHER 125 DISTRICT NO ,/G')ROUP ZONE P ESSED BY WATER HEATER 1 50 /� } GAS SYSTEM OUTLETS 1 50 INDUSTR CL WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM 30 ` INSPECTION RECORD u F- u W IL Z APPROVALS DATE INSPECTOR 5 SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLCDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/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 E BED SIDE IAL P PE r UTILITY CO NOTIFIED v r� SIGNATU I �1 / /// ,..� ,g OF PERMITTE !�, FINAL VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENG R t ,jL-�0�8 0 1 7 Z8 APR 2 3 5 D 3.25- `' �] WORKERS'COMPENSATION DECLARATION 78:887 i , ` APPLICATION FOR PLUMBING PERMIT .'I hereby affirm that I have a certificate of'consent consent to self cez-aa) insure, or a certificate of Workers,'Compensation Insurance,or ' a certified copy thereof(Sec 3800,Lab C ��yy COUNTY OF LOS ANGEL B SAFETY Policy Nour Company � ��. _;_f; Certified copy,is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING OADDRESS WEZ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM i FEE department LOCALITY, p WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i SHOWER OWNER , LAVATORYMAI L (This section need not be,completed if the work`mvolved ADDRESS by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL NO I certify,,that in the performance of the work for which this DISHWASHER - U hermit is issued, I shall not employ any person in any manner r CONTRACTOR so as to be me subject to the rkers' pensation Laws CLOTHES WASHER f 0 ADDRESS Date Applicant L SWIMMING POOL RECEPTOR U NOTICE APPLICANT If, after king this Certificate of CITY TEL NO a Exemption, you, should become subject to the Workers" LAWN SPRINKLER SYSTEM STATE LIC Compensation provisions of the'Labor Code, you must forth- LICENSE NO CLASS c�j6� Z with comply,,with such' provisions or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS DISTRICT N�O/ P CES ED BY LICENSED'CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed'under provisions bf Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3,of the Busi- FINAL VALIDA ION ness and Professions Code, and my license is in full force and DATE �^ — effect FINAL P License Number Lic Class BY Contractor Date' Z `� I am'exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- �"—r�i ✓✓✓ iness and Professions Code) TOTAL FEE PY i Lic or Reg No Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby-affirm that I am exempt from the Contractor's Address ' r License Law for the following reason (Section 7031 5, Busi- t Tel No - 3'2 °9 A ' ness and Professions Code) I, as owner of the property, am exclusively contracting to 0 0 o o 5 with licensed contractors to construct ,the project ' ' ` + ' (Section 7044, Business and Professions Code) 2'- 0 2 a Q Q y CONSTRUCTION LENDING AGENCY o 0 0 2 8.Q Q I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is2 01 —. 80 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 SEE REVERSE FOR EXPLANATORY LANGUAGE- ordma and to law, egulating Plumbing, and hereby auth iz repr _en ativ o this County to enter upon the abov -m io pro rty or inspection purposes Sig ture of Permittee Date _ '