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Home My Public Portal About9468 LA ROSA DR_Plumbing__ 76A667 (CE-817)- 5/73 APPLICATION FOR .PLUMBING PERMIT COUNTY OF LOS ANGELES" DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: 7NEAREST HARVEY T. BRANDT, COUNTY ENGINEER FOR APPLICANT TO FILL IN (PRINT OR TYPE) U Ci NUMBER FIXTURE OR ITEM @ FEE -- , OWNER L L WATER CLOSET 1.75 MAI L BATH TUB 1.75 ADDRESS 6 L Q+ 12� M SHOWER f 1.75 CIT �, LCs TEL. NO. LAVATORY 1,75 CONTRACTOR SINK 1.75 ADDRESS' DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER J 1.75 STATE' LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZONE F CESSED BY LAWN SPRINKLER SYSTEM 1.75 �. WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL d GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD CD OUTLETS OVER 5 PER-SYSTEM .30 O� W Z r Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE S 3 00 TOTAL FEE X APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK - Name _ ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THISHOT WATER HEATER. 6_-0:2-740' 9Yi APPLICATION pn.tI_ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES •� WITH ALL COUNTY ORDINANCES AND STATE- LAWS REGULATING PLUMBING GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALI•FO,RN IA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO, RESIDE IN THE RI ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL •SIGNATURE - OF PERMITTEE PERMIT VALIDATION CK :M.O. CASH PLAN CHECK VAL IDATIGW CK. o. CASH 1 6 9. 3 r,APR z 5 5 'D .4.7 5 a9 ' - -• ` 76A6i7 (CE-817) - 5/73 APPLICATN FOR UM•BI•NG PERMIT - COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER - BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLEBUILDING TO- ADDRESS �d' HARVEY T,.. BRANDT, COUNTY ENGINEER, LOCACITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. �_��d ��P ..�J/L /•'E `C�"� Y NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 1.75 ��,f ,�a`n -`' .�v ,MAIL , BATH TUB 1.75 ADDRESS SHOWER 1.75 CITY . '� n: ,"' TEL•NO. ��i��J LAVATORY 1,75 C0NTRAC TG SINK 1,75 ADDRESS DISHWASHER 1.75 `-CITY yTEL. N0. t CLOTHES WASHER 1.75 STATE LIC LICENSE NO• -CLASS.`-! ' SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP T NE F CESS D:BY - LAWN SPRINKLER SYSTEM 1.75 ,� WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL a GAS SYSTEM OUTLETS 1.75INSPECTI.04 RECORD OU OUTLETS OVER " 5 PER SYSTEM 30 p F— LLJ Plan check fee See.Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE , S APPROVALS DATE INS PECTOR'S�S I GNAT URE Plan chec_ p UNDER UNDER SLAB WORK Nanie ROUGH PLUMBING , Address GAS•PIPING City Tel. No.. GAS VENT HOT WATER HEATER - IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND, STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES ,WITH ALL COUNTY ORDINANCES AND STATE LAWS,REGULATING PLUMBING. GAS TEST =7y, -:d�. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED - LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF CALI FORN IA OR THAT 1 AM THE LEGAL OWN , AND INTEND TO ' RESIDE IN THE ABOVE DES, ,B RESIDENTI L PR PERTY. - -�� ///J FINAL 911,I"- SIGNATURE ' � L/f! , ' OF PERMITTEE �/ PERMIT VALIDATIONM•0. CASH l PLAN CHECK VALIDATION CK. M.O. CASH , fJ� '2.8 9tr`_'9AR_.28 . 5 .D- 4.7 5 A98 76AS67 17 25M SETS 7-40 APPLICATION FOR PERMIT' DEPARTMENT OF BUILDING AND SAFETY �' COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER TDISTRICT G UP OE P . N; 1 FOR APPLCANT TO FILL IN PLUMBER -� EIVED BY READY FORDATE ISSUED ADDRESS ` FIRST INSPECTION CITY �`-y *,�- -�vf TEL. No. JOB ADDRESS �i'"C.�a � ./1-•! 7'k� COUNTY LICENSE NO. EXPIRES Sh" Q "el LOCALITY } �,��`7 ��"•CF� I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NEAREST ANGELES COUNTY LICENSE. CROSS ST. c OWNER 'v MAIL ' PLUMBER ADDRESS q. PERMIT FEE 19 $1.00 FOR THE FIRST FIXTURE OR CITY TEL. No. ITEM LISTED BELOW, PLUS SOO FOR EACH ADDITIONAL I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE. $1.00. MINIMUM FEE FOR ANY PERMIT $1.00. EACH GAS SYSTEM IS A SEPARATE ITEM. OWNER NUMBER TYPE OF FIXTURE OR ITEM WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY GAS SYSTEM_v__OUTLETS , WATER HEATER SLOP SINK J Q FLOOR SINK Z FLOOR DRAIN O Q DISHWASHER O DRINKING FOUNTAIN URINAL MISCELLANEOUS APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING ' GAS VENT S� CESSPOOL / SEPTIC TANK - DRAIN ( ) PIT ( ) $ SEPTIC TANK CESSPOOL $ SEWER HOUSE SEWER $ GAS TEST yq TOTAL FEE $ l� UTILITY CO.NOTIFIED FINAL 78"687 17 3-49 ® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES , i P L U D' WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. t 70 PLUMBER !EO!'►'L �E LGL JQ/2/E D. RECEIVED BY READY FOR DATE ISSUED /J / FIRST INSPECTION ADDRESS � 'y x/0'.QJ& 09fP__ •/ BUILDING CITY ADDRESS s 1 c ill/1�»a�1�inTEt�,yQF.r �,q• COUNTY LOCALITY v/ _ e® F.�1 �✓ LICENSE NO. EXPIRES NEAREST r� CROSS d�,t�'f�Ak�6) PERNIIT FEES ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL - WATER CLOSET (TOILET) 0.50 $ ADDRESS - _ BATH TUB @ 0.50 El-CITY TEL. NO. / SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOV ,lS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGUL J4 PLUMBING. I CERT-1 IT-H T ' i' l -if6�rV LOS LAUNDRY TUB OR TRAY @ 0.50 A"IF G'1atESuCt)IIN'F-Yk` ICEN6E--OR=I�p -TSI E".L'EGAL-�_0' ER OF THE RESIDEk P�jRO/jPE/R/TY-D�S� RIB ABOVE. GAS SYSTEM OUTLETS @ O.50 PERMITTEE �� SIGNATURE OF WATER HEATER @ 0.50 c SLOP SINK @ 0.50 INSPECTIO/NIRECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 � ��,�� l/rj�f1>.'S''.• '� �I HOUSE SEWER @ 0.5017 14 W tl6- _ !rl—Q /V Z MISCELLANEOUSS. `•� 0 r iG Ir . O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT / C/ CESSPOOL @ 1.00 CESSPOOL �Ir �7�✓ SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 I SEWER PERMIT . 1.00 GAS TEST TOTAL FEE 1 $ 021 UTILITY CO. NOTIFIED CIO FINAL WORKERS'COMPENSATION DECLARATION . APPLICATION FOR PLUMBING PERMIT ` 4 hereby affirm that I have a•certificate of consent to.self 76A667A '• insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or. c 1'f cop r r of 3800, La C') .000NTY'OELOS ANGELES BUILDING AND SAFETY 7�cc No ny , 2--Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /�Q• /I p�� Certified copy is filed with the county building inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE ' LOCALITY Date T— S'Appli4ant WATER CLOSET - NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' .4 -BATH TUB CROSS ST ' COMPENSATION INSURANCE, / OWNER SHOWER /0 �-- (This section need not be completed if the work involved by MAIL y� the permit is for one hundred dollars($100)or less.) LAVATORY 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 Compensation Laws DISHWASHER CONTRACTOR 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 „ Compe'nsati'on provisions'of the Labor Code, yo'u must forth- CITY' TEL NO LAWN SPRINKLER SYSTEM ' with comply with such provisions or this'permit shall be STATE ++,p4 H UC. deemed revoked WATER HEATER, LICENSE NO L.' (/� CLASS -LICENSED CONTRACTORS DECLARATION DISTRICT NO P ESSED, Y GAS SYSTEM .. OUTLETS Thereby affirm that I am licensed under provisions of Chapter 9 (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 FINA 6-7�j �j DATE ' 7 VALI ATION 60J License Number-I22:7497-7—Q7 %Lic. Class FINA O $ � Contractor ` n 444k' Doti^- BY ❑ V saa I am exempt under Sec •� N B:BP C. for.this reason'' Plan check fee Date: PLUMBING PERMIT ISSUING FEE Signature• TOTAL FEE 6 Plan check applicant SINGLE FAMILY , 2 b 1,'9 A HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address #_o o.o'o o 5Law for the.following reason (Section'7031.5, Business and Professions Code)—City Tel. No - f o .o4650 ❑ 1, as owner,of the property, will do the work and the 4 v structure is not, intended or,offered-for sale (Section o o•o F = 7044, Business and Professions Code). ,'. CONSTRUCTION LENDING'AGENCYo a.o 8--8 5 - I hereby affirm that there is a-construction lending,ogency 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 outhonze,4epresentatives of this County to enter.upon the above- entioned property for ee tion urp ses SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per a Date