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Home My Public Portal About9515 LA ROSA DR_Plumbing__ D.B.17 SM SETS a-as APPLICATION FOR PERMIT 'DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ��'�� 1 Wm. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRACT NO. GR SPI ZONE /PER�MIT NO. ROUGH FIXTURES COMPLETE / / / ) 7/ HEATER CESSPOOL I SEPTIC TANK RECEIVED BY READY FOR DATEISSUED G4�r- FIRST INSPECTION ✓ ,� / �� 6 GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY yf Q NAM EVlf , ` �-.'1+^' ,.+_:: „_.� A :. ��/s$-- ADDRESS r L /1 .�_pr-�,s,�"r .A m ADDRESS ll �) R �`r` �'w,t7� `(✓3'!'r�9,�J✓� � LOCALITY �.�' _.; .;: A �U�' r..+ V CITY `" L ( TEL.NRY ,G� j#� el CROSS ST. `._„sl ,% _. .F IL COUNTY �. } p T. No.�/�� ' � u%j�,'/ EXPIRES�-3 ;-' � NAME � 1/ LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL O ADDRESS, NORTH / e CIT`! 7 .v^. > TEL.NO'/�_L-eh '� I AM THE LEGAL POSSESSOR OF THE ABOVE LOS a ANGELES COUNTY CERTIFICATIL OF QUALIFIC 71ON. PLUMBER I i j I AM THE LEGAL OWNER OF TH PROPERTY DESC IBE, !1 .ABOVE. m 3 i OWNER CORRECTIONS SOUTH J z DESCRIPTION OF WORK � z BATH TUB FURNACE a SHOWER —DISHWASHER 0 / LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE f INSPECTOR'S�NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METES GAS SODA FOUNTAIN GAS PIPING / OUTL -- GAS VENT CESSPOOL I I TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOI-. SEPTIC TANK SEWER I UTILITY CO.NOTIFIED I I JTOTAL FEE ..(�Z� I FINAL DEPARTMENT OF BUILDING AND SAFETY ,;r`. APPLICATION FOR PERMIT / COUNTY OF LOS ANGELES' PLUMBING (12- O WN.J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DluTRICT NO. GROUP ZONE PERMIT . ROUGH FIXTURES COMPLETE HEATER CESSPOOL -I SEPTIC TANK RECEIVED BY._ READY FOR DATA ISSUED -FIRST-INSPECTION' AS MISCELLANEOUSwaiiiiiii .� A��(P�'1IPLIITC,(ApiN�TT FILL IN/� pHEAVILY-OUTLINED j +PO(�RTIgOp_N ONLY JOB E NAME M. C. 1'-rFYl/•=Q' Il �ltltlirW'f1.L"�-1T� W ADDRESS it. � / / ADDRESS 123 No- -Clovedy ®" LOCALITY r��-lfe)_ff NEAREST d CITY N CROSS ST. �(' COUNTY CERT.NO. EXPIRES W NAME ZL✓�,f P�t�(``-��''; �" e LOCATION OF SEPTIC TANK, OR CESSPOOL Z. MAIL NORTH O ��JJ CITY TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM.THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. . VI OWNER i CORRECTIONS SOUTH_ W DESCRIPTION OF WORK BATH TUB FURNACE J IL SHOWER DISHWASHER :3 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP - SLOP SINK FLOOR DRAIN WASH TRAY URINAL , APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS,VENT I CESSPOOL I �+ TOTAL NUMBEROFFIXTUR � sem, SEPTIC TANK CESSPOOI n!p SEPTIC TANK S G�d^ �A SEWER UTILITY CO.NOTIFIED TOTAL FEE -FINAL i 78A687-CE#817 10-82 I �/- APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Tern le Cit FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET $1.25 OWNER E A Plarsh MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY Tem le City TEL. NO. LAVATORY 1.25 CONTRACTO SINK 1.25 ADDRESS 10920 E. Grand DISHWASHER 1.25 CITYTeMpl_p 0i ty TEL. N LAUNDRY TUB 1.25 CONTRACTOR'S ATE l[E:j REGISTRATION NO. `L COUNTY CLOTHES WASHER 1.25 DISTRICT NO. I GROUP ZONE PROCESSED BY 1 WATER HEATER 1.50 :�; o-3A-( v ✓ru GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD u ac a LLA 06 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEEO GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT �_ A WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE f0 A OF PERMITTEE -�--�-- FINAL VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R APR 2 5 5 D 3) 5 0^ �: WORKERS'.COMPENSATION DECLARATION20-0026 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have 6 certificcte of consent to self in- 76A667A PW 4/87 sure,or a certificate of Workers'Compensation Inivaonce,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) Polic No. CompanyCOUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Y r P y', ❑ Certified copy is hereb,,Pfurnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING F-1i/ Certified copy is filed with the county building inspection ADDRESS � kol , 05A le department. NUMBER FIXTURE.OR ITEM @ FEE LOCALITY-7 WATER CLOSET(TOILET) e le- C I Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER 63 rPt, V C (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- SINK mit is issued, I shall not employ any person in any Kaer so CITY TEL. NO. ;r6, as to become subject to"the Workers C pensatios. DISHWASHER _ CONTRACTOR C,/ Date_ �� Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this,you subject Workers' of.Ex- en- ADDRESS em tionshould become subt to the Wk 'Com SWIMMING POOL RECEPTOR P y Compen- TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRO E D BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 1 fe d Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL q VALIDATION DATF� ��/ p License Number Lic. Class V FINAL Contractor Date BY d O I am exempt under Sec. 7o`t Ll U B.BP.C. for this reason o W tiey a�Ll_ g � Plan check fee ate: PLUMBING PERMIT ISSUING FEE $ VC Signature TOTAL FEE S LE FAMILY HOME OWNS -BUILDER DECLARATION Plan check applicant . I hereby affirm that I am exempt from the Contractor's License Name -r Law for the following reason (Section 7031.5, Business and a Professions Code): Address, ��"•�.t Qa 50 (� I, as owner of the property, will do the work and the City Tel. No. _ tructure is not intended or offered for�sale(Section 7044, 1 I T ENS Business and Professions Code). 2050 CONSTRUCTION LENDING AGENCY TO I i t ) m- a I hereby affirm that there is a construction lending agency for �' >=t X.U.NJ the performance of the work for which this'permit is issued r (Sec. 3097, Civ. C.). i L•t` E Lender's Name r 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 author' a represent ves of this County to enter upon the abov - ntioned rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE J--p Signature Permittee Date WORKER,5' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT •I }aereby cffirm'that I have a certificate of consent to self 76A667A iri$ure, gr'6 certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. aFOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING, 95 I f5— �n gq d'' V6Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM ! FEE ADDRESS tion department. LOCALITY C+ IV Date -Applicant ' WATER CLOSET O✓ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. C vd COMPENSATION INSURANCESHOWER O J► OWNER �. (This section need not be completed if the work involved by v MAIL the permit is for one hundred dollars (:100)or less.) LAVATORY U ADDRESS v 1 certify that in the performance of the work for which this f permit is issued, I shall not employ a y person in ny manner SINK CITY Tepvi Ie, Ci TEL. NO. 6 20 so as to become subject to the Work Compe ation Laws. DISHWASHER v CONTRACTOR �. Date 11 / Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making(/his Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER �j /� LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ORQGESSED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS L //i;/ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VAL ATION a DATE License Number Lic. Class O FIN U. Contractor Date B �. I am exempt under Sec. O� 26610 A B.$P.C. for this reason Ltd Plan check fee # o o o 0,0 5 a Date: PLUMBING PERMIT ISSUING FEE$ U S ( o 0 4 O U ' pL 5o Z Signature TOTAL FEE o o 0 5 5 0 Plan check applicant 0 3 0.9`�8 7 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. (L4 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 1111110. ordinances and State laws regulating Plumbing, and hereby au orize repre`se tatives of this County to enter upon the o ve-mentione property for inspection purposes. G ?7 SEE REVERSE FOR EXPLANATORY LANGUAGE hA_W1 1 /ignatur of Permittee Dche WORIKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT !7 I b76A667 DPW 4/87 ere.:>y,`.y#firm that I have a certificate of consent to self in- 76A667A - sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company �. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT.OR TYPE) BUILDING F7 Certified copy is filed with the county building inspection ADDRESS ,_5DK department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) V Date - Applicant - NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' J BATH TUB CROSS ST. w'i } COMPENSATION INSURANCE SHOWER OWNER —�1 106 (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- SINK CITY TEL. NO. mit is issued, I shall not employ any person in y manner so as to become subject to the Workers' omZaton aws. DISHWASHER �] 1CONTRACTOR 0L" Vie Iff Date r +�° 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 SYSTEM ly with such provisions or this permit-shall be deemed revok- STATE UC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY khereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ' 0� 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 VALIDATION A fec(. DATE �—� 'v License Number Lic. Class O 0 FINAL Contractor Date BY O rr I am exempt under Sec. B.&P.C. for this reason ► 'Plan check fee Date: PLUMBING PERMIT ISSUING FEE $ Signature TOTAL FEE r� Q SINGLE FAMILY .�,r� HOME OWNER-BUILDER DECLARATION Plan check applicant I 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 "T I, 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). ► 'R-ITAi 20 a 5 CONSTRUCTION LENDING AGENCY711 _ I hereby affirm that there is a construction.lending agency for : _ •fi >:•_v the performance of the work for which this permit is issued ;; {;� ;-� I (Sec. 3097, Civ. C.). Lender's Name :z;{ _ti;'ii ' { 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 Stat laws regulating Plumbing, and hereby aut orize represe tives of this County to enter upon the ab e-mention d ro erty for i ction purposes. I�—> SEE REVERSE FOR EXPLANATORY LANGUAGE S ggnaIur of P rm ee ate