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Home My Public Portal About9571 LA ROSA DR_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER ADDRESS O PPLI ANT TO FILL IN NEAREST LOCALITY BUILDING ADDRESS CR SSST � � (/Q , I DISTRICT NO VGROUP ZONE/ PERMIT NO. LOCALITY 1 CT r A _ /7 l ) J NEAREST s [/ �1 CROSS ST n RECEIVED BY Ready for Inspection DATE((ISSUED OWNER , I�+v�i!/L_ 44 MAIL /f_ INDUSTRIAL ADDRESSJ nU �,�,TJ WASTE APPROVAL CITY A AA 1,�J enTEL.NO. (� -Q,�S INSPECTION RECORD / PLUMBER ). `�-'Oi -Qr=C"." �� _/�1t.✓�-•� .-► ADDRESS U ( -WA-AAL( LICENSE N0. /4i�d ,, rA l r� ,%O @_^V ' - CITY-1 -- 1' /— TEL-NO- 6 1 Mr COUNTY r PERMIT FEES z NUMBER TYPE OF FIXTURE OR ITEM FEE 0 T WATER CLOSET(TOILET) @ 0.80 $ 1 BATHTUB @ 080 �D SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0 80 4,Q 1 KITCHEN SINK @ 080 /h LAUNDRY TUB OR TRAY @ 0 80 ua SLOP SINK @ 0 80 FLOORSINK @ 080 FLOOR DRAIN @ 080 DISHWASHER @ 080 DRINKING FOUNTAIN @ 0.80 URINAL @ 080 GAS SYSTEM OUTLETS @ 1.00 DD J WATER HEATER @ 1 00 DO MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING TOTAL FEE 011D GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TESTAND STATE OF 0 T AM THE LEGAL IR ER OF THE ABOVjjELIFORNIA D SCRRIIBED R H IDENTIAL PROP RTY.OWN UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE- _ _.._.._..--_-.--•.--.•---•-•.---.._---. FINAL vo 76A667 DBS 17 1/53 r WCW, KERS'COMPENSATION DECLARATION zeaeerw I hereby affirm that I-have •a certifieAte of consent to self CE e17 (2-80) APPLICATION FOR PLUMBING PERMIT , , insure, or a certificdte of Wc,-i'kers'Compensation Insurance,or-, �- a cerltified copy thereof(6ec 3800,Lab C) n ' ,/� >ETN� COUNTY OF LOS ANGELES ! BUILDING AND SAFETY Policy No ' o pang f? Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ❑ ADDRESS Certified copy'ts filed w count nil in inspection NUMBER, FIXTURE OR ITEM O FEE, ie�jpa^rt�mejlt WATER CLOSET LOCALITY �G F ,Date_ fr Applicarit the NEAREST . BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER` OWNER $'f LAVATORY MAIL } (This section, need not be completed if the work involved ADDRESSS a by the permit` is for one hundred dollars ($100) or less.) SINK CITY �O�G TEL NO I certify that,im the performance of the work for which this DISHWASHER, permit is issued, I shall hot employ any person in any manner, CONTRACTOR `A��D� 0 so as to become subject to the Workers' Compensation Laws CLOTHES-WASHER Date ADDRESS,Applicant _ SWIMMING POOL RECEPTOR / py- NOTICE TO APPLICANT If, after making this Certificate of CITY ll — i d Q Z1 TE O Fq/14& to Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATELIC Z Compensation provisions of the Labor Code, you must forth- MCENSE NO&33p;�,• CLASS C �41 with comply with such WATER HEATER p y provisions or this permit Shall be DISTRICT NO PR CESSpED BY deemed revoked. GAS SYSTEM OUTLETS �' r/ LICENSED CONTRACTORS DECLARATION OUTLETS OVER rJ 1 �Q I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM -9 (commencing with Section 7000) of-Division 3-of the-Buse= ,t i FINAL —` VALIDATION ness and Professions Code, and my license'is in full force and W "" DATE / effect � R_ FINAL License Number`^((5Lic Classy ^� BY Contractor�pJ �[)t-e1[L�dij�ate �7 �( !— I am exempt from the licensing requirements as I am a Plan check fee �L/y licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 70 acting in my professional capacity (Section 7051, Bus- iness and Professions Code) TOTAL FEE y 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 2491.3A. License Law for the following reason (Section 7031 5, Busi- City Tel No # ° ° °'° ° Jr ness and Professions Code) I, as owner of the property, yam exclusively contracting ,2 ° - 1 Q 0 0 with licensed contractors to construct the project ° ° 1 = (Section 7044, Business and Professions Code) ° O F O 5 CONSTRUCTION LENDING AGENCY O G,2 3—8 1 '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 SEE REVERSE FOR EXPLANATORY LANGUAGE zy or ces and State laws regulating Plumbing, and hereby Deth ize represent ves of this County to enter upon the a -mentioned o er fo p do purposes �oI Signature of Per ee to WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I hzv_eba certificate of consent to self CE 917 (2-90) APPLICATION FOR P L U M B,I N G PERMIT ; {� insure, or a certificate of,lVorkers'Compensation Insurance,or �J a certified copy thereof(Sec 3800,Lab C) d COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Com pany c� Certified copy is hereby furnished // _ FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /�^-7/ F—/4 I7d Certified co is filed with 7 count buil NUMBER FIXTURE OR ITEM • FEE ADDRESS J / 7 )'— copy y f y g inspection depart ent l/� WATER CLOSET LOCALITY L` GAJ i c Date G - ti Applicant NEAREST BATH TUB CROSS ST T.G , /!S(-(/19 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER f�J/2S, �- J LAVATORY MAIL /� } (This section need not be completed if the work involved ADDRESS _ CL by the permit is for one hundred dollars ($100) or less.) SINK CITY10 `• L 1 7—� TEL NOZ � U I certify that in the performance of the work for which this DISHWASHER �,r lr permit is issued, I shall not employ any person in any manner CONTRACTOR / �G G�/5 `� �� ¢ so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS/t, I G ��(yt_��J� U Date Applicant SWIMMING POOL RECEPTOR LU NOTICE TO APPLICANT If, after making this Certificate of CITY Ly�(r G/ GN TEL NO � .. � Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM' STATE LIC Compensation provisions of the Labor Code, you must forth- z WATER HEATER LICENSE NO2CLAS with comply with such provisions or this permit shall be DISTRICT NO P SSE BY deemed revoked GAS SYSTEM OUTLETS C 0 LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE effect l ti FINAL License Numb ((�� Lic Class _ BY Contractor t/�'' �d-s O1A,P PAhate —3 — / I am exempt from the licensing requirements as I am a Plan check fee ( Axl licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- 71�% :9 1 3 8.O A iness and Professions Code) TOTAL FEE 0000 Lic or Reg No Date Plan check applicant # o5 ~ HOME OWNER-BUILDER DECLARATION Name 2 ° ° 1 0,00 I hereby affirm that I am exempt from the Contractor's Address ° ° ° 1 Q 0 0 6 License Law for the following reason (Section 7031 5, Busi- City Tel No (�,3,�—8 1 ness and Professions Code) F1I, as owner of the property,-am exclusively contracting with licensedcontractors to construct the project (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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordingpa) and State laws regulating Plumbing, and hereby auth6rize/representatives of this County to enter upon the abedve-me tion! r eft o nspection purposes i ( Signature of Permittee Date 5 ' WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT • I hereby affirm that I have a certificate of consent to self insure, 76A667A or a certificate of Worker's Compensation Insurance, or certified r copy thereof(Sec 3800 Lab C) - - ' - �� _COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS _�_�.`,;,,DEPT..OF.PUBLlC WORKS DIV`.' Policy NA Company m' iIln/� _ Certified copy is hereby furnished ` ' r � FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /J17/ Certified copy is filed with the county uddi i tion ADDRESS / dep rtme r NUMBER FIXTURE OR ITEM Q FEE LOCALITY / Date Applicant WATER CLOSET , NEAREST CERTIFICATE OF EXEMPTION FROM WORKE BATH TUB l CROSS S COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less) „ OWNER I certify that in the pertormance,of the work for which this permit LAVATORY is issued, I shall not employ an - MAIL p y y person-in any manner so as to SINK -ADDRESS95-7-1e X00 r become subject to the Workers' Compensation Laws � DISWASHER CITY TEL NO ZE-ts Date ApplicantCLOTHES WASHER CONTRAC70 NOTICE TO APPLICANT If, after making this Certificate of Exemption,you should'become subject to the Workers' Compensation SWIMMING POOL RECEPTOR , provisions of the Labor Code, you must forthwith comply-with such ADDRESS ldyo v. provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM79 _ LICENSED CONTRACTORS DECLARATION CITY TEL NO S//Q f d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER ` + , (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO �'� CLASS V Professions Code, and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY Q .5 PER SYSTEM I ,/L O License Number S r �V Lic Class i FINALZS'� - VALIDATION a DATE Contractor (� Date C0 ❑ I am exempt under Sec FINAL Z B&P C for this-reaso - -• Planrcheck fee Date 00, PLUMBING PERMIT ISSUING FEE$ Q Signature - ❑ TOTAL FEE c / Plan check applicant ] ' a SINGLE FAMILY _ •- j 8 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law -=-- -for the following reason (Section 7031 5, Business and Professions Address Code) r❑ Clty . Tel No 65 I, as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, BusinessPoo. C and Professions Code) I 1 11 1 1"ll IN F2 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 Ad ress I certify th I have read this application and state that the above - information is correct I agree to comply with all County,ordinances and Stat laws re Ung Plumbing, and hereby `au'thorize t represent tives of is ounty to enter upon the above-mentioned r property or in cti purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature o Per ittee bate,'