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HomeMy Public PortalAbout9813 LA ROSA DR_Plumbing__ 76A607-CES1710-60 APPLICATION- FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVLSION BUDDING G[a�3 JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS /, WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ' FOR APPLICANT'TO FILL IN � NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER L 2, WATER CLOSET MAQ. _ e� 2 BATH TDB ADDRESS Cm TEL NO. y(Ip SHOWER LAVATORY. CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL. NO. 7 LAUNDRY TUB REGISTRATION NO. [-,j•� 33 9 o CATE Yg O TUTE NTY CLOTHES WASHER DISTRICT NO. GROUP ZONE PRO SED BY 7 WATER HEATER O Q— GAS SYSTEM INDUSTRIAL ttt 1 WASTE APPROVAL INSPECTION RECORD I o' JAI- e _ nit z D ® $1.00 PER ITEM/ /f') �1 OR FIXTURE S iv ©I/ APPROVALS DATE- INSPECTOR'S SIGNATURE PERMIT S 2100 UNOER'SLAB WORK TOTAL FEE ROUGH PLUMBING 4 I QD GAS PIPING /�✓''I',�14� '�P�'�-✓� I HEREBY ACKNOWLEDGE THAT I 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 �,Il/ate U /MI PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDJOR PLUMBING FIXTURES LICENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ) / DESCRIBED RESIDENTIAL ROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL VALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENG'R ��tDG592b FEB 19 5 D . L12 .00 ° '. WORKERS' COMPENSATION have' SATIGN DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that have n certificate of consent to self 76A667A insure, od a certificate of Workers' Compensation Insurance, CE 817(REV. 10/8I) or jffified copy thereof (Sec. 38 , Lab. C j COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy or& ompon) nrQ/k Od7 -!d✓� - Certified copy is hereby furnished. BUILDING' ,�lr FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS . '� IF a,C Of Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM rr FEE LOCALITY n�P /Q l'r Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST' COMPENSATION INSURANCE SHOWER OWNER �`� Nct� PLUS' (This section need not be completed if the work involved by MAIL -��tt,, the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS M l I certify that in the performance of the work for which this '/. permit is issued, I shall not employ any person in.any manner SINK CITY e /„ TEL. NO. Y//y 7 so as to become subject to the Workers Compensation Lows. DISHWASHER tv CONTRACTOR 6 OZ Date Applicant CLOTHES WASHER ADDRESS A , / NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR �y Compensation-provisions of-the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TPnt /`e l (.%r/ TEL. NO. r with comply with. such provisions or this permit shall be STATE LIC. deemed revoked.. WATER HEATER LICENSE NO. () CLASS 4C_717 LICENSED CONTRACTORS DECLARATION DISTRICT NO.— ESSED BY I hereby offirm that I am licensed under provisions of Chapter 9 - GAS SYSTEM OUTLETS Cr (commencing with Section 7000) of Division 3 of the BusinessOUTLETS OVER d and Professions Code,and my license is in full force and effect. 5 PERSYSTEMFINAL _ VAL ATION O License Number f/o 373s Lic. Class a DATE����� O � L� r-�sFI �384.4A Con04�/'��� pate B � U ❑ W I am exempt under Sec. # e e ' e0 5 H B.BP.C. for this reason , .( - 1650 Z Plan check fee Dote: PLUMBING PERMIT ISSUING FEE$ l .� e • e 1 E1 5 0 5 Signature TOTAL FEE i 6 01. 1 5=86 Plan check applicant SINGLE.FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the - structure is not intended or offered for.sale (Section Poo7044, 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 Nome - Lender's Address I certify that I hove 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 authorize representatives of this,County to enter upon the above-mentioned property f r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'th'COMP.ENSATIONDECLARATION APPLICATION FOR PLUMBING PERMIT 1, hereby offjrm than have a certificate of consent to self 76A66]q' ips'tire, or o 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 a �R6rne nTl Policy Na omPany r Certified copy is hereby furnished. ❑ - FOR APPLICANT TO FILL IN(PRINT,OR TYPE) BUILDING ' L Certified copy is filed with th aunty building in c- ADDRESS. tion department NUMBER FIXTURE OR ITEM @ FEE' I I 1 LOCALITY• p WATER CLOSET Date U App¢ CLNEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH-TUBv CROSS'ST. 171 COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by - the permit is for one hundred dollars $100 or less. O MAIL P ( I ) LAVATORY - .ADDRESS I.certify thal'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.^�E(� Z Z so,as to became subject to the Workers'Compensation Laws. DISHWASHER CONTRALTO Date Applicant - CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESSu I Fl 5 Exemption, you should become subject to the Workers` SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CIT ANO •' 4TEL. NO. `•Z SS with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. ' deemed revoked. WATER HEATER LICENSE NO. 3S CLASS LICENSED CONTRACTORS DECLARATION - DISTRICT NO.. '/ P OCESSED BY GAS SYSTEM OUTLETS I hereby affirm that am licensed under provisions of Chapter 9 t } (commencing with Section y license of Division 3 of the Business OUTLETS OVER d 20 and Professions Code,and my lice//nse is in full force and effect. 5 PER SYSTEM FINAL V ATION O License Number SS V) fele Lic Class, DATE D V OC y• ,E $� FINA O �• `N ' Contract D- Date 1O BY V W ❑ a I am exempt under Sec. N B.BP.C. for this reason Z Plan check fee Pilo, - Date: (J PLUMBING PERMIT ISSUING FEE$- Signature TOTAL FEE �3 1 1,4 A SINGLE FAMILY Plan check.applicant # e e e e is 5 HOME OWNER-BUILDER DECLARATION Name I • * 40 S O I hereby affirm that I am exempt from the Contractor's License Address - Law for the following reason (Section 7031.5, Business and 4 Q 5 0 Professions Code): City Tel. No. • e e ❑ I, as owner of the property, will do the work and the I.Q 1 0—85 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. 1 agree to comply with all County and no ces and State laws regulating Plumbing, and hereby out or a representatives f- s County to enter upon the an v mentioned propgLt f i spection purposes. U �5 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee FDate