HomeMy Public PortalAbout9816 LA ROSA DR_Plumbing__ 76A667-CE817&S9
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING !6 /� 77 O�-�L
TORN A. LAMBIE. County Englnear ADDRESS / `_
CASSATT D. GRIFFIN, Sup I of Building
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST..
NUMBER FIXTURE OR ITEM OWNER oriy7 a
{� WATER CLOSET MAIL "
ADDRESS
BATH TUA
` CITY TEL. NO.
SHOWER
y LAVATORY CONTRACTOR Alert Plbg & FT
SINE ADDRESS 1393"3 S. Crenshaw glycl - ,
DISHWASHER CITY Hawthorne M. NO. Os q-
CON�—LAUNDRY TUB EGIS RAT ONSNO. � 68479 C-36 COUNTY ❑
CLOTHES WASHER. DISTRICTNO. GROUP_ ZONE PROCESSEDBBYY
WATER HEATER ✓sL— .1J� /f{'/'J "
GAS SYSTEM INDUSTRIAL ;N
WASTE APPROVAL
IN/SPECTION COAD
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APPROVALS DATE' INSPECTOR'S SIGNATURE
PERMIT $ Z 00 UNDER SLAB WORK r--
TOTALFEE ROUGH PLUMBING O-
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AMB STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �.,/ yI
CALIFORNIA OR THAT 1 AM THE LE AL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPS s UTIL ITY CO. NOTIFIED Q�Cnn n
SIG
ATURPERME TE / �/� �
FINAL -z;Zj as.A.I—
AUDATION ROBERT A. WOOD:
H.0. CASH SUPERVISING MECHANICAL ENG'R
I �80952 MAR 23 . .. 5 .A 12.00 r /
yy�V
VORKERS' COMPENSATION DECLARATION I.hereb APPLICATION FOR PLUMBING PERMIT
6DPW 4/90
y;,affirm that f have a certificate of consent to self in- 7A667A667A
"sure,'ora certificate of Workers'CompensatiomInsurance,ora C,IILJIII
certified copy thereof (Sec. 3800, Lab. CI.)
Policy NCI / Company xL� COUNTY OF LOS ANGELES. " ' DEPT. OF PUBLIC WORKS
[k-'Certified copy is hereby furnished. 51
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGi
Certified copy is filed with the county building inspection ADDRESS (L�
department. NUMBER FIXTURE OR ITEM @ FEE
r7 ��• LOCALITY
Date 1:91—C&
Applicant WATER CLOSET(TOILET)_ NEAREST.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work Involved by - MAIL. .
the permit is for one hundred dollars ($100)or less.). LAVATORY ADDRESS
I certify that in the performance of the work for which this per- SINK. -
mit is issued, I shall not employ any person in any manner so CITY TEL. NO.
as to become subject to the Workers'Compensation Cows. DISHWASHER
CONTRACTOR
Date- Applicant CLOTHES WASHER 7
ADDRESS
NOTICE TO APPLICANT: If, after making thiWorlkefs' te'of Ex- SWIMMING.POOI RECEPTOR
emotion,you should become subject to the Workers'ith cam - R CITY TEL. NOCJfiI�
sabot provisions of the La bhi Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE --AUC.
ed. WATER HEATER LICENSE NO. b D� CLASS 1(5
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that 1 am licensed under provisions of Chapter GAS SYSTEM OUTLETS - U, (j
9(commencing with Section 7000)of Division of the Business OUTLETS OVER O
and Professions Code,.and my license is in full force and ef- 5 PER SYSTEM FINAL ^T VALIDATION
fect. /6 HOSE BIB DATE }
License Number
/�,/ /ic. ClassesFIN
O
Contractor///fd/
Q
am exempt under Sec. - U
B.&P,C. for this reasont
Plan check fee c_ .t y
�/34, te0 PLUMBING PERMIT ISSUING FEE$ FyCCT.p i
Signoture
TOTAL FEE � 3303 'rtJ.wJ
SINGLE FAMILY
HOM OWNER-BUILDER DECLARATION Plan check applicant 1 ITEMS
I hereby affirm that I am exempt from the Contractor's License Nome TOTAL 43 m 835
Low for the following reason (Section 7031.5,-Business and
Professions Code): Address CHECK 43.35
El I, as owner of the property, will do the work and'the City Tel, No. CHANGE .00
structure isnot intended or offered for sale(Section 7044, _
Business and Professions Code). ►
CONSTRUCTION LENDING AGENCY � _-
0000-6001 7/ 8/96
1 hereby affirm that there is a construction lending agency for 7272 1 AM 9s26
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 pool
ordinances and State laws regulating Plumbing, and hereby
authorize representatives o this County to enterupon the -
above- ntio proper{ or in ion u -
..�:yG SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign aty of Permittee , 'Date .,