HomeMy Public PortalAbout9817 LA ROSA DR_Plumbing__ .76A607-CE81710-60 vIL�'
APPLICATION FOR PLUMBING PERMIT .
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGT/
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS rzgl
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY �� —
FOR APPLICANT TO FILL IN NEARSCROSS TST. i�4 7
NUMBER FIXTURE OR ITEM OWNER
All-1
21 WATER CLOSET
ADDAPSS
BATH TAR
CITY TEL. NO. Q(�
SHOWER
CONTRACTOR 4 ��
LAVATORY
SIINB ADDRESS
DISHWASHER CITY B ^ N` TEL. NO. r.0' 7q y
LAUNDRY TDR CONTRACTOR'S STATE
REGISTRATION NO. L,-J(, 33 ®a COUNTY
CLOTHES WASHER DISTRICT NO. GROUP ZONE R S6ED,"/BY
WATER HEATER � S _ C{7Li�(_
GAS SYSTEM INDUSTRW.
WASTE APPROVAL
INSPECTION RECORD a
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® 81.00 PER ITEM /,/1
!D OR FIXTURE $ `V O(1 APPROVALS PATE, INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK P?dkv
TOTAL FEE •f ROUGH PLUMBING t111 "/1 „ _/11 _.r.wz
I—tZ do GAS PIPING $WIVPI� vsy lol'
1 HEREBY ACKNOWLEDGE THAT 1 HAVE =HIS APPLICATION p
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT I � ., —42-..)WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
'
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 7;✓
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 1'
CALIFORNIA OR THAT I AM THE LEGAL OWNER THE ABOVE
DESCRIBED RESIDENTIALOPERTY. UTILITY CO. NOTIFIED
SIGNATURE 'p
OF PERMITTE sem'
FINAL
OVALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENG'R
cK
�;f;�s 5 9 4 % FE3 19 5 D 1 2.0 0
'WORKER'S thatIhave a certificate of
7SAS670PW9/e9 APPLICATION FOR PLUMBING PERMIT
20-002A
I hereby affirm that I have a certificate of consent to self.insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company _ - -
❑ Certified copy is hereby furnished. ..rQ) t'
❑ - / FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING - t4L� T
Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
1
Date Applicant 1 WATER CLOSET ,•-{ NEAREST
BATH TUB
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE ASSESSOR -
(This section need not be completed if the workinvolved by the SHOWER { 4 �� MAP BOOK PAGE PARCEL
permit is for one hundred dollars($700)or less.) 1 LAVATORY ^7 ,� OWNER
I certify that in the performance of the work for which this permit _ "!
is issued, I shall not employ any person in any manner so as to SINK MAIL 9r
ADDRESS
become subject to the Workers' Compensation Laws. r•�
DISWASHER CITY ' TEL.NO.g/]{ r10 Y '7 J
V Date -Applicant "1iYN� //Ul// �L, CLOTHES WASHER
I
NOTCECE T T: If, after making flits Certificate of CONTRALTO
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION I - CITY TEL.NO.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER - 4 S 5 (L
(commencing with Section 7000) of Division 3 of the Business and STATE LIC. O
1 1�1 y V
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASSIT S_
OUTLETS OVER DISTRICT NO, O SSED BY 12
5 PER SYSTEM s:"• Q(L Q
License Number Lic.Class 1 11�� ✓ V F
�'tJSZ, r rJ�5 FINAL V
DATE Z ZZ _�/t VALIDATION LI
Contractor Date `r (n
❑ am exempt under Sec. BF .IN _ % ACCT
; � Z
8.8P.C.for this reason ^/ FAL. .a
Plan check fee ► ��'�7 0 9r°
Date: • �T
Signature - PLUMBING PERMIT ISSUING FEE$ C,q: S
❑ _ TOTAL FEE vl .j(7 2 HEMS
SINGLE FAMILY Plan check applicant TQE`4` 97 - 50
HOME OWNER-BUILDER DECLARATION Name -- 9, I
=
I hereby affirm that I am exempt from the Contractor's License Law _ 4F�G4i'. ��
for the following reason (Section 7031.5, Business and Professions Address
We): CHANGE rrl
i � City Tel. Na
I, as owner of the property,will do the work and the structure ii
is not intended or offered for sale (Section 7044, Business
and Professions Code). 131�Ijlj-fJEf�y O/11:+92
,
CONSTRUCTION LENDING AGENCY Ay IR:45
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. /� '� Y
Lender's Name v
Lender's Atldress 99/Yr i, -5I�_77�- ' '
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 authorize
representatives of this County to enter upon the above-mentioned
property for inspecti purq seq. SEE REVERSE FOR EXPLANATORY LANGUAGE - -
Signatur o' Permittee Date