HomeMy Public PortalAbout9832 LA ROSA DR_Plumbing__ 76 A G67—CE 817 8/68
F APPLICATION FOR PLUMBING PMIT
COUNTY 'OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BDnDINc p 7 Z
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS a7 J
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY lM 19
FOR APPLICANT TO FILL IN (PR NT OR TYPE) CROSS ST. c, n 1 f✓ 1 INUMBER FIXTURE OR ITEM .EACH FEE
OWNER
WATER CLOSET 1.50 f`O
Iun
'HATH TUB 1.50 �(�> ADDRESS
SHOWER 1.50 CITY`" TEL. NO.
LAVATORY 1.50 ` 4--4 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50
DISTRICT NO. GROUP ZONE ESSED BY >-
LAWN SPRINKLER SYSTEM 2.00 ���c, % �_9 V
WATER HEATER 1.50 INDUSTRIAL Z
WASTE APPROVAL C)
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD w
OUTLETS OVER D_
5 PER SYSTEM _30 h
Z
Plan check fee 251 of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE '
APPROVALS 'DATE R ECTOR'ssIGN4uRE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING 0
A,Idre Ss GAS PIPING
GAS VENT
Cit)' TCI, NO. HOT WATER HEATER
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING,
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDIOR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RES JOE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATURE Q li '
OF PERMITTE V JACK R. ALLEN, suP RVISING E HANICAL ENG'R.
PERMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALIDATION CK. .O. CASH
1 eG" - 6,10 3R: Ii',10V 13 5. 4 � 6-50—
y
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT i�N �g
I hereby affirm that I have�a certificate of consent to self 76A667A
insure, or a certificate of orkers' Compensation Insurance, CE.817(REV. 10/81)
or a certified copy there S c. 3800,.Lob. C,) - COUNTY OFF OSANGEJPS - BUILDING AND SAFETY
Policy No. any
Certified yis e b furnished. - BUILDING
0 Certified o y' fi t t e county building ins P ec- FOR APPLY NTT FILL IN(PRI OR TYPE) -
ADDRESS
Lon dep rt a I. NUMBER FIXTURE OR ITEM nn FEE
- LOCALITY V
Date pelican( WATER CLOSET NEAREST /
CER FICATE OF EXEMPTION FROM WORKERS' BATHTUB 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 ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY � TEL NO.
sous to become subject to the Work/py�/�Com /e/n///s/(uytgion Laws. DISHWASHER
Ii�� "— CONTRACTOR
OR s
L/ c
Date � Applicant CLOTHES WASHER f' '
NOTICE TO APPLICANT: 1f, after making this Certificate of - ADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the.Labor Code, you must forth- CITY TEL —
. with comply with such provisions or this LAWN SPRINKLER SYSTEM
p y p permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. �� CLA55 C
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRO S D BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS f^f Oh
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM
�r�/ y /��y� DA EL / VALID ION 60
License Number 32`/ Lic. Class �✓ - V
FIN
Contractor Dat By/
I am exempt under Sec. .d
y
6.8P.C. for this reason , Z
-
Plan check fee
PLUMBING PERMIT ISSUING FEE$ ,
Signature_ -
' TOTAL FEE �S�
Plon.check applicant -
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Low for the following reason (Section 7031.5, Business and $
ElJProfessionsCode): '
) City � Tel. No.
1, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section -
@$Bn s and Professions Code). ,
tLRUCTI�N7LENDIfJ�AGEN`C�°+(�en.�ry ,
I hereby affirm that'here
Is a co Wr6clion.IEnding ogentyy°f r -
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 oll County .
ordinances and State laws regulating Plumbing, and hereby '
authorize representatives of this County to enter upon the
above-memi.ned,Ffroperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Si azure of Permitte Date -