HomeMy Public PortalAbout10102 LANDSEER ST_Plumbing__ 76A607-CEa17 10-60
APPLICATION FOR PLUMBING. PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY'DIVISION BUILDING 10102 LandHeer
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUP'T OF BUILDING LOCALITY Temple City '
,
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER J B Weber Construction CO
WATER CLOSET MAIL
BATHTUB ADDRESS
1 SHOWER CITY TEL NO.
CONTRACTOR alley Plumbing Co
z LAVATORY
1 LAV ADDRESS —&42 W. 'Fleetwood P-1 .
DISHWASHER CITY Ui en ora TEL. NO.
Ed' -5-1TE
3..
CORI AL
LAUNDRY TUB REGISTRATION NO. 160247 COUNTY
1 CLOTHES WASHER DISTRICT NO. GROUP ZONE 0 SEED BY
WATER HEATER (� J
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL }
INSPECTION RECORD o_
0
a
N
.Z
Lm PER ITEM
10 ° ORF MURE $ I .
APPROVALS DATE` INS PECTOR'3SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING-H l ' �
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING. HOT WATER HEATER a &1 A p
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED A3 REQUIRED BY LOS ANGELES COUNTY AND STATE OF {ter ! v "• �.��',a' - -
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST �`i'-,.,y-
DESCRIBED RESIDENTIAL PROP RTY. UTILITY CO. NOTIFIED
SIGNATURE'
OF PERMITT
FINAL
VALIDATION ROBERT. A. WOOD
cK
M.0. CASH SUPERVISING MECHANICAL ENG'R
Lho 3 3 7:-134 OCT 1 : 5 D12 .0"0 0
WORKERS'COMPENSATION DECLARATION 76A667A
1 hereby*affirm that I have a certificate of consepf'to self CE'efi(?-so)' APPLICATION FOR, PLUMBING, P E R M IT
insure, or a�certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.) / �J
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.' Company'
El Certified copy is hereby furnished. FOR APPLICANT'TO FILL IN (PRINT OR TYPE) BUILDING e�
Certified copy is filed with the county building inspection
NUMBER FIXTURE OR ITEM 0., FEE ADDRESS _[(7 0( ,S(v
department. LOCALITY
WATER CLOSET-
Date Applicant NEAREST. a�
BATH TUB CROSS ST.
CERTIFICATE OF,EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER � 0� L4�y
y LAVATORY MAIL
(This.section'need`not be completed if the work involved ADDRESS (7 O CL
by the permit is for one hundred,dollars ($,100) or less.) ' SINK CITY LLQ, 'G��� TEL NO. 7s V
I'certify that in the performance of the work for which thisDISHWASHER 2
permit is issued, I shall not employ'any person in any manner CONTRACTOR 0
so as to become subject to,the Workers' Compensation Laws.• CLOTHES WASHERti
ADDRESS jJ y �L U
Date ApplicantIy,,/�.��, SWIMMING POOL RECEPTOR , r' ! d
NOTICE.TO APPLICANT: If, after making this Certificate of CITY. TEL. NO. to
Exemption, 'you should become subject to 'the' Workers' LAWN,SPRINKLER SYSTEM. STATE ' LIC. ?
Compensation'provisions of.the Labor Code, you must forth- LICENSE NO. CLASS
With comply with such, provisions or this permit shall be' WATER HEATER
,deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P CESSED B
LICENSED CONTRACTORS DECLARATION OUTLETS OVER T e4,
I hereby affirm that I am-licensed under provisions of Chapter 5 PER SYSTEM -
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE —
effect.
FINAL
License Number Lic:Class
BY ,
Contractor Date
I am'exempt from the licensing requirements as I am a Plan check fee ;
licensed architect or a registered professional engineer, PLUMBING PERMIT ISSUING-FEE$
acting, in my professional capacity (Section 7051, Bus- /
iness and Professions Code). TOTAL FEE Sv
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 ,
License Law,for the following reason (Section 7031.5,, Busi- City Tel'.No.
ness•and Professions Code): t 3 0 A
FiI, as owner of the property,, am exclusively contracting
with licensed contractors to 'construct -the project # o-o`.o'o o 2
(Section 2044,•Business and Professions Code). '
CONSTRUCTION LENDING AGENCY 2'0 a 2 5'O•
I hereby affirm that there is a construction lending agency 4 •'o 0,01 25 0-,",
for, the performance of'the work for which this permit is
issued(Sec. 3097,Civ.C.). 8'2 2 2`—8'2
Lender's Name `
Lender's Address j .a
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
ordinances and State laws regulating Plumbing, and hereby
author' e're esentatives 'of this County to enter upon the - _ _
abov en ' ed p erty for i ection purposes. ,
S' nature of Permittee , Date ,-. - '