HomeMy Public PortalAbout8811-13 LAS TUNAS DR_Plumbing__ B-17 3AB APPLICATION FOR PLUMBING PERMIT
"B-17B�p 7
DIVISION OF BUILDING AND SAFETY y
Department of County Engineer
County of Los Angeles _
WM. J. FOX. COUNTY ENGINEER BUILDING O '.t —1UNR 5
O
' CASBATT D. GRIFFIN. $UP'T OF BWLDING ADDRESS
LOCALITY Ti
ryrFOR APPLICANT TO FILL IN NEAREST
OWNER I I RNC '7- -r CROSS ST. SG TEL,
DISTRICT 0. I 1 GROU I NE I flEEOT i0fl INSPECT IOX
MAIL 3
_ADDRESS
INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL
PLUMBER j - \'I I G�-/ ` h \INSPECTION RECORD
ADDRESS ^..1F'/ 1�� �D `TT-� Y ��h ✓ \D` 1F3 Q�4�6L1 SLi-lt\ �Y p��aA
CITY �/V LI\pC TEL. NO. 1 T -L'-7—" )
LICENSE NO. C^ 3 lG -z S17/ �D,
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) S '
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
2 TOTAL NO. a o.eo APPROVALS
DATE INSPECTOR'S SIGNATURE
GA S SY STEM—OUTLETS n 1.00 _
WATER HEATER Ca 1.00 UNDER SLAB WORK
PERMIT 5 1 00 1't
ROUGH PLUMN
BIG R �-05S �Y'S✓CYP^
-'T G.45 PIPING
TOTAL FEE R &2Q GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER f !�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES LO 1S 1
PLUMBING, V N
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF y
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL PR RTY.
SIGNATURE 11
OF PERMITTEE FINAL J'/'
WILLIAM J. FOX, COUNTY NGINEER VALIDATION R. A. WOOD, CHIEF PLBG. INSPECTOR
`��� U s: s= 13 J 2 .6
WORKERS'COMPENSATION DECLARATION ,�r�11� APPLICATION FOR PLUMB
IN IP�RMIT
I Ebreby affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/8))
or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESS
F-1
tion deportment. NUMBER FIXTURE OR ITEM p FEE LOCALITY c
Date Applitont I WATER CLOSET 00 NEAREST
CROSS ST./1
CERTIFICATE OF EXEMPTION FROM WORKERS' � BATH TUB (/
COMPENSATION INSURANCE SHOWER OWNER j
(This section need not be red dotedlga if the work involved by �`1L !� I'(J"-4 S .C/�
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
! A J /
permit is issued, I shall not employ any person in any manner SINK CITY J ryG TEL. NO. � W �
so as to become subject to the Workers Com ensat,o Laws. DISHWASHER
CONTRACTOR (W C
Date ApplicantC.2& CLOTHES WASHER ADDRESS
NOTI E TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
^�
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. ^ /
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. / WATER HEATER LICENSE NO, CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. 1OCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL _ �f ..e/ VALID ION
/� -� DAT (i C/� d
License Number—q r.pl 19, Lic. Class S.- L U
,L �� FIN J U.
Contractor 4✓ t✓/ 106 Date if 4 . L B
❑
am exempt under Sec. O
F
U
B.BP.C. for this reason LU
Plan check fee , ELI
Date: to
J n PLUMBING PERMIT ISSUING FEE$ 0 Z
Signature4 r (w�(" A/2 '
TOTAL FEE
Plan check applicant
SINGLE FAMILY L9 6 33.9 A
HOME OWNER-BUILDER DECLARATION Name # o o e e o 5
I hereby affirm that I am exempt from the Contractor's License
Address
Low for the following reason (Section 7031.5, Business and o 0 0 4 Q 5 Q 6
Professions Code): City Tel. No. 01, 14 -87
❑ 1, as owner of the property, will do the work and the
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 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
outhcrize re re entatives of this County to enter upon the
0 ave-me d property for ' sp tion purposes.
I.
/ , i q-
SEE REVERSE FOR EXPLANATORY LANGUAGE
I
Signature of Permittee Date