HomeMy Public PortalAbout9151 LAS TUNAS DR_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING -
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
LOCALITY �t
FOR APPLICANT O FILLIN NEAREST
BUILDING CROSS ST.
ADDRESS
DISTRICT NO. GROUP ZONE PERMIT NO,
LOCALITY G /
NEAREST REOEIV D BY Ready for Inspection
CROSS ST. DATEISSUED-A&I P
OWNER �3
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY TEL.NO. INSPECTION RECORD
PLUMBER yi7i
ADDRESS 'ter — -
CIT TEL.
/� ATE
LICEN N0. (� n COUNTY
J
PERMIf tEES Q
z_
JLIMSER TYPE OF FIXTURE OR ITEM FEE I?
WATER CLOSET(TOILET) @ 0.80 $
O
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ '0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM.............OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE 1p,0-0 GAS PIPING
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES A
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED _9
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST 10 '2.•.
AND STATE OF CALIF RNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE D C ED RESIDENTIAL PROP TY. UTILITY CO.NOTIFIED e~
SIGNATURE j
OF PERMITTEE. C f•-.. ---------------
- -......-.
FINAL
76A667 DBS 17 Ob 12-53
WORKERS'COMPENSATION DECLARATIONAPPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90
Y 76A667A
sure,or a certificate of Workers'Compensation Insurance,or a n
certified copy thereof (Sec. 3800, Lab. C.)�/ IIuII
Policy Notb&'i 1l-`45*a 4 cTO� COUNTY OF LOS ANGELES DEPT:OF PUBLIC WORKS
Certified copy is hereby furnished.
FOR APPLICANT TO FILL.IN(PRINT OR TYPE) BUILDING > —�
pp) Certified copy is filed with the county building inspection ADDRESS
4G NUMBER FIXTURE OR ITEM FEE LOCALITY
department. @
Date�_7 4 `�/ T Applicant Jg l- WATER.CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'- BATH TUB CROSS ST.
COMPENSATION INSURANCE OWNER
SHOWER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS X -4y__
1 certify that in the performance of the work for Which this per- S1 NK
mit is issued, I shall not employ any person in any manner so CITY J TEL. NV, _ 4//
as to become subject to The Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Dare. Applicant CLOTHES WASHER ADDRESS �
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY ��,�/TEL. NO� '' �
cation provisions of the Laho-Code,you must forthwith comp- LAWN:SPRINKLER SYSTEMS
ly with.such provisions or this permit shall be deemed revok- STATE LIC.
ed.. WATER'HEATER LICENSE NO. �� CLASS 6`-J
4C7 3to
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter ' GAS SYSTEM OUTLETS �7r.
9(commencing with Section 7000)of Division.3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL 4ALIDATION
fect. � �� ��� / HOSE BIB DATE
License Number 'Lic. Clas _ Xe T' a
H=:•:1 °a
i FINAL "_ ?,a; _U
Contractor — 1 ate 1— / BY __ u i°__tcl�
- T•I E i �.
I am exempt under Sec. L V
! '
B.BP.C. for this reason TOTAL
Plan Check fee popI.L`L- 4 �
a `°
UJ
Date: PLUMBING PERMIT ISSUING FEE$ Z
Signature O� •._. t ff i
TOTAL FEE d
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Name 1+010 3001 i1. 't'
-Law for the following reason (Section 7031.5, Business and �'
it +a ice:
Professions Code): Address
❑ I, as owner of the property, will do the work and the City �j 31 Tel. No.�� �g0
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 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- entioned property for inspection purposes.
.2 f�_ SEE REVERSE FOR EXPLANATORY LANGUAGE_
Signature of Permittee Date