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Home My Public Portal About9174 LAS TUNAS DR_Plumbing__ D. B. 17 7-40 25M APPLICATION FOR PERMIT DEPARTMENT OF BUdLDING AND SAFETY COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER I NATURE OF INSTALLATION DISTRICT O. _ GROUP ZONE PERMIT N[�}o(�.}�/� ROUGH •C Al-q I � 8 1 PLUMBING I FIXTURES OMPLETE RECEIVED BY READY FOR ''/D(�ATE ISSUED HEATER CESSPOOL SEPTIC TANK 24 - 1IFIRST�'N�E NV � ��GAS MISCELLANEOUS 1 � `yY APPLICA`�NT F,IELLL� IN HEAVILY OUTLINED PORTION � ONLY �� NAME a at s ADDRESS fADDRESS'o ,I +� LOCALITY {yam , �,(��q / � �/,•}� -1 CITY /////® TEL NO �� (12 'CROSSSSTCOUNTY / ' �/(/S+tll, �/�V'✓w/�,?G CERT NO. U EXPIRES W NAMEMAIL LOCATION OF SEPTIC TANK, OR CESSPOOL O ADDRESS NORTH CITY TEL No. I AM THE'LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. m q a W OWNER 3 CORRECTIONS SOUTH J DESCRIPTION OF WORK z BATH Tue FURNACE SHOWER DISHWASHER U .t.r } 1-AVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN APPROVALS WASH TRAY URINAL WATER CLOSET, DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK SEWER CESSPOOL SEPTIC TANK $ UTILITY CO. NOTIFIED TOTAL FEE / FINAL I WORKERS'COMPENSATION DECLARATION APPLICATION ION FOO PLUMBING PERMIT 1 hereby, 76A667 affirm that I have a certificate of consent to self in- DPW 4/90 sure,or certificate of Workers'Compensation Insurance,or a 6A667A `, t certified copy thereof (Sec 3800, Lab C ) r 1" c11L-Jlli COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No Company ❑ Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS department NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER L� ,61TTJ�J (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS Icer itify that in the performance of the work for which this per- / mit s issued, I shall not employ any person in any manner so SINK CITY TEL NO as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL NO sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ^� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER U and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect HOSE BIB DATE License Number Lic Class /`n n ACC A s CL O _/�G- �•G !.� �� FINAL, (/,(�/ � . Contractor Date BY .7�7Lt3 43.40 I am exempt under Sec ITEMS B &P C for this reason40 W Plan check fee � TOTAL �-3, Date PLUMBING PERMIT ISSUING FEE$ CASH 43.40 z Signature TOTAL FEE !:p Gj GHAIdGE .00 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I-hereby affirm that 1 am exempt from the Contractor's License Name 9/27/95 Law for the following reason (Section 7031 5, Business and 1 FM 5:07 Professions Code) Address ' I, as owner of the property, will do the work and the City Tel No o 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 jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for ins ection purposes _ SEE REVERSE FOR EXPLANATORY LANGUAGE AS,gature o ermit Date